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Health Minister Ann Keen has announced Government plans for an £8 million campaign to improve early diagnosis of cancer.

Following the Prime Minister’s pledge that patients with suspected cancer will receive results of diagnostic tests within a week, primary care trusts (PCTs) are being invited to bid for up to £100,000 to fund regional initiatives aimed at one or more of the three cancers with the highest mortality rates—breast, colorectal and lung cancer. PCTs will be able to use the money for advertising campaigns, outreach and public information strategies, and will be asked to measure the success of their activities so that the most effective can be implemented countrywide.

According to Ann Keen the aim is “to save up to 10,000 extra lives a year through early diagnosis and intervention”. National Cancer Director Sir Mike Richards commented: “This money will enable the NHS locally to raise awareness of the symptoms of the biggest cancer killers and to encourage patients to visit their GP earlier.”

 

The National Institute for Health and Clinical Excellence (NICE) has recommended rituximab as a treatment for patients with relapsed or refractory chronic lymphocytic leukaemia (CLL). The final draft guidance recommends rituximab be given in combination with fludarabine and cyclophosphamide for this disease, except where the patient has not responded to fludarabine, or has relapsed within 6 months of treatment, or has previously been treated with rituximab.

CLL is caused by the uncontrolled growth of abnormal B-cells, which interfere with the body’s ability to tackle infections. Rituximab is a monoclonal antibody that targets a specific surface protein of both healthy and abnormal B-cells, resulting in cell death.

Ken Campbell, clinical information officer at Leukaemia and Lymphoma Research welcomed the news, saying: “CLL is the commonest form of leukaemia in the Western world. It is important that when treatment is necessary, as many options as possible are available.” Hilary Tovey, policy manager at Cancer Research UK, added: “Rituximab has already had a big impact on the chances of survival for patients with lymphoma. NICE’s decision to recommend this drug is further good news for patients with CLL.”

 

A blood DNA test that can detect even microscopic residual tumours has been developed by American scientists. The test, known as PARE (Personalised Analysis of Rearranged Ends) may transform cancer treatment by allowing doctors to monitor patient progress more accurately (Leary et al. Sci Transl Med 2010). While the technique cannot help with initial detection—because a biopsy of the existing tumour is required to provide DNA for sequencing and comparison with the patient’s healthy tissue—it is capable of detecting residual cancer cells at levels that would be missed by conventional methods, such as computed tomography scans. Such sensitivity of detection would mean that some patients could be spared unnecessary chemotherapy or surgery, while others could receive potentially life-saving extra treatment.

PARE works by identifying genetic rearrangements peculiar to an individual patient’s tumour cells, which can then be used to detect matching sequences in the blood with high specificity and sensitivity. So far, the technique has proven successful at detecting microscopic tumours in four patients with bowel cancer and two with breast cancer. Unlike many reported advances in cancer care, this one could be available in as little as 5 years according to research leader Professor Victor Velculescu, of the Johns Hopkins Kimmel Cancer Center in Baltimore, USA. Current test costs are around £3,200 but are set to fall as DNA sequencing technology becomes cheaper.

Professor Mike Stratton of the Cancer Genome Project at the Wellcome Trust Sanger Institute near Cambridge, UK, welcomed the news, saying: “This is highly important work that will have profound implications for the development of individualised care.” With more than 82,000 people in the UK being diagnosed with breast or bowel cancer every year, the implications are already enormous, but the hope is that the technique can be applied to many other forms of cancer.

Bayer Healthcare has appealed against the National Institute for Health and Clinical Excellence (NICE) decision not to recommend sorafenib (Nexavar®) for advanced liver cancer.

Approximately 85% of primary liver cancers are hepatocellular carcinoma (HCC). Although there are procedures such as local resection, radiofrequency ablation and chemoembolisation for the treatment of HCC, approximately 50% of patients are ineligible for these therapies. Sorafenib was proposed as a treatment for those patients ineligible for conventional therapies—estimated to number 700 per year.

Sorafenib was rejected on the grounds that it was not considered to be cost effective. The NICE technology appraisal’s lowest cost estimate for the drug was just under £52,000 per quality-adjusted life year (QALY)—considerably higher than NICE’s QALY threshold of £20,000–£30,000.

Commenting on the decision, Mike Hobday, Head of Campaigns at Macmillan Cancer support said: “We are extremely disappointed that NICE has decided not to recommend sorafenib as a treatment for people with advanced liver cancer.” He added: “It is a scandal that the only licensed drug proven to significantly prolong the lives of people with this devastating disease has been rejected, leaving them with no treatment options.”

The decision to reject sorafenib was announced on the 19th November 2009, and the appeal against the recommendation was heard on the 26th February 2010. A final decision is awaited.