Early Detection related publications from the University of Cambridge

Are artificial intelligence/machine learning (AI/ML) algorithms ready for implementation in community and primary care settings to facilitate the early detection of skin cancer?

Jones OT, Matin RN, van der Schaar M, Prathivadi Bhayankaram K, Ranmuthu CKI, Islam MS, Behiyat D, Boscott R, Calanzani N, Emery J, Williams HC, Walter FM.

Lancet Digital Health. 24 May 2022. doi.org/10.1016/S2589-7500(22)00023-1

Artificial Intelligence (AI) aimed at detecting skin cancer is not yet ready for use in primary care settings, due to a lack of evidence in settings where the prevalence of skin cancer is low, according to CanTest researchers.

Substitution mutational signatures in whole-genome–sequenced cancers in the UK population

Degasperi A, Zou X, Dias Amarante T, Martinez-Martinez A, Koh GCC, Dias JML, Heskin L, Chmelova L, Rinaldi G, Wang VYW, Nanda AS, Bernstein A, Momen SE, Young J, Perez-Gil D, Memari Y, Badja C, Shooter S, Czarnecki J, Brown MA, Davies HR, Nik-Zainal S.

Science, 22 Apr 2022. Vol 376, Issue 6591. https://doi.org/10.1126/science.abl9283

In the largest cohort of whole-genome–sequenced samples to date, researchers have uncovered important new clues about the causes of cancer, including 58 new mutational signatures, suggesting that there are additional causes of cancer that we don't yet fully understand.

The future of early cancer detection

Fitzgerald RC, Antoniou AC, Fruk L, Rosenfeld N

Nat Med 28, 666–677 (2022). doi.org/10.1038/s41591-022-01746-x

In this article, Rebecca Fitzgerald and colleagues review the latest advances in early cancer detection and consider future strategies that take a proactive approach to personalised, risk-based screening.

The article is part of a Focus Issue in Nature Medicine, dedicated to 'The Future of Cancer Research', which takes stock of progress and explores ways to deliver research and care that is innovative, sustainable, and patient-focused.

Early detection of cancer

Crosby D, Bhatia S, Brindle KM, Coussens LM, Dive C, Emberton M, Esener S, Fitzgerald RC, Gambhir SS, Kuhn P, Rebbeck TR, Balasubramanian S

Science, 18 March 2022, Vol 375, Issue 6586. https://doi.org/10.1126/science.aay9040

In this review article Crosby et al. discuss the importance of cancer early detection and the main challenges that need to be overcome to better understand the early events in tumorigenesis that are detectable in screening tests. The results of these tests can then be reliably interpreted to determine whether an individual requires treatment.

Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett's oesophagus surveillance

Pilonis ND, Killcoyne S, Tan WK, O’Donovan M, Malhotra S, Tripathi M, Miremadi A, Debiram-Beecham I, Evans T, Phillips R, Morris DL, Vickery C, Harrison J, di Pietro M, Ortiz-Fernandez-Sordo J, Haidry R, Kerridge A, Sasieni PD, Fitzgerald RC

Lancet Oncol 2022, January 11, 2022 https://doi.org/10.1016/S1470-2045(21)00667-7

Use of a Cytosponge biomarker panel to prioritise endoscopic Barrett's oesophagus surveillance: a cross-sectional study followed by a real-world prospective pilot

Endoscopic surveillance is recommended for patients with Barrett's oesophagus because, although the progression risk is low, endoscopic intervention is highly effective for high-grade dysplasia and cancer. However, repeated endoscopy has associated harms and access has been limited during the COVID-19 pandemic. We aimed to evaluate the role of a non-endoscopic device (Cytosponge) coupled with laboratory biomarkers and clinical factors to prioritise endoscopy for Barrett's oesophagus.

Synonymous mutations reveal genome-wide levels of positive selection in healthy tissues

Poon GYP, Watson CJ, Fisher DS, Blundell JR

Nature Genetics. http://doi.org/10.1038/s41588-021-00957-1

Scientists in research group of Jamie Blundell at the University of Cambridge have discovered a way of measuring how many potentially cancer-causing mutations remain to be discovered across the human genome. Cancer-associated mutations are known to expand in healthy human tissues as we age. The acquisition of these “driver” mutations is often the first step towards the development of cancer. However, the total number of driver mutations across the human genome remains unknown as studies typically only survey the 1% of the genome which codes for genes. How much mutational “dark matter” is lurking in the remaining 99% of the genome?

First-in-human pilot study of snapshot multispectral endoscopy for early detection of Barrett’s-related neoplasia

Waterhouse DJ, Bano S, Januszewicz W, Stoyanov D, Fitzgerald RC, di Pietro M, Bohndiek SE

Journal of Biomedical Optics, 26(10), 106002 (2021). https://doi.org/10.1117/1.JBO.26.10.106002

The early detection of dysplasia in patients with Barrett’s esophagus could improve outcomes by enabling curative intervention; however, dysplasia is often inconspicuous using conventional white-light endoscopy.

We sought to determine whether multispectral imaging (MSI) could be applied in endoscopy to improve detection of dysplasia in the upper gastrointestinal (GI) tract.

