̽��ֱ�� of Cambridge - Charlotte Coles

Report highlights inequalities and hidden suffering among people living with breast cancer

cjb250 — Mon, 15 Apr 2024 22:31:36 +0000

Many people with breast cancer ‘systematically left behind’, say researchers in Lancet Commission led by Professor Charlotte Coles.

A very healthy relationship: the ̽��ֱ�� and the NHS

cjb250 — Mon, 03 Jul 2023 15:40:21 +0000

As the NHS celebrates its 75th anniversary, we look at how the close relationship between the ̽��ֱ�� and the hospitals on its doorstep is driving major improvements in how we care for patients.

Radiotherapy boost cuts breast cancer treatment time by at least one week

cjb250 — Mon, 03 Jul 2023 08:04:03 +0000

Results from the IMPORT HIGH trial, published in ̽��ֱ��Lancet, show that giving some breast cancer patients a targeted additional dose of radiotherapy at the same time as treatment to the whole breast (known as simultaneous integrated boost or SIB) cuts the time taken to complete treatment by at least one week.

̽��ֱ��trial, funded by Cancer Research UK and the National Institute of Health Research and Care Research (NIHR), found that SIB radiotherapy given at the right dose works just as well as existing radiotherapy techniques in reducing the risk of the cancer returning in the treated breast.

̽��ֱ��chance of the cancer returning to the treated breast remained very low after 5 years across all treatment groups. Patients given the lower dose of SIB radiotherapy reported similar rates of side-effects, like breast hardening or firmness, as those who received the standard sequential radiotherapy schedule.

Currently, women with a higher than average risk of cancer coming back in their treated breast are given an additional radiotherapy dose to the original site of the tumour after radiotherapy is given to the entire breast. This approach, known as sequential boost, maximises the chances that any remaining cancer cells are removed from the breast.

But it takes longer for women to complete sequential boost radiotherapy, requiring them to attend more hospital appointments. In the UK, many women requiring breast boost radiotherapy are given 4 weeks of radiotherapy – 3 weeks to the whole breast with 1 week boost afterwards. In some countries, women are given 6.5 weeks of radiotherapy – 5 weeks of whole breast radiotherapy with 1-1.5 weeks boost afterwards. SIB radiotherapy cuts this down to just 3 weeks in total.

A boost treatment also increases the chance of having potentially long term side-effects after treatment, including changes in shape, size and texture of the breast that can affect women’s self-esteem and wellbeing.

In total, 2,617 patients at 76 centres took part in the trial. Patients were divided into three groups. ̽��ֱ��first group received whole breast radiotherapy with a sequential boost over 4.5 weeks in total. ̽��ֱ��second and third groups each received two different doses of SIB radiotherapy. Patients received whole breast radiotherapy with a simultaneous boost of either lower or higher dose a dose over 3 weeks in total. There was no advantage shown for those who received the higher boost dose it also led to slightly increased rates of side effects.

Professor of Breast Cancer Clinical Oncology at Cambridge ̽��ֱ��, NIHR Professor and chief investigator for the trial, Professor Charlotte Coles, said: “Some women have to live with permanent breast changes after radiotherapy which may affect their well-being. With SIB, we can deliver high-quality effective radiotherapy whilst minimising toxicity from it.

“This is a careful step towards even shorter courses of radiotherapy that include more complex techniques. By delivering more targeted boost radiotherapy over shorter time periods, women can get on with their lives more quickly."

̽��ֱ��NIHR-funded FAST Forward trial, which was also led by the ICR-CTSU and reported results in 2020, showed that whole breast radiotherapy could be given over a week. Researchers are now hoping to run another clinical trial to find out if SIB radiotherapy can be delivered to patients requiring a boost in just one week.

Professor Judith Bliss, Professor of Clinical Trials at ̽��ֱ��Institute of Cancer Research, London, Director of the Cancer Research UK-funded Clinical Trials and Statistics Unit at the ICR which is managing the IMPORT HIGH trial, said: “For some patients who have a higher risk of seeing their cancer return in the treated breast, delivering an extra, targeted boost of radiotherapy to breast tissue close to the original tumour site is an effective way to lower that risk and help keep cancer from returning to the breast.

