A new test to better treat early oesophageal cancer

  • Health
  • Saturday, 11 May 2019

A new test might help to decrease the 80% of oesophageal tumours that are not shrunk before surgery by standard chemotherapy. — TNS

Researchers at Queen’s University Belfast (Queen’s) in the United Kingdom have developed a test that could radically improve the lives of people with oesophageal cancer through a personalised medicine approach.

The researchers at Queen’s and the University of Cambridge, UK, in partnership with the stratified medicine company Almac Diagnostic Services, have validated a test that, for the first time, could enable clinicians to decide the most appropriate chemotherapy for early stage oesophageal cancer.

This personalised medicine approach of tailoring treatment to the individual could lead to more patients having their tumours successfully removed, improving their prognosis and quality of life.

Current treatment for oesophageal cancer involves a course of standard chemotherapy aimed at reducing tumour size before follow-up surgery can be carried out to remove it.

However, only around 20% of tumours will reduce in size with standard chemotherapy.

For oncologists, identifying the most effective chemotherapy to reduce the size of oesophageal tumours before they are operated on is a challenge.

Queen’s senior clinical lecturer and study lead author Dr Richard Turkington explains: “The UK has the highest incidence in the world of a particular type of oesophageal cancer called oesophageal adenocarcinoma, with 16,000 cases each year.

“One-third of patients are diagnosed with tumours that have not spread and can be removed by surgery, following a course of chemotherapy.

“However, less than one in five patients show evidence of shrinkage from the chemotherapy when their tumour is removed.

“In order to cure more oesophageal cancers, we need to identify the most effective treatment for each patient to give them the best chance of all of their cancer being removed.

“At present, we apply a ‘one-size-fits-all’ approach where everyone gets the same type of chemotherapy before their surgery.

“But we know that different chemotherapies work better for different patients, so we need to match the right treatment to the right patient.

“This test enables us to gain a molecular understanding of each patient’s cancer, which could then inform the decision to select the right chemotherapy to shrink the tumour.”

For this test, Queen’s collaborated with Almac, which previously developed the DNA Damage Immune Response (DDIR) Signature to personalise chemotherapy for breast cancer.

Further studies have indicated that it may be applied to other cancer types.

The DDIR Signature is a 44-gene signature that uses the expression of each gene present in each tumour sample to generate a score for the patient.

A high score indicates that the tumour has a higher likelihood of responding to DNA-damaging chemotherapies.

The research team is continuing to test the assay further in other sample collections and through clinical trials.

The research was published in the journal Gut on Mac 9, 2019.

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