Evolution and progression of Barrett’s oesophagus to oesophageal cancer

Killcoyne S and Fitzgerald RC

Nat Rev Cancer (2021). DOI: 10.1038/s41568-021-00400-x

Cancer cells are shaped through an evolutionary process of DNA mutation, cell selection and population expansion. Early steps in this process are driven by a set of mutated driver genes and structural alterations to the genome through copy number gains or losses. Oesophageal adenocarcinoma (EAC) and the pre-invasive tissue, Barrett’s oesophagus (BE), provide an ideal example in which to observe and study this evolution. BE displays early genomic instability, specifically in copy number changes that may later be observed in EAC. Furthermore, these early changes result in patterns of progression (that is, ‘born bad’, gradual or catastrophic) that may help to describe the evolution of EAC. As only a small proportion of patients with BE will go on to develop cancer, a better understanding of these patterns and the resulting genomic changes should improve early detection in EAC and may provide clues for the evolution of cancer more broadly.

Molecular phenotyping reveals the identity of Barrett’s esophagus and its malignant transition

Nowicki-Osuch K, Zhuang L, Jammula S, Bleaney CW, Mahbubani KT, Devonshire G, Katz-Summercorn A, Eling N, Wilbrey-Clark A, Madissoon E, Gamble J, Di Pietro M, O’Donovan M, Meyer KB, Saeb-Parsy K, Sharrocks AD, Teichmann SA, Marioni JC, Fitzgerald RC

Science; 13 Aug 2021; DOI: 10.1126/science.abd1449

A study by a multidisciplinary group of scientists, led by Professor Rebecca Fitzgerald, found that a particular subtype of oesophageal cancer known as oesophageal adenocarcinoma is always preceded by Barrett’s oesophagus, and confirms the importance of screening for Barrett's.

The research team analysed tissue samples from patients with Barrett’s oesophagus and from organ donors who have never had the condition. Lead authors Dr Karol Nowicki-Osuch and Dr Lizhe Zhuang established a detailed ‘atlas’ of human cells and tissues from all possible origins of Barrett’s oesophagus. They found that all oesophageal adenocarcinoma cells begin as stomach cells before transforming into Barrett’s cells and then into cancer cells.

First experience in clinical application of hyperspectral endoscopy for evaluation of colonic polyps

Yoon J, Joseph J, Waterhouse DJ, Borzy C, Siemens K, Diamond S, Tsikitis VL, Bohndiek SEJ

Biophotonics 2021, e202100078. doi.org/10.1002/jbio.202100078

A study led by Professor Sarah Bohndiek, University of Cambridge and Professor V Liana Tsikitis, Oregon Health and Science University sought to evaluate the potential of a hyperspectral endoscope (HySE) to enhance colonic polyp discrimination for detection and resection.

They designed, built and tested a new compact HySE in a proof-of-concept clinical study and successfully collected spectra from three tissue types in seven patients undergoing routine colonoscopy screening. The acquired spectral data from normal tissue and polyps, both pre- and post- resection, were subjected to quantitative analysis using spectral angle mapping and machine learning, which discriminated the data by tissue type, meriting further investigation of HySE as a clinical tool.

Reasons for intending to accept or decline kidney cancer screening: thematic analysis of free text from an online survey

Freer-Smith C, Harvey-Kelly L, Mills K, Harrison H, Rossi SH, Griffin SJ, Stewart GD, Usher-Smith JA

BMJ Open 2021;11:e044961. DOI: 10.1136/bmjopen-2020-044961

This paper explores public attitudes towards screening for kidney cancer and assesses whether targeted screening of higher risk individuals might be possible. Published in BMJ Open, the research shows that most people think positively about potential kidney cancer screening and anticipate that they would attend if they were invited. Urine testing or low-dose computerised tomography (CT) scans, combined with lung screening, were the preferred test options. Several existing risk models are potentially useful in predicting who is more likely to get kidney cancer and could be used to identify those at higher risk for targeted screening. Using genetics or risk models, to determine eligibility for screening, would be acceptable to most people.

Spectral Endoscopy Enhances Contrast for Neoplasia in Surveillance of Barrett's Esophagus

Waterhouse D, Januszewicz W, Ali S, Fitzgerald RC, di Pietro M, Bohndiek SE

Cancer Res May 26 2021 DOI: 10.1158/0008-5472.CAN-21-0474

A study lead by Dale Waterhouse, demonstrates the potential of spectral endoscopy to reveal disease-associated vascular changes and to provide high-contrast delineation of neoplasia in the esophagus.

Early detection of esophageal neoplasia enables curative endoscopic therapy, but the current diagnostic standard of care has low sensitivity because early neoplasia is often inconspicuous with conventional white-light endoscopy. Here, we hypothesized that spectral endoscopy could enhance contrast for neoplasia in surveillance of patients with Barrett's esophagus. A custom spectral endoscope was deployed in a pilot clinical study of 20 patients to capture 715 in vivo tissue spectra matched with gold standard diagnosis from histopathology.

A biomechanical switch regulates the transition towards homeostasis in esophageal epithelium

McGinn J, Hallou A, Han S, Krizic K, Ulyanchenko S, Iglesias-Bartolome R, England FJ, Verstreken C, Chalut KJ, Jensen KB, Simons BD, Alcolea MP

Nat Cell Biol (2021) DOI: 10.1038/s41556-021-00679-w

Epithelial cells are highly dynamic and can rapidly adapt their behavior in response to tissue perturbations and increasing tissue demands. However, the processes that finely control these responses and, particularly, the mechanisms that ensure the correct switch to and from normal tissue homeostasis are largely unknown. Here we explore changes in cell behaviour happening at the interface between postnatal development and homeostasis in the epithelium of the mouse esophagus, as a physiological model exemplifying a rapid but controlled tissue growth transition.