"IMPORT HIGH has uncovered how we can streamline our delivery of these radiotherapy boosts - giving them simultaneously with whole breast radiotherapy - without impacting the effectiveness of treatment, or causing patients additional side effects. We hope this trial will change clinical practice - allowing women to benefit from sophisticated radiotherapy delivery with shorter treatment times and fewer hospital visits."

̽��ֱ��team hope that SIB radiotherapy could reduce the costs for patients travelling to hospital and cut the time taken to undergo treatment and recovery. It could be quickly adopted by the NHS and health systems worldwide as standard radiotherapy equipment is used, freeing up valuable appointment visits that could be used to treat more cancer patients sooner.

Chief Executive of Cancer Research UK, Michelle Mitchell, said: “At a time when health services across the UK are facing chronic staff shortages in cancer services, we need to look at new ways to get more patients treated as quickly as possible. In addition to training up more staff, more precise forms of radiotherapy can help to reduce the number of people who are waiting too long to begin vital treatment.

“Trials like IMPORT HIGH are leading the way in delivering smarter radiotherapy with existing technology. We hope that treatment centres across the UK and globally will rapidly adopt this approach to beat breast cancer sooner and give patients more precious time with their loved ones.”

Reference
Coles, CE et al. Dose-escalated simultaneous integrated boost radiotherapy in early breast cancer (IMPORT HIGH): a multicentre, phase 3, non-inferiority, open-label, randomised controlled trial. Lancet; 8 June 2023; DOI: 10.1016/S0140-6736(23)00619-0

Adapted from a press release by Cancer Research UK.

Treatment times for radiotherapy could be reduced for some early breast cancer patients, according to a trial led by ̽��ֱ�� of Cambridge and ̽��ֱ��Institute of Cancer Research, London.

This is a careful step towards even shorter courses of radiotherapy that include more complex techniques. By delivering more targeted boost radiotherapy over shorter time periods, women can get on with their lives more quickly

Charlotte Coles

Patrick Harrison/Cancer Research UK

Professor Charlotte Coles

Helen Lee (46) from Mepal near Cambridge

In October 2013, Helen Lee first noticed an unusual twinge in her right breast and had a hunch that something wasn’t right. Her GP couldn’t feel anything when she examined Helen but referred her to the Breast Unit at Addenbrooke’s Hospital for a mammogram to reassure her.

But, at the young age of 36, Helen was diagnosed with breast cancer. ̽��ֱ��mammogram revealed a tumour just over 2cm in size located deep in her breast tissue. She remembered:

“I felt quite relieved because I knew there was something wrong. And my surgeon said it was so deep I wouldn't have felt it. So I was actually really lucky otherwise I would have come in at 51 for screening and it might not have been treatable by then.”

Helen had surgery a few weeks after her diagnosis, followed by a course of chemotherapy. When she was due to begin radiotherapy treatment she was asked if she would like to take part in the IMPORT HIGH trial. Helen was assigned to a group receiving a targeted radiotherapy boost delivered simultaneously during her whole breast radiotherapy treatment, which reduced her treatment from 23 sessions over 4.5 weeks to 15 sessions over 3 weeks.

After undergoing surgery, chemotherapy and radiotherapy treatment, Helen has now been clear of cancer for nearly 10 years. Since her diagnosis and treatment, she has taken part regularly in Cancer Research UK Race for Life, Pretty Muddy and Shine Night Walk events in Cambridge, Bedford and Stamford, fundraising for life-saving research into future treatments for cancer patients.

Reflecting on her cancer journey, Helen said: “One thing that really struck me, at one of the first Cambridge Race for Life events that I did after my diagnosis, was watching the screen on Parker's Piece where they're playing the films where the scientists are talking about what they've been working on.

“I felt so overwhelmed that all of the people there that day were part of saving my life, and that all the people who took part in trials 10 years ago, 15 years ago, 20 years ago, everything they've done meant that I survived my cancer.”