A systematic CRISPR screen defines mutational mechanisms underpinning signatures caused by replication errors and endogenous DNA damage

Zou X, Koh GCC , Nanda AS, Degasperi A, Urgo K, Roumeliotis TI, Agu CA, Badja C, Momen S, Young J, Amarante TD, Side L, Brice G, Perez-Alonso V, Rueda D, Gomez C, Bushell W, Harris R, Choudhary JS, Genomics England Research Consortium, Jiricny J, Skarnes WC and Nik-Zainal S.

Nat Cancer (2021). https://doi.org/10.1038/s43018-021-00200-0

A new way to identify tumours that could be sensitive to particular immunotherapies has been developed using data from thousands of NHS cancer patient samples sequenced through the 100,000 Genomes Project.

Mutational signatures are imprints of pathophysiological processes arising through tumorigenesis. We generated isogenic CRISPR–Cas9 knockouts (∆) of 43 genes in human induced pluripotent stem cells, cultured them in the absence of added DNA damage and performed whole-genome sequencing of 173 subclones. ∆OGG1, ∆UNG, ∆EXO1, ∆RNF168, ∆MLH1, ∆MSH2, ∆MSH6, ∆PMS1 and ∆PMS2 produced marked mutational signatures indicative of them being critical mitigators of endogenous DNA modifications.

Triage-driven diagnosis of Barrett’s esophagus for early detection of esophageal adenocarcinoma using deep learning

Gehrung M, Crispin-Ortuzar M, Berman AG, O'Donovan M, Fitzgerald RC, Markowetz F

Nat Medicine (2021), DOI:10.1038/s41591-021-01287-9

Artificial intelligence (AI) could help free up pathologist time and allow them to focus on diagnosing the most tricky cases of Barrett’s oesophagus, according to a Cancer Research UK-funded study.

COX2 regulates senescence secretome composition and senescence surveillance through PGE2

Gonçalves S, Yin K, Ito Y, Chan A, Olan I, Gough S, Cassidy L, Serrao E, Smith S, Young A, Narita M, Hoare M

Cell Reports, Volume 34, Issue 11, 108860, March 16, 2021. DOI: 10.1016/j.celrep.2021.108860

Senescent cells trigger their own immune-mediated destruction, termed senescence surveillance. This is dependent on the inflammatory senescence-associated secretory phenotype (SASP), which includes COX2, an enzyme with complex roles in cancer. The role COX2 plays during senescence surveillance is unknown.

Gonçalves et al. identify COX2 as a regulator of senescence secretome composition through an autocrine feedback loop involving PGE2 and EP4. During hepatocyte senescence, Cox2 is critical to tumor suppression, Cxcl1 expression, the immune microenvironment, and immunemediated senescence surveillance, partially through PGE2.

Time-resolved single-cell analysis of Brca1 associated mammary tumourigenesis reveals aberrant differentiation of luminal progenitors

Bach K, Pensa S, Zarocsinceva M, Kania K, Stockis J, Pinaud S, Lazarus KA, Shehata M, Simões BM, Greenhalgh AR, Howell SJ, Clarke RB, Caldas C, Halim TYF, Marioni JC, Khaled WT

Nature Communications, volume 12, Article number: 1502 (2021). DOI:10.1038/s41467-021-21783-3

Researchers may have found the earliest changes that occur in seemingly healthy breast tissue long before any tumours appear. The study, funded by Cancer Research UK, showed that before becoming cancerous, breast cells with the BRCA1 gene mutation undergo changes similar to those normally seen in late pregnancy. Not all women who have BRCA1 mutations will go on to develop cancer so for some, life-changing surgery may be unnecessary, or could at least be delayed until early warning signs are spotted.

Artificial intelligence techniques could help with earlier diagnosis of cancer in primary care: a systematic review

Jones OT, Calanzani N, Saji S, Duffy SW, Emery J, Hamilton W, Singh H, de Wit NJ, Walter FM.

J Med Internet Res 2021;23(3):e23483. DOI: 10.2196/23483

Artificial Intelligence (AI) techniques can be applied to primary care data to facilitate the early diagnosis of cancer, according to the first international review of studies on this topic.

Breast cancer risk genes — association analysis in more than 113,000 women

Breast Cancer Association Consortium; Easton DF et al.

N Engl J Med 2021; 384:428-439. DOI: 10.1056/NEJMoa1913948

A study led by Doug Easton (Director of the Centre for Cancer Genetic Epidemiology, member of the Early Detection Programme) is the most ambitious project carried out to date to shed light on the role of heredity in breast cancer. The analysis of samples from over 113,000 women reveals the nine most important genes that increase the risk of breast cancer. The research, published in the New England Journal of Medicine on 4th February 2021, was undertaken by a large international consortium of 250 researchers from over 25 countries, coordinated from Cambridge.

Discovery of PTN as a serum-based biomarker of pro-metastatic prostate cancer

Liu S, Shen M, Hsu E-C, Zhang CA, Garcia-Marques F, Nolley R, Koul K, Rice MA, Aslan M, Pitteri SJ, Massie C, George A, Brooks JD, Gnanapragasam VJ, Stoyanova T.

Br J Cancer (2020). DOI:10.1038/s41416-020-01200-0

Publication from principal investigators Mr Vincent Gnanapragasam & Assistant Professor Tanya Stoyanova from work supported by a joint pump-priming award from the Cancer Research UK Cambridge Centre Early Detection Programme and the Canary Center at Stanford.

The diagnostic performance of CA125 for the detection of ovarian and non-ovarian cancer in primary care: A population-based cohort study

Hamilton W, Abel G, Crosbie EJ, Rous B, Walter FM

PLOS Medicine, published: October 28 2020. DOI:10.1371/journal.pmed.1003295

A blood test already available to GPs in the UK is more predictive of ovarian cancer than previously thought and could also help pick up other forms of cancer.

Robustness to misalignment of low-cost, compact quantitative phase imaging architectures

Fitzpatrick CRM, Wilson A, Sawyer TW, Christopher PJ, Wilkinson TD, Bohndiek SE, Gordon GSD.

OSA Continuum 3, 2660-2679 (2020), published: October 15 2020. DOI:10.1364/OSAC.395498

Quantitative phase imaging is becoming widely used in microscopy to elucidate previously unresolvable features based on their scattering behaviour and refractive index contrast, for example structural tissue changes indicative of diseases such as cancer. Bringing such measurements into an endoscopic setting could aid clinical decision making by enhancing contrast for early stage disease in vivo. A range of diagnostic approaches are currently being developed for capsule endoscopes; this work provides a preliminary look at some key considerations for bringing phase imaging into this setting.

Cellular senescence in cancer: from mechanisms to detection

Ou HL, Hoffmann R, González‐López C, Doherty G, Korkola JE, Muñoz‐Espín D

Molecular Oncology, published: September 27 2020. DOI: 10.1002/1878-0261.12807

This review piece from the Muñoz‐Espín lab highlights the occurrence and impact of senescence in neoplasia and advanced tumours, and recapitulates cutting-edge technologies for detecting senescence with significant potential for clinical utilisation. We anticipate these detection tools may facilitate a more precise monitoring of early tumours and their microenvironment, and a response assessment of patients to therapy in the near future.

A guide to assessing cellular senescence in vitro and in vivo

González‐Gualda E, Baker AG, Fruk L, Muñoz‐Espín D

FEBS Journal, published: September 22 2020. DOI: 10.1111/febs.15570

A review piece from the Muñoz‐Espín lab - The reliable assessment and identification of senescence is not only crucial for better understanding its underlying biology, but also imperative for the development of diagnostic and therapeutic strategies aimed at targeting senescence in the clinic.

Breath biopsy assessment of liver disease using an exogenous volatile organic compound - toward improved detection of liver impairment

Ferrandino G, Orf I, Smith R, Calcagno M, Thind AK, Debiram-Beecham I, Williams M, Gandelman O, de Saedeleer A, Kibble G, Lydon AM, Mayhew CA, Allsworth M, Boyle B, van der Schee MP, Allison M, Hoare M, Snowdon VK.

Clinical and Translational Gastroenterology: September 2020 - Volume 11 - Issue 9 - p e00239 DOI: 10.14309/ctg.0000000000000239

Liver cirrhosis and its complication — hepatocellular carcinoma (HCC) — have been associated with increased exhaled limonene. It is currently unclear whether this increase is more strongly associated with the presence of HCC or with the severity of liver dysfunction.

Covid-19 test and trace: Look for the super-locals to access “hard to reach” groups

Arteaga I, Fagan Robinson K, McDonald M,

BMJ Opinion, published: September 10 2020.

Opinion piece funded by Early Detection Programme pump priming award with so-called 'hard-to-reach' communities: Look for the super-locals to access "hard to reach" groups.

Genomic copy number predicts esophageal cancer years before transformation

Killcoyne S, Gregson E, Wedge D, Woodcock DJ, Eldridge MD, de la Rue R, Miremadi A, Abbas S, Blasko A, Kosimidou C, Januszewicz W, Jenkins AV, Gerstung M, Fitzgerald RC

Nature Medicine, published: September 7 2020. DOI:10.1038/s41591-020-1033-y

DNA from tissue biopsies taken from patients with Barrett’s oesophagus – a risk factor for oesophageal cancer – could show which patients are most likely to develop the disease eight years before diagnosis, suggests a study led by researchers at the University of Cambridge and EMBL’s European Bioinformatics Institute (EMBL-EBI).

Current evidence on screening for renal cancer

Usher Smith J, Simmons RK, Rossi SH, Stewart GD,

Nature Reviews Urology, published: August 28 2020. DOI:10.1038/s41585-020-0363-3

Renal cell carcinoma (RCC) incidence is increasing worldwide. A high proportion of individuals are asymptomatic at diagnosis, but RCC has a high mortality rate. These facts suggest that RCC meets some of the criteria for screening, and a new analysis shows that screening for RCC could potentially be cost-effective. This perspective article considers the current evidence on renal cancer screening.

Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial

Fitzgerald RC, Di Pietro M, O’Donovan M, Maroni R, Muldrew B, Debiram-Beecham I, Gehrung M, Offman J, Tripathi M, Smith SG, Aigret B, Walter FM, Rubin G, Sasieni P

The Lancet, published: August 1 2020. DOI:10.1016/S0140-6736(20)31099-0

Treatment of dysplastic Barrett's oesophagus prevents progression to adenocarcinoma; however, the optimal diagnostic strategy for Barrett's oesophagus is unclear. The Cytosponge-trefoil factor 3 (TFF3) is a non-endoscopic test for Barrett's oesophagus. The aim of this study was to investigate whether offering this test to patients on medication for gastro-oesophageal reflux would increase the detection of Barrett's oesophagus compared with standard management.