̽��ֱ��text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Cambridge researchers elected to Academy of Medical Sciences Fellowship 2023

lw355 — Thu, 18 May 2023 08:00:52 +0000

̽��ֱ��new Fellows have been elected to the Academy in recognition of their exceptional contributions to the advancement of biomedical and health science, cutting-edge research discoveries and translating developments into benefits for patients and wider society.

They join a prestigious Fellowship of 1,400 esteemed researchers who are central to the Academy’s work. This includes providing career support to the next generation of researchers and contributing to the Academy’s influential policy work to improve health in the UK and globally.

Professor Dame Anne Johnson PMedSci, President of the Academy of Medical Sciences, said: “These new Fellows are pioneering biomedical research and driving life-saving improvements in healthcare. It’s a pleasure to recognise and celebrate their exceptional talent by welcoming them to the Fellowship.

“This year, we are celebrating our 25th anniversary. ̽��ֱ��Fellowship is our greatest asset, and their broad expertise and dynamic ability has shaped the Academy to become the influential, expert voice of health. As we look to the future, the collective wisdom our new Fellows bring will be pivotal in achieving our mission to create an open and progressive research sector to improve the health of people everywhere.”

̽��ֱ��new Cambridge Fellows are:

Professor Charlotte Coles FMedSci

Professor of Breast Cancer Clinical Oncology, Department of Oncology, NIHR Research Professor and Director of Cancer Research UK RadNet Cambridge

Professor Coles leads practice-changing breast radiotherapy trials, has influenced international hypofractionation policy and is addressing global health, gender and equity challenges within the Lancet Breast Cancer Commission.

“It’s an honour to be elected as a new Fellow of the Academy of Medical Sciences. This is a result of research collaborations in Cambridge, the UK and internationally and I’d like to thank these wonderful colleagues, especially patient advocates,” said Coles.

“I hope to contribute to the Academy’s work to increase equity, diversity and inclusion within leadership roles, including lower- and middle-income countries, to enrich research and improve the culture in Medical Sciences.”

Professor Emanuele Di Angelantonio FMedSci

Professor of Clinical Epidemiology and Donor Health, Department of Public Health and Primary Care, and Head of Health Data Science Centre, Human Technopole (Milan)

Professor Di Angelantonio’s research has focused on addressing major clinical and public health priorities in cardiovascular disease (CVD) and transfusion medicine. His election recognises his many contributions both in helping resolve important controversies in CVD prevention strategies and in improving the safety and efficiency of blood donation.

“I am delighted and honoured to be elected to the Fellowship of the Academy of Medical Sciences, which I recognise is an outcome of the collaborations with many colleagues in UK and worldwide,” said Di Angelantonio.

“Research excellence across medical sciences and translation to health improvements has been at the centre of the Academy’s mission and I am very pleased to now be able to contribute to fulfilling this aim as a Fellow.”

Dr Rita Horvath FMedSci

Director of Research in Genetics of Rare Neurological Disorders in the Department of Clinical Neurosciences and Honorary Consultant in Neurology

Dr Horvath is an academic neurologist using genomics and biochemistry to diagnose rare, inherited neurological disorders, with a focus on mitochondrial diseases. Throughout her career she has combined fundamental experimental work with clinical studies. She pioneered the development and implementation of next generation sequencing in the diagnosis of rare neurogenetic diseases in the UK, leading to precision genetic approaches. She has established extensive international collaborations, having impact in Europe, but also for underserved groups in countries where such expertise is lacking.

“I am delighted and honoured to be elected to this Fellowship, which recognises the impact of my work. I would not have achieved it without the support of my excellent colleagues and research team, for which I give my sincere thanks,” said Horvath.

“As a Hungarian woman working in different countries before I arrived in the UK in 2007, I feel particularly proud of this award, which I recognise is an outcome of the open and fair research environment in Cambridge. This Fellowship enables me to further expand my research to develop effective treatments for patients with rare inherited neurological diseases.”