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Use of Cytosponge as a triaging tool to upper gastrointestinal endoscopy during the COVID-19 pandemic

Di Pietro M, Modolell I, O’Donovan M, Price C, Debiram-Beecham I, Pilonis ND, Fitzgerald RC

The Lancet Gastroenterology and Hepatology, published: July 30 2020. DOI: 10.1016/S2468-1253(20)30242-9

During the COVID-19 pandemic, endoscopy services were severely curtailed—eg, in England, UK, a 30% reduction of diagnostic endoscopies has been reported for the period between January and April, 2020, compared with the same period in 2019, with an estimated 750 oesophagogastric cancers going undiagnosed. A delay in oesophageal cancer diagnosis could adversely affect outcomes, such as has previously been seen with low endoscopy referral rates being linked with poor outcomes from oesophageal cancer. This paper outlines how the Cytosponge was used for some patients referred for urgent endoscopy during this time.

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Personalized early detection and prevention of breast cancer: ENVISION consensus statement

Pashayan N, Antoniou AC, Ivanus U, Esserman LJ, Easton DF, French D, Sroczynski G, Hall P, Cuzick J, Evans DG, Simard J, Garcia-Closas M, Schmutzler R, Wegwarth O, Pharoah P, Moorthie S, De Montgolfier S, Baron C, Herceg Z, Turnbull C, Balleyguier C, Rossi PG, Wesseling J, Ritschie D, Tischkowitz M, Broeders M, Reisel D, Metspalu A, Callender T, de Koning H, Devilee P, Delaloge S, Schmidt MK and Widschwendter M.

Nature Reviews Clinical Oncology, Published: June 18 2020. doi: 10.1038/s41571-020-0388-9

The European Collaborative on Personalised Early Detection and Prevention of Breast Cancer (ENVISION) brings together several international research consortia working on different aspects of the personalised early detection and prevention of breast cancer. In a consensus conference held in 2019, the members of this network identified research areas requiring development to enable evidence-based personalised interventions that might improve the benefits and reduce the harms of existing breast cancer screening and prevention programmes. The implementation of such programmes would require health-care systems to be open to learning and adapting, the engagement of a diverse range of stakeholders and tailoring to societal norms and values, while also addressing the ethical and legal issues. In this Consensus Statement, we discuss the current state of breast cancer risk prediction, risk-stratified prevention and early detection strategies, and their implementation. Throughout, we highlight priorities for advancing each of these areas.

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ctDNA monitoring using patient-specific sequencing and integration of variant reads

Wan JCM, Heider K, Gale D, Murphy S, Fisher E, Mouliere F, Ruiz-Valdepenas A, Sntonja A, Morris J, Chandrananda D, Marshall A, Gill AB, Chan PY, Barker E, Young G, Cooper WN, Hudecova I, Marass F, Mair R, Brindle K, Stewart G, Abraham JE, Caldas C, Rassl D, Rintoul RC, Alifrangis C, Middleton M, Gallagher FA, Parkinson C, Durrani A, McDermott U, Smith CG, Massie CM, Corrie PG, Rosenfeld N

Science Translational Medicine, Published: June 17 2020: Vol. 12, Issue 548. doi: 10.1126/scitranslmed.aaz8084

A new method of analysing cancer patients’ blood for evidence of the disease could be up to ten times more sensitive than previous methods according to new research funded by Cancer Research UK.

In the coming years, this method and others based on this approach could lead to tests that more accurately determine if a patient is likely to relapse after having treatment, and could pave the way for the development of pinprick home blood tests to monitor patients.

The technique uses personalised genetic testing of a patient’s tumour to search blood samples for hundreds of different genetic mutations in circulating tumour DNA (ctDNA); DNA released by cancer cells into the bloodstream.

Combined with new methods to analyse this data to remove background noise and enhance the signal, the team was able to reach a level of sensitivity that in some cases could find one mutant DNA molecule amongst a million pieces of DNA – approximately ten times more sensitive than previous methods.

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Homologous recombination DNA repair deficiency and PARP inhibition activity in primary triple negative breast cancer

Chopra N, Tovey H, Pearson A, Cutts R, Toms C, Proszek P, Hubank M, Dowsett M, Dodson A, Daley F, Kriplani D, Gevensleben H, Davies HR, Degasperi A, Roylance R, Chan S, Tutt A, Skene A, Evans A, Bliss JM, Nik-Zainal S, Turner NC .

Nat. Commun, published: May 29 2020. DOI:10.1038/s41467-020-16142-7

We apply our mutational-signature-based algorithm, HRDetect, into a proof-of-principle clinical trial, RIO (EudraCT 2014-003319-12), where patients with a very aggressive form of breast cancer called triple negative breast cancer, are given PARP-inhibition as a first line agent in a two-week window. We demonstrate that HRDetect is able to identify TNBCs that have a functional HR-deficiency and that this is associated with activity to PARP-inhibition. This was a really important trial that has opened RCTs to our clinical algorithm.

Spatial competition shapes the dynamic mutational landscape of normal esophageal epithelium

Colom B, Alcolea MP, Piedrafita G, Hall MWJ, Wabik A, Dentro SC, Fowler JC, Herms A, King C, Ong SH, Sood RK, Gerstung M, Martincorena I, Hall BA and Jones PH

Nature Genetics, Published: May 18 2020. doi: 10.1038/s41588-020-0624-3

The expansion of ‘mutant’ cells that could lead to cancer is often kept in check by their neighbours, research from the Wellcome Sanger Institute, the University of Cambridge and their collaborators has found. The team discovered that when equally-matched cells in the oesophagus of mice coincided, they acted as a brake on one another’s growth.

The study, in Nature Genetics, describes the ‘rules of the game’ of competition between oesophageal cells for the first time. By understanding these rules, the hope is that therapies can be developed to reduce the competitiveness of mutant clone cells that are more likely to become cancerous.

Clones are communities of cells descended from a single stem cell through the normal process of cell division. Tissues in the human body consist of patchworks of clones, with DNA mutations that occur naturally throughout life being passed on from parent to daughter cell.

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Perspective: The challenge of early detection in cancer

Pashayan N and Pharoah PDP.

Science, Published: May 8 2020. doi: 10.1126/science.aaz2078

In this Science Perspective article, the authors caution that earlier detection and an apparent increase in survival may not always signify improved prognosis because some patients will die at the same time despite earlier detection of their tumour, and some patients will die of other causes.

They go on to discuss the particular issues with screening – where an early detection test is given to large groups of the healthy population with the intention of detecting cancer at an early stage when it can be cured and before it has spread. The success of screening for various cancers is dependent on how quickly different tumours grow, when a tumour is likely to spread, how sensitive screening is at detecting small tumours, and how often screening occurs.

Using breast screening as an example, they point out that to detect the most aggressive cancers early enough to be curable, screening would need to detect tumours smaller than currently possible and would need to take place more frequently than at present. They also highlight the risk of overdiagnosis and overtreatment if early detection tests are not able to distinguish between fast-growing aggressive tumours and slow-growing indolent tumours.

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Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: A longitudinal data-linkage study using primary care electronic health records

Zhou Y, Abel GA, Hamilton W, Singh H, Walter FM and Lyratzopoulos G.

Elsevier, Published online: April 22 2020. doi: 10.1016/j.canep.2020.101703

Sub-optimal use or interpretation of imaging investigations prior to diagnosis of certain cancers may be associated with less timely diagnosis, but pre-diagnostic imaging activity for urological cancer is unknown.

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Clinical utility and cost modelling of the phi test to triage referrals into image-based diagnostic services for suspected prostate cancer: the PRIM (Phi to RefIne Mri) study

Kim L, Boxall N, George A, Burling K, Acher P, Aning J, McCracken S, Page T and Gnanapragasam VJ.

BMC Medicine, published April 17 2020. DOI: 10.1186/s12916-020-01548-3

The clinical pathway to detect and diagnose prostate cancer has been revolutionised by the use of multiparametric MRI (mpMRI pre-biopsy). mpMRI however remains a resource-intensive test and is highly operator dependent with variable effectiveness with regard to its negative predictive value. Here we tested the use of the phi assay in standard clinical practice to pre-select men at the highest risk of harbouring significant cancer and hence refine the use of mpMRI and biopsies.

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A novel split mode TFBAR device for quantitative measurements of prostate specific antigen in a small sample of whole blood

Wajs E, Rughoobur G, Burling K, George A, Flewitt AJ and Gnanapragasam VJ.

Nanoscale, published April 15 2020. DOI: 10.1039/d0nr00416b

Easy monitoring of prostate specific antigen (PSA) directly from blood samples would present a significant improvement as compared to conventional diagnostic methods. In this work, a split mode thin film bulk acoustic resonator (TFBAR) device was employed for the first time for label-free measurements of PSA concentrations in the whole blood and without sample pre-treatment. The surface of the sensor was covalently modified with anti-PSA antibodies and demonstrated a very high sensitivity of 101 kHz mL ng−1 and low limit of detection (LOD) of 0.34 ng mL−1 in model spiked solutions. It has previously been widely believed that significant pre-processing of blood samples would be required for TFBAR biosensors. Importantly, this work demonstrates that this is not the case, and TFBAR technology provides a cost-effective means for point-of-care (POC) diagnostics and monitoring of PSA in hospitals and in doctors’ offices. Additionally, the accuracy of the developed biosensor, with respect to a commercial auto analyser (Beckman Coulter Access), was evaluated to analyse clinical samples, giving well-matched results between the two methods, thus showing a practical application in quantitative monitoring of PSA levels in the whole blood with very good signal recovery.

Galacto‐conjugation of Navitoclax as an efficient strategy to increase senolytic specificity and reduce platelet toxicity

Estela González‐Gualda, Marta Páez‐Ribes, Beatriz Lozano‐Torres, David Macias, Joseph R. Wilson III, Cristina González‐López, Hui‐Ling Ou, Sofía Mirón‐Barroso, Zhenguang Zhang, Araceli Lérida‐Viso, Juan F. Blandez, Andrea Bernardos, Félix Sancenón, Miguel Rovira, Ljiljana Fruk, Carla P. Martins, Manuel Serrano, Gary J. Doherty, Ramón Martínez‐Máñez, Daniel Muñoz‐Espín.

Aging Cell, published: March 31 2020. DOI: 10.1111/acel.13133.

Pharmacologically active compounds with preferential cytotoxic activity for senescent cells, known as senolytics, can ameliorate or even revert pathological manifestations of senescence in numerous preclinical mouse disease models, including cancer models. However, translation of senolytic therapies to human disease is hampered by their suboptimal specificity for senescent cells and important toxicities that narrow their therapeutic windows. We have previously shown that the high levels of senescence-associated lysosomal b-galactosidase (SA-b-gal) found within senescent cells can be exploited to specifically release tracers and cytotoxic cargoes from galactose-encapsulated nanoparticles within these cells. Here we show that galacto-conjugation of the BCL-2 family inhibitor navitoclax results in a potent senolytic prodrug (Nav-Gal), that can be preferentially activated by SA-b-gal activity in a wide range of cell types. Nav-Gal selectively induces senescent cell apoptosis and has a higher senolytic index than navitoclax (through reduced activation in non-senescent cells). Nav-Gal enhances the cytotoxicity of standard senescence-inducing chemotherapy (cisplatin) in human A549 lung cancer cells. Concomitant treatment with cisplatin and Nav-Gal in vivo results in the eradication of senescent lung cancer cells and significantly reduces tumour growth. Importantly, galacto-conjugation reduces navitoclax-induced platelet apoptosis in human and murine blood samples treated ex vivo, and thrombocytopaenia at therapeutically-effective concentrations in murine lung cancer models. Taken together, we provide a potentially versatile strategy for generating effective senolytic prodrugs with reduced toxicities.

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The evolutionary dynamics and fitness landscape of clonal hematopoiesis

Watson CJ, Papula AL, Poon GYP, Wong WH, Young AL, Druley TE, Fisher DS and Blundell JR.

Science (2020), published March 27 2020. DOI: 10.1126/science.aay9333

Cancer is evolution at the cellular level. As we age, we acquire mutations in the cells that make up our tissues. Whilst the vast majority of these mutations are harmless, some of them increase the Darwinian ‘fitness’ of cells, allowing them to expand and outcompete our healthy cells. These expansions increase the chance of accumulating further cancer-causing mutations and can thus increase the risk of developing cancer. A major question in the field of early cancer detection is therefore: which specific mutations enable cells to expand most rapidly, and thus might confer the highest risk of cancer? Blood’s relative ease of sampling has resulted in the generation of a huge amount of genomic data in recent years and this provides us with an ideal opportunity to answer this question.

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Evaluating clinician acceptability of the prototype CanRisk tool for predicting risk of breast and ovarian cancer: A multi-methods study

Archer, S, de Villiers CB, Scheibl F, Carver T, Hartley S, Lee A, Cunningham AP, Easton DF, McIntosh JG, Emery J, Tischkowitz M, Antoniou AC and Walter FM.

PLOS One Journal, published March 6 2020. DOI: 10.1371/journal.pone.0229999

There is a growing focus on the development of multi-factorial cancer risk prediction algorithms alongside tools that operationalise them for clinical use. BOADICEA is a breast and ovarian cancer risk prediction model incorporating genetic and other risk factors. A new user-friendly Web-based tool (CanRisk.org) has been developed to apply BOADICEA. This study aimed to explore the acceptability of the prototype CanRisk tool among two healthcare professional groups to inform further development, evaluation and implementation.

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Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies

Freeman K, Dinnes J, Chuchu N, Takwoingi Y, Bayliss SE, Matin RN, Jain A, Walter FM, Williams HC and Deeks, JJ.

BMJ (2020), published February 10 2020. DOI: 10.1136/bmj.m127

Skin cancer is one of the most common cancers in the world, and the incidence is increasing. As skin cancer smartphone applications provide a technological approach to assist people with suspicious lesions to decide whether they should seek further medical attention, this study was undertaken to examine the validity and accuracy of these applications.

Click here for the commentary by Ben Goldacre.

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A practical framework and online tool for mutational signature analyses show inter-tissue variation and driver dependencies

Degasperi A, Dias Amarante T, Czarnecki J, Shooter S, Zou X, Glodzik D, Morganella S, Nanda AS, Badja C, Koh G, Momen SE, Georgakopoulos-Soares I, Dias JML, Young J, Memari Y, Davies H, Nik-Zainal S

Nat Cancer, published: February 17 2020. DOI:10.1038/s43018-020-0027-5

We highlight how the vast number of mutation patterns that we call mutational signatures in human cancers demonstrate some inter-tissue variation, and we present a practical framework for how to use mutational signatures to stratify patient cancers more accurately. We also advance one of our clinical algorithms called HRDetect which helps to identify tumors with HR-deficiency more accurately across all tumour types.

Genomic evidence supports a clonal diaspora model for metastases of esophageal adenocarcinoma

Noorani A, Li X, Goddard M, Crawte J, Alexandrov LB, Secrier M, Eldridge MD, Bower L, Weaver J, Lao-Sirieix P, Martincorena I, Debiram-Beecham I, Gerhan N, MacRae S, Malhotra S, Miremadi A, Thomas T, Galbraith S, Petersen L, Preston SD, Gilligan D, Hindmarsh A, Hardwick RH, Stratton MR, Wedge DC and Fitzgerald RC.

Nature Genetics (2020), published January 6 2020. DOI: 10.1038/s41588-019-0551-3

This paper studies the pattern and timing of metastatic spread in esophageal adenocarcinoma (EAC) because of the the poor outcomes. 388 samples from across 18 individuals with EAC were analysed using whole-genome sequencing and phylogenetic analysis and showed that in 90% of patients multiple subclones from the primary tumor spread very rapidly from the primary site to form multiple metastases. These include lymph nodes and distant tissues- a mode of dissemination also called 'clonal diaspora'. Metastatic subclones at autopsy were present in tissue and blood samples from earlier time points. These findings will impact the understanding and clinical evaluation of EAC.

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Quantitative phase and polarization imaging through an optical fiber applied to detection of early esophageal tumorigenesis

Gordon GSD, Joseph J, Alcolea MP, Sawyer T, Williams C, Fitzpatrick CRM, Jones PH, di Pietro M, Fitzgerald RC, Wilkinson TD and Bohndiek SE.