Professor Eric Miska FMedSci

Herchel Smith Chair of Molecular Genetics and Head of Department of Biochemistry, Affiliated Senior Group Leader at the Gurdon Institute, Associate Faculty at the Wellcome Sanger Institute and Fellow of St John’s College

Professor Miska is a molecular geneticist who has carried out pioneering work on RNA biology. His work led to fundamentally new insights into how small RNA molecules control our genes and protect organisms from selfish genes and viruses, and how RNA can carry heritable information across generations. Miska is Founder and Director of STORM Therapeutics Ltd, which creates novel therapies that inhibit RNA modifying enzymes for use in oncology and other diseases.

“Wonderful recognition of the work of an amazing team of researchers I have the pleasure to work with,” said Miska. “Most of our research has been done using the roundworm C. elegans. As Friedrich Nietzsche wrote in Thus Spoke Zarathustra: ‘You have evolved from worm to man, but much within you is still worm’.”

Professor Serena Nik-Zainal FMedSci

NIHR Research Professor, Professor of Genomic Medicine and Bioinformatics, Department of Medical Genetics and Early Cancer Institute, and Honorary Fellow of Murray Edwards College

Professor Nik-Zainal’s research is focused on investigating the vast number of mutations that occur in human DNA from birth, causing patterns called ‘mutational signatures’, and the associated physiological changes to cellular function, in progressive diseases such as cancer and neurodegeneration. She uses a combination of experimental and computational methods to understand biology and to develop clinical tests for early detection and precision diagnostics. Her team also builds computational tools to enable genomic advances become more accessible across the NHS.

“What an honour it is to be elected to the Fellowship. This is a wonderful recognition of the work from my team,” said Nik-Zainal. “We are thrilled and hugely indebted to all our inspiring collaborators, supporters and patients, who have shared in our passion and joined us on our path, exploring biomedical science and translating insights into patient benefit.”

Professor Julian Rayner FMedSci

Director of the Cambridge Institute for Medical Research, School of Clinical Medicine, Honorary Faculty at the Wellcome Sanger Institute, and Director of Wellcome Connecting Science

Professor Rayner’s research has made significant contributions to our understanding of how malaria parasites recognise and invade human red blood cells to cause disease. His work has helped to identify new vaccine targets, such as a protein essential for red blood cell invasion that is now in early stage human vaccine testing, and inform antimalarial drug development, through co-leading the first ever genome-scale functional screens in malaria parasites. He collaborates closely with researchers in malaria-endemic countries and is strongly committed to engaging public audiences with the process and outcomes of science.

“Malaria is a devastating and too often forgotten disease that still kills more than half a million children every year. Tackling it requires deep collaboration and working across disciplines. I’m enormously honoured by this announcement, which reflects not my work but the work of all the talented people I’ve been lucky enough to host in my lab, and collaborations with friends and colleagues across the world,” said Rayner.

“I’m excited to become a Fellow of the Academy of Medical Sciences because I strongly share their conviction that science is not just for scientists. I believe that dialogue, learning and public engagement are all fundamental and essential parts of the research process, and I look forward to contributing to their leading role in these areas.”

Professor James Rowe FMedSci

Professor of Cognitive Neurology, Department of Clinical Neurosciences, and MRC Cognition and Brain Sciences Unit

Professor Rowe leads a highly interdisciplinary research team at the Cambridge Centre for Frontotemporal Dementia and at Dementias Platform UK to improve the diagnosis and treatment of people affected by dementia. His work integrates cognitive neuroscience, brain imaging, fluidic biomarkers, computational models and neuropathology for experimental medicine studies and clinical trials. He is motivated by his busy clinical practice and the need for better diversity and inclusivity throughout medical research.

“I am delighted and honoured to be elected to the Fellowship of the Academy of Medical Sciences. It is a testament to the many wonderful colleagues and students I have been fortunate to work with, and to inspirational mentors,” said Rowe.

“Research excellence, and translation of research for direct human benefit, comes from innovation and collaboration in diverse cross-disciplinary teams. I believe in the vision and values of the Academy as the route to better health for all.”

In addition, two researchers from the wider community have also been elected:

Dr Trevor Lawley FMedSci, Senior Group Leader, Wellcome Sanger Institute and Chief Scientific Officer, Microbiotica

Professor Ben Lehner FRS FMedSci, Senior Group Leader, Human Genetics Programme, Wellcome Sanger Institute

Seven Cambridge ̽��ֱ�� researchers are among the 59 biomedical and health researchers elected to the Academy of Medical Sciences Fellowship.

As we look to the future, the collective wisdom our new Fellows bring will be pivotal in achieving our mission to create an open and progressive research sector to improve the health of people everywhere

Professor Dame Anne Johnson, President of the Academy of Medical Sciences

Clockwise from top left: E. Di Angelantonio, J. Rayner, J. Rowe, R. Horvath, S. Nik-Zainal, E. Miska, C. Coles

Yes

First UK proton beam therapy trial for breast cancer launches

cjb250 — Wed, 04 Jan 2023 09:17:27 +0000

̽��ֱ��trial will compare proton beam therapy – which can target radiotherapy beams more precisely – with standard radiotherapy for patients who are at greater risk of long-term heart problems after radiotherapy treatment. It will help to determine whether proton beam therapy can help to deliver adequate doses of radiotherapy to breast tissue, while minimising off-target radiation delivered to the heart.

̽��ֱ��trial will enrol 192 people across a planned 22 sites in the UK. People allocated to receive proton beam therapy will be treated at either ̽��ֱ��Christie NHS Foundation Trust in Manchester or ̽��ֱ�� College London Hospitals NHS Foundation Trust, with accommodation provided for those who are travelling far from home.

̽��ֱ��PARABLE trial is being led by researchers at the ̽��ֱ�� of Cambridge, Institute of Cancer Research, London, and the Royal Marsden NHS Foundation Trust and managed by the Cancer Research UK-funded Clinical Trials and Statistics Unit at ̽��ֱ��Institute of Cancer Research (ICR). It is funded by a National Institute for Health and Care Research and Medical Research Council partnership. ̽��ֱ��NHS proton centres – UCLH and ̽��ֱ��Christie – also provided expert guidance on the trial protocol development.

Every year in the UK over 30,000 people with breast cancer receive radiotherapy following surgery as part of their treatment. Standard breast cancer radiotherapy uses high energy x-rays to kill cancer cells. As well as lowering the risk of cancer coming back, radiotherapy can increase survival rates.

Standard breast cancer radiotherapy is very effective for the vast majority of people and the benefits far outweigh small side effects. However, there can be a very small risk of radiotherapy leading to heart problems much later in life (less than one per cent of people treated). ̽��ֱ��risk of heart problems later in life due to breast radiotherapy maybe be higher than one per cent for a very small group of people. This is usually because their breast tissue and the lymph nodes which require radiotherapy treatment are located close to the heart, and/or because they have an increased underlying risk of developing heart problems later in life.

Professor Charlotte Coles, Professor of Breast Cancer Clinical Oncology at the ̽��ֱ�� of Cambridge, Consultant Oncologist at Addenbrooke’s Hospital and Chief Investigator of the PARABLE trial, said: “Although only a very small group of people are affected by a higher risk of heart problems later in life, it can still be a serious issue. Most patients treated with radiotherapy have decades of healthy life ahead of them and we need to do everything we can to avoid possible future heart problems related to treatment.

“Standard breast radiotherapy is really effective for most people with very few side effects, but there is a small group of patients for whom proton beam therapy may be a better option.”

Proton beam therapy uses charged particles instead of X-rays to target tumours more precisely. Researchers hope it will allow doctors to deliver the required dose of radiotherapy where it’s needed, while minimising the dose of radiation delivered to the heart, and without increasing the risk of early side effects such as skin redness and changes in breast appearance.

̽��ֱ��average radiotherapy dose that the heart is likely to receive from the radiotherapy planning scan can be estimated and together with age and other medical history, this information is used to predict the potential small lifetime risk of heart problems.