Journal of Biomedical Optics 24(12), 126004 (2019), published December 16 2019. DOI: 10.1117/1.JBO.24.12.126004

Phase and polarisation of coherent light are highly perturbed by interaction with microstructural changes in premalignant tissue, holding promise for label-free detection of early tumours in endoscopically accessible tissues such as the gastrointestinal tract. Flexible optical multicore fiber (MCF) bundles used in conventional diagnostic endoscopy and endomicroscopy scramble phase and polarization, restricting clinicians instead to low-contrast amplitude-only imaging. We apply a transmission matrix characterisation approach to produce full-field en-face images of amplitude, quantitative phase, and resolved polarimetric properties through an MCF. We first demonstrate imaging and quantification of biologically relevant amounts of optical scattering and birefringence in tissue-mimicking phantoms. We present an entropy metric that enables imaging of phase heterogeneity, indicative of disordered tissue microstructure associated with early tumours. Finally, we demonstrate that the spatial distribution of phase and polarisation information enables label-free visualisation of early tumours in esophageal mouse tissues, which are not identifiable using conventional amplitude-only information.

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Targeting senescent cells in translational medicine

Paez-Ribes M, González-Gualda E, Doherty GJ, Muñoz‐Espín D

EMBO Molecular Medicine (2019), e10234, published November 19 2019. DOI: 10.15252/emmm.201810234

Organismal ageing is a complex process driving progressive impairment of functionality and regenerative potential of tissues. Cellular senescence is a state of stable cell cycle arrest occurring in response to damage and stress and is considered a hallmark of ageing. Senescent cells accumulate in multiple organs during ageing, contribute to tissue dysfunction and give rise to pathological manifestations. Senescence is therefore a defining feature of a variety of human age‐related disorders, including cancer, and targeted elimination of these cells has recently emerged as a promising therapeutic approach to ameliorate tissue damage and promote repair and regeneration. In addition, in vivo identification of senescent cells has significant potential for early diagnosis of multiple pathologies. Here, we review existing senolytics, small molecules and drug delivery tools used in preclinical therapeutic strategies involving cellular senescence, as well as probes to trace senescent cells. We also review the clinical research landscape in senescence and discuss how identifying and targeting cellular senescence might positively affect pathological and ageing processes.

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Mayo's impact on patent applications related to biotech, diagnostics, and personalized medicine?

Aboy M, Crespo C, Liddell K, Minssen T, Liddicoat J

Nature Biotechnology 37, 513–518, published May 3 2019. DOI: 10.1038/s41587-019-0111-5

Six years on this paper looks at the impact of the US Supreme Court decision in the Mayo v. Prometheus case on patent subject-matter eligibility and the prosecution of biotech-related patent applications before the US Patent and Trademark Office.

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A roadmap for the clinical implementation of optical-imaging biomarkers

Waterhouse DJ, Fitzpatrick CRM, Pogue BW, O'Connor JPB & Bohndiek SE

Nature Biomedical Engineering. Published April 29, 2019. doi: 10.1038/s41551-019-0392-5

We have worked with the author of the original roadmap for cancer imaging biomarkers, Prof. James O’Connor, and leading biophotonics expert Prof. Brian Pogue to develop a dedicated roadmap for clinical implementation tailored specifically to optical-imaging biomarkers. The perspective draws on two case studies: the endoscopic visualisation of dysplasia in Barrett’s oesophagus in secondary care and the detection of malignant melanoma in primary care. These are used to identify key characteristics that are important for successful clinical implementation and highlight key decision points in the pathway.

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A clinically translatable hyperspectral endoscopy (HySE) system for imaging the gastrointestinal tract

J Yoon, Joseph J, Waterhouse DJ, Luthman AS, Gordon GSD, di Pietro M, Januszewicz W, Fitzgerald RC & Bohndiek SE

Nature Communications. Published April 23, 2019. doi: 10.1038/s41467-019-09484-4

Hyperspectral imaging (HSI) enables visualisation of morphological and biochemical information, which could improve disease diagnostic accuracy. Unfortunately, the wide range of image distortions that arise during flexible endoscopy in the clinic have made integration of HSI challenging. To address this challenge, we demonstrate a hyperspectral endoscope (HySE) that simultaneously records intrinsically co-registered hyperspectral and standard-of-care white light images, which allows image distortions to be compensated computationally and an accurate hyperspectral data cube to be reconstructed as the endoscope moves in the lumen. Evaluation of HySE performance shows excellent spatial, spectral and temporal resolution and high colour fidelity. Application of HySE enables: quantification of blood oxygenation levels in tissue mimicking phantoms; differentiation of spectral profiles from normal and pathological ex vivo human tissues; and recording of hyperspectral data under freehand motion within an intact ex vivo pig oesophagus model. HySE therefore shows potential for enabling HSI in clinical endoscopy.

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Incidence of second and higher order smoking-related primary cancers following lung cancer: a population-based cohort study

Barclay ME, Lyratzopoulos G, Walter FM, Jefferies S, Peake MD & Rintoul RC

BMJ journal Thorax. Published February 18, 2019. doi: 10.1136/thoraxjnl-2018-212456

Collaborative research by statistician Matt Barclay (Public Health and Primary Care) with Georgios Lyratzopoulos, Fiona Walter (Public Health and Primary Care), Sarah Jefferies (CUH, Oncology), Michael Peake (University of Leicester) and Robert Rintoul (Oncology) strongly suggests that lung cancer follow-up should be extended from five to ten years.

Five-year survival of patients with lung cancer has doubled in England during the past 15 years as lung cancer treatment has become more effective. This new study, published in the BMJ journal Thorax, finds that amongst lung cancer survivors, particularly women, there is a higher risk of getting a second smoking-related cancer for at least a decade from the time of the first primary lung cancer diagnosis. The population-based cohort study shows that those aged 50–79 at first diagnosis are at particularly high risk.

The new evidence strongly suggests the need for extended lung cancer follow-up and surveillance for other smoking-related cancers including head and neck, laryngeal and oesophageal squamous cell carcinoma, will need careful evaluation.

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