Professor Judith Bliss, Director of the Cancer Research UK-funded Clinical Trials and Statistics Unit at ̽��ֱ��Institute of Cancer Research, London, which is managing the PARABLE trial, said: “ ̽��ֱ��PARABLE trial will measure average dose of radiotherapy delivered to the heart to predict long-term heart damage. Using this early predictor will allow us to uncover the potential benefits of using proton beam therapy for long term heart health in years rather than decades.”

People who are predicted to have at least a two per cent or more potential lifetime risk of heart problems from radiotherapy will be invited to take part. Around 500 out of every 30,000 people who receive radiotherapy for breast cancer fall into this category. People who enter the trial will either receive standard radiotherapy or proton beam therapy.

̽��ֱ��trial will measure radiation dose delivered to the heart as an early predictor of possible heart problems, to avoid the need for lengthy follow up for many years before results are available.

People in the trial will also record their experiences using questionnaires so that researchers can assess side-effects including skin reactions, breast pain and swelling, and other symptoms which are particularly important for patients.

Proton beam therapy has been used in other countries to treat breast cancer, but numbers of participants in these trials are small and there have been no reported trials that directly compare proton beam therapy with standard radiotherapy.

̽��ֱ��researchers stress the importance of evaluating the benefits of proton beam therapy – which is expensive and only available in certain locations across the UK – thoroughly in a clinical trial.

Dr Anna Kirby, Consultant Clinical Oncologist at the Royal Marsden NHS Foundation Trust, Breast Cancer Radiotherapy Team Lead at ̽��ֱ��Institute of Cancer Research, London, and Radiotherapy Lead for the PARABLE trial, said: “We have already learnt a huge amount about how to optimise and standardise current breast cancer radiotherapy practices alongside optimising proton beam therapy approaches. We hope that the PARABLE trial will help us to further personalise radiotherapy treatments and ensure that people can access the radiotherapy approach that is best for them, regardless of where they live.

Adapted from a press release from ̽��ֱ��Institute of Cancer Research

Cambridge researchers are jointly leading the first UK trial to test the benefits of proton beam therapy for certain patients with breast cancer.

Standard breast radiotherapy is really effective for most people with very few side effects, but there is a small group of patients for whom proton beam therapy may be a better option

Charlotte Coles

FatCamera (Getty Images)

An Asian woman in her 60s embraces her mid-30s daughter who is battling cancer - stock photo

Kim Jones: Patient story

Kim Jones, 44, a school caterer from Ely, was diagnosed with breast cancer in February 2022 after noticing some thickening of the skin and painful twinges in her left breast. Her GP referred her for urgent scans at the breast clinic, and after having mammograms, ultrasounds and biopsies, the diagnosis was confirmed.

Kim was then referred to Addenbrooke's Hospital in Cambridge, where she had chemotherapy followed by a mastectomy and lymph node removal. Following acceptance to the PARABLE trial, Kim's proton beam therapy commenced at ̽��ֱ��Christie on 24 October.

Kim said: "I was told I might be suitable to participate in the PARABLE trial as it would potentially benefit patients with a high risk of long-term heart complications. As I already had an issue with my heart, the trial seemed like a great idea.

"When I was told that I'd been accepted onto the trial, I felt very lucky to have the opportunity to get this treatment. Clinical trials are incredibly important as they are the best way to evaluate which treatments work the best."

" ̽��ֱ��proton beam therapy centre at ̽��ֱ��Christie is bright and spacious and feels very relaxing. My experience of being treated at ̽��ֱ��Christie so far has been superb. ̽��ֱ��staff are wonderful and seem to have thought of everything. Their care is second to none, and I feel completely safe in their hands."

Following the proton beam therapy, Kim will have further chemotherapy and hormone therapy at Addenbrooke's.

Kim is married to Mark, and they have two boys, Dylan, age 14, and Elwood, age 11. She enjoys walking, reading, live music and spending time with her family.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes