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New AI tools set to advance early cancer detection and prevention

Written by Louise Stanley on . Posted in Cancer outcomes, Early diagnosis and detection, Health inequalities.

Birmingham researchers are to play a role in Cancer Research UK’s recently announced £10 million AI detection programme, jointly supported by the National Institute for Health and Care Research (NIHR) and the Engineering and Physical Sciences Research Council (EPSRC) and involving 18 institutions including BHP founder-member the University of Birmingham.

Over the next five years, the Cancer Data-Driven Detection programme will harness vast quantities of data, link datasets and develop new tools to predict cancer risk – ultimately increasing the number of people diagnosed with cancer at its earliest stages.

The programme aims to access and link data from different sources – including health records, genomics, family history, demographics, and behavioural data – to develop advanced statistical models that help scientists accurately predict who is most likely to get cancer. Alongside this, the programme will develop powerful new tools which use AI to analyse the data and calculate an individual’s risk of cancer throughout their lifetime.

Researchers from University of Birmingham will take on specific roles in the programme, alongside approximately 40 others working together collaboratively. Professor Sudha Sundar, gynaecological cancer surgeon and a clinical academic in the University’s Department of Cancer and Genomic Sciences, is advising as a clinical practitioner in the multi-cancer risk prediction area of the work. Dr Ameeta Retzer from the Centre for Evidence and Implementation Science will lead on the cross-cutting Equity, Diversity and Inclusion theme, drawing on her expertise in health inequalities and research equity.

Dr Ameeta Retzer said: “Across the whole programme we will work to embed equality, diversity and inclusion since we know that cancer doesn’t affect everyone equally. It is vital that we ensure our research will benefit everyone, across all communities, equitably and that’s why I look forward to ensuring this strand of work has prominence in all areas of the programme.”

Over the next five years, the funding will build the infrastructure required to access and link these datasets, train new data scientists, create the algorithms behind the risk models and evaluate the algorithms and AI tools to ensure that they are giving accurate and clinically useful information about cancer risk.

The models generated from this research could be used to help people at higher risk of cancer in different ways. For example, the NHS could offer more frequent cancer screening sessions or screening at a younger age to those at higher risk, whilst those at lower risk could be spared unnecessary tests. People identified as higher risk could also be sent for cancer testing faster when they go to their GP with possible cancer signs or symptoms. Individuals at higher risk could also access different ways to prevent cancer.

Professor Sudha Sundar, whose clinical practice is based at BHP member Sandwell and West Birmingham NHS Trust, commented: “With cancer cases on the rise, it is essential that we work to identify and diagnose cancers earlier so that patients can begin treatments soon, which in most cancers vastly improves their quality of life and chances of survival. Screening is one way of identifying cancer sooners. Multi-cancer earlier detection tests represent an exciting progression in the scope of cancer screening programmes and this is part of the Cancer Data-Driven Detection programme that is exciting to explore further.”

The scientific programme will be guided by partnerships with cancer patients, the public, clinical experts and industry, while addressing ethical and legal considerations to ensure that the models and tools work well in practice.

Professor Antonis Antoniou, Director of the Cancer Data Driven Detection programme and Professor of Cancer Risk Prediction at the University of Cambridge, said: “Finding people at the highest risk of developing cancer, including those with vague symptoms, is a major challenge. The UK’s strengths in population-scale data resources, combined with advanced analytical tools like AI, offer tremendous opportunities to link disparate datasets and uncover clues that could lead to earlier detection, diagnosis, and prevention of more cancers.

“The Cancer Data Driven Detection programme will build the partnerships and infrastructure needed to make data-driven cancer early detection, diagnosis and prevention a routine part of frontline healthcare. Ultimately, it could inform public health policy and empower individuals and their healthcare providers to make shared decisions. By understanding individual cancer risks, people can take proactive steps to stop cancer before it gets worse or even begins in the first place.”

Earlier diagnosis of cancer saves lives. Yet according to analysis of NHS figures by Cancer Research UK, only 54.4% of cancers in England are diagnosed at stages one and two, where treatment is more likely to be successful. NHS England has set a target to diagnose 75% of cancers at stages one and two by 2028, and this will only be achieved with research and embracing new technologies to catch cancer earlier.

Professor Lucy Chappell, Chief Scientific Adviser at the Department of Health and Social Care (DHSC) and Chief Executive Officer of the NIHR, commented: “Detecting and diagnosing cancer earlier is key to improved survival and quality of life for patients. By leveraging AI to enable healthcare professionals to identify people at a greater risk of cancer, this initiative could improve the way patients are screened and diagnosed. This programme’s AI-driven insights could lead to more effective treatment and improved survival, helping patients to live longer, healthier lives.”

The Cancer Data Driven Detection programme is jointly supported by Cancer Research UK, the National Institute for Health & Care Research, the Engineering & Physical Sciences Research Council, Health Data Research UK, and Administrative Data Research UK.

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Researchers at the Royal Orthopaedic Hospital secure funding to develop cancer-killing injectable paste for bone tumours

Written by Louise Stanley on . Posted in Cancer outcomes, Experimental medicine.

The Dubrowsky Lab at BHP member the Royal Orthopaedic Hospital (ROH) has secured a £110k grant from Orthopaedic Research UK to develop an injectable paste with anticancer and bone regenerative properties.

The project will see researchers at ROH work with BHP members Aston University to produce an injectable paste comprised of gallium-doped bioglass that, if proved effective, could be used to treat patients with primary and metastatic bone cancer.

Dr Lucas Souza, Research Lab Manager at the Dubrowsky Lab and Lead Researcher for this new project, comments: “Advances in treatment of bone cancer have reached a plateau over the past 40 years, in part due to a lack of research studies into treatments and the complexity and challenges that come with treating bone tumours. Innovative and effective therapeutic approaches are needed and this grant from Orthopaedic Research UK provides vital funds for us to continue our research into the use of gallium-doped bioglass in the treatment of bone cancer.”

Gallium is a metallic element that has cancer-killing properties. When combined with bioactive glass the material can kill cancer cells that remain when a tumour is removed and accelerate the regeneration of the bone defect. In addition, the material also prevents bacterial contamination in the surgical site. A recent study led by Aston University in collaboration with the ROH found that bioactive glasses doped with the metal have a 99 percent success rate of eliminating cancerous cells.

The injectable paste is to function as a drug delivery system for localised delivery of anticancer gallium ions (GaBG) and bisphosphonates whilst regenerating bone. The team hypothesise that the GaBG and bisphosphonates will promote rapid bone formation and will prevent cancer re-occurrence by killing residual cancer cells and regulating local osteoclastic activity.

The new therapeutic approach will be particularly useful in reducing cancer re-occurrence, implant site infections and implant failure rates in cases of bone tumours where large resections for complete tumour removal is either not possible, e.g. when tumours are located too close to vital organs, or not recommended, e.g. in the treatment of bone metastases and aggressive benign bone tumours (such as Giant-cell tumour of bone) when the harm inflicted by a large surgical procedure may be greater than its benefits. It could also be used in combination with minimally invasive intralesional therapies such as cryoablation or radiofrequency ablation for optimal management of metastatic bone lesions.

Dr Lucas Souza adds: “The proposed biomaterial has the potential to drastically improve treatment outcomes of bone tumour patients by reducing cancer re-occurrence, implant-site infection rates, and implant failure rates leading to reduced time in hospital beds, less use of antibiotics, and fewer revision surgeries. Taken together, these benefits could improve survival rates, functionality and quality of life of bone cancer patients.”

Dr Lucas Souza will be supported by Professor Adrian Gardner, Director of Research and Development at the Royal Orthopaedic Hospital and Professor of Clinical Orthopaedics at Aston University, as well as Mr Jonathan Stevenson, Orthopaedic Oncology and Arthroplasty Consultant. The project is also supported by collaborators Professor Richard Martin and Dr Eirini Theodosiou from Aston University and Professor Joao Lopes from the Brazilian Aeronautics Institute of Technology.

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Most accurate ultrasound test could detect 96% of ovarian cancers

Written by Louise Stanley on . Posted in Cancer outcomes, Early diagnosis and detection.

An ultrasound test that detected 96% of ovarian cancers in postmenopausal women should replace the current standard of care test in the UK, according to a new study by BHP members.

In a paper published in Lancet Oncology, researchers funded by the NIHR and led by Professor Sudha Sundar conducted a head-to-head comparison of all currently-available tests to diagnose ovarian cancer in postmenopausal women, in a high-quality diagnostic test accuracy study.

Of the six diagnostic tests investigated, the IOTA ADNEX model which looks at ultrasound features (how the lump looks on ultrasound) had the best accuracy of all and could detect up to 96% of ovarian cancers.

The ultrasound test outperforms the current standard of care in the UK significantly and so researchers recommend that the IOTA ultrasound ADNEX model should replace the current standard of care test in the UK which identifies 83% of ovarian cancers.

Sudha Sundar, Professor of Gynaecological Cancer at the University of Birmingham and consultant in gynaecological cancer surgery at Sandwell and West Birmingham NHS Trust – both BHP members – said: “This is the first time that a head-to-head study of all available ovarian cancer tests has been done in the same population. Here we studied their use with symptomatic, post-menopausal women who are most at risk of this cancer. Our trial found that the IOTA ADNEX ultrasound protocol had highest sensitivity for detecting ovarian cancer compared to the standard of care and other tests.

“The ultrasound test also performs well when delivered by a trained sonographer who has received specific training, certification and quality assurance, and as the vast majority of ultrasound scans are performed by sonographers it is important that a new standard is able to be delivered by as many clinical professionals as possible.

“We found that the higher sensitivity of the IOTA ADNEX model is likely to lead to some women who don’t have cancer also being flagged up as having a higher risk of cancer. We however did discuss this extensively with patients, cancer charity Target ovarian cancer and NHS experts who all agreed that in postmenopausal women who are at higher risk of ovarian cancer, picking up more women with cancer would benefit women overall.”

Annwen Jones OBE, Chief Executive at Target Ovarian Cancer said: “Early diagnosis of ovarian cancer is vital, and we are pleased to see this research demonstrate that there are more accurate ways of using ultrasound. The faster and earlier ovarian cancer is diagnosed, the easier it is to treat and the more successful the outcomes. Alongside this innovative research, we need to see greater awareness of the symptoms of ovarian cancer so that women know to come forward to their GP for testing and receive the best possible treatment as quickly as possible. It is crucial that new ways of working like this are rolled out as quickly as possible.”

The research team note that the IOTA ADNEX model achieved 96% accuracy when delivered by NHS sonographers who were appropriately trained and received quality assurance. As most scans worldwide are carried out by sonographers rather than gynaecologists, introductory free online resources have been created by the researchers for NHS staff to undergo the specialist ultrasound training to obtain certification and quality assurance.

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Birmingham opens Europe’s first pancreatic cancer mRNA vaccine trial

Written by Louise Stanley on . Posted in Cancer outcomes, Clinical trials, Experimental medicine.

Researchers at BHP founding-members University Hospitals Birmingham NHS Foundation Trust (UHB) and the University of Birmingham have opened a trial to study how messenger RNA (mRNA) cancer vaccines may be used to prevent recurrence of pancreatic cancer. The Queen Elizabeth Hospital Birmingham (QEHB) is the first hospital in Europe to recruit into such a trial.

Pancreatic cancer is among the deadliest cancers globally, with a survival rate beyond 10 years of just 5% in England (2013-2017). It is often only when the cancer has reached an advanced stage that physical symptoms appear, at which point it becomes more difficult to treat.

The trial aims to recruit patients undergoing surgery to remove pancreatic ductal adenocarcinoma (PDAC), an extremely aggressive disease that accounts for 90% of all pancreatic cancers.

Patients enrolled in the study will either receive an investigational cancer vaccine combined with chemotherapy (treatment group) or standard chemotherapy alone (control group).

In this investigational therapeutic cancer vaccine, mRNA is used to deliver the instructions for building several proteins (neoantigens) found in a person’s cancer. In doing so, the trial vaccine aims to train the immune system to recognise and attack the set of proteins (usually found on microscopic cancer cells) when it encounters it again.

Following surgery, samples of the patients’ tumour tissue and blood are sent to laboratories, to design and manufacture the investigational cancer vaccine. For the patients eligible for the trial, a mRNA-based cancer treatment is manufactured with mRNA specific to the proteins in that individual’s tumour.

This novel treatment approach is aimed at training the immune system to recognise and attack cancer cells, to potentially prevent cancer recurrence and increase the prospect of a patient being cured.

Dr Shivan Sivakumar, Principal Investigator of the trial, Associate Professor in Oncology at the University of Birmingham and Consultant Medical Oncologist at QEHB said: “We are incredibly proud that the Queen Elizabeth Hospital Birmingham is the first site in Europe to enrol a patient to this investigational pancreatic cancer vaccine trial. This achievement highlights Birmingham’s leading role in advancing cancer treatment, offering new hope for patients battling one of the most challenging cancers we face today.

“We recently also became the first site in Europe to open an immunotherapy study in cholangiocarcinoma (bile duct cancer), another deadly cancer. Birmingham is positioning itself to be a leading centre in Europe to test novel treatments for these hard-to-treat cancers and I find it humbling that patients in the Midlands have been able to enrol onto this trial, before anyone else in Europe.”

Professor Kiran Patel, Chief Medical Officer at UHB, which operates QEHB, added: “We are very fortunate to have exceptional infrastructure and world-class talent that positions us perfectly to lead in vital areas of cancer research.

“This trial showcases the expertise and dedication of our medical professionals, and the fantastic teams supporting them, who are at the leading edge of clinical research here in Birmingham.

“To be the first site to open in Europe, reaffirms our role as a national and international centre for cutting-edge oncology and highlights our commitment to improving patient outcomes through pioneering approaches.”

Jo Gray, Head of Research and Development Operations at UHB, said: “Through the National Institute for Health and Care Research (NIHR) Wellcome Trust Clinical Research Facility (CRF), we are able to provide expert care to patients receiving experimental therapies. Birmingham is the first site outside of North America to open and to enrol a patient onto this complex, early phase trial, that addresses an important need to identify better post-surgery treatments for pancreatic cancer.”

Professor Neil Hanley, Head of the College of Medical and Dental Sciences at the University of Birmingham, said: “This work epitomises why the University of Birmingham and its tremendous partnership with UHB is delivering life-changing impacts.

“Whilst such approaches were being investigated before 2020, we now know the power of mRNA vaccines from the COVID-19 pandemic; to tilt those discoveries from a time of tremendous challenge towards a much-needed world of new cancer treatments is inspiring for all of us.

“Birmingham is the ideal place to open this trial, with one of the leading pancreatic cancer units in the UK and serving a super diverse population. The chemistry between the university and hospitals is clear. By working as one team under the banner of Birmingham Health Partners, we are delivering the kind of cutting-edge research leading to transformational clinical care that befits Birmingham as an innovative city at the forefront of health and life sciences.”

Dr Chris Macdonald, Head of Research at Pancreatic Cancer UK, said: “For too long we have had so few treatment options for people with pancreatic cancer. Surgery is currently the only potential cure and yet, tragically, in 75% of cases the cancer reoccurs within a year. Finally, there is hope on the horizon.

“We are absolutely delighted that Queen Elizabeth Hospital Birmingham is the first site in Europe to enrol a patient to an individualised pancreatic cancer vaccine trial. We will be following the results with great interest, as the potential here cannot be understated. If this research proves successful, the vaccine could be a vital new weapon against the deadliest common cancer.”

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‘Symptom triggered’ test can detect early-stage aggressive ovarian cancer in 1 in 4 cases

Written by Louise Stanley on . Posted in Cancer outcomes, Early diagnosis and detection.

Symptom triggered testing, prompted by symptoms such as pain, abdominal bloating/swelling, and feeling full soon after starting to eat, can pick up early-stage aggressive ovarian cancer in 1 in 4 of those affected, according to new research.

A study published in the International Journal of Gynaecological Cancer and funded by the National Institute for Health and Care Research found that the UK’s protocol for picking up early-stage disease in women with high grade serous ovarian cancer—the most common, aggressive, and lethal form of the disease— is an effective way to diagnose even early-stage ovarian cancer.

The findings also show that complete surgical removal of the cancerous tissue is possible even in more advanced disease, providing that women with suspicious symptoms are expedited for investigation and treatment, they add.

A team of researchers led by BHP founding member the University of Birmingham analysed data for 1741 women taking part in the Refining Ovarian Cancer Test accuracy Scores (ROCkeTS) study, which involves 24 UK hospitals. The women had all been fast tracked for treatment under the symptom-triggered testing rapid access pathway.

Sudha Sundar, Professor of Gynaecological Cancer at the University of Birmingham and the Pan Birmingham Gynaecological Cancer Centre at BHP member Sandwell and West Birmingham Hospital NHS Trust said:

“Our figures demonstrate that in a real-world setting, symptom-based testing can potentially lead to diagnosis of high grade serous ovarian cancer with low disease spread and results in a high proportion of complete surgical removal of the cancer.”

“These findings challenge the assumption that the disease should always be considered to be in its advanced stages in women once they develop symptoms.

“More importantly, our findings emphasise the importance of increasing an awareness of ovarian cancer symptoms to facilitate earlier diagnosis via referral through the fast-track pathway to improve patient outcomes.”

Key findings

  • Among participants in the study, 119 (7%) were diagnosed with high grade serous ovarian cancer with an average age of 63, and 90% had gone through the menopause.
  • In most of these women (112; 94%) cancer didn’t hugely interfere with their daily lives, as they were classified with a performance status of 0 or 1, meaning they either were fully active, or were able to do everything but strenuous activities.
  • One in four (30; 25%) had early stage I or II disease.
  • Visible cancerous tissue was completely removed in 73 (61%) and almost completely removed in 18 (15%). The disease was only deemed to be inoperable in 9 (8%).
  • The extent of cancer was low in 43 of the 119 (36%), meaning that it was localised in the pelvis; moderate in 34 (29%), meaning that it had spread to the lower abdomen; and high in 32 (27%), meaning that it had spread up to any of the liver, pancreas, diaphragm or spleen. Information on disease extent wasn’t available for 10 (8.5%) women.
  • Surgery to remove as much of the tumour as possible, which is associated with longer survival, was carried out in more than three in four women (93 ,78%), with almost two thirds receiving surgery ahead of chemotherapy (78, 65%,). 36 (30%) were given chemotherapy to shrink the tumour ahead of surgery; 5 (4%) women didn’t have surgery, information on this was not available for 17 (14%) women.

The UK adopted symptom-triggered testing for ovarian cancer in 2011. Women, especially those over 50 years with these symptoms are tested for levels of the tell-tale protein CA125 in their blood and given an ultrasound scan. Abnormal results prompt a fast-track referral for hospital review by a gynaecologist within 2 weeks.

Ovarian cancer is the seventh most common cancer amongst women worldwide, and the sixth most common cause of cancer death in the UK. While most (93%) women diagnosed with early-stage disease (I or II) survive for more than 5 years, only 13% of those diagnosed with advanced disease (stages III or IV) do so.

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Researchers at the Royal Orthopaedic Hospital and Aston University explore novel bone cancer therapy

Written by Louise Stanley on . Posted in Cancer outcomes, Experimental medicine.

Lucas Souza, Research Laboratory Manager for the Dubrowsky Regenerative Medicine Laboratory at the Royal Orthopaedic Hospital (pictured), is partnered with Professor Richard Martin, director of the Advanced Materials Research Centre at Aston University to explore a new way to treat bone cancer.

As bone cancer researchers, we are seeking to tackle the problem of bone tumours across all fronts. We are currently exploring how the metal element gallium could be used to support the treatment of bone tumours due to its cancer-killing properties.

Bone tumours can be either primary (originated in the bone tissue) or secondary (originated in another tissue and metastasise to bone tissue). We have already proved in a previous study that primary bone cancer cells are four times more sensitive to gallium than normal cells. In that study we wanted to understand if doping bioactive glasses, used in orthopaedic and dental surgeries for its bone forming properties, with gallium would support positive outcomes for bone cancer patients. We were able to show that the use of gallium embedded in bioactive glasses is an excellent strategy to support bone repair whilst selectively killing bone cancer cells which can potentially culminate with better treatment outcomes and reduced cancer recurrence rates.

The next phase of this study is exploring the use of gallium against bone metastases – cancer that originated in another tissue before spreading to bone. The ultimate goal is to prove whether cells from bone metastases also have greater sensitivity to gallium so it could be used as an adjuvant medicine to control metastatic growth in the treatment of other types of cancer that usually metastasise to bone, such as breast, lung, and prostate cancer.

If successful, we will combine the gallium-doped bioactive glass powder with biodegradable polymers to make a minimally invasive injective gel that surgeons can use to treat both primary and secondary bone tumours. This gel will have the potential to reduce cancer recurrence and implant failure rates, leading to reduced time in hospital beds, reduced use of antibiotics, fewer revision surgeries, and increased survival rates.

It is also hoped that this innovation could be used to improve outcomes for patients with vertebral metastases and other types of primary bone tumours where surgery and radiation is less effective due to their proximity to the spinal cord.

The safety and effectiveness of these biomaterials will need to be tested further, but the initial results are really promising. Treatments for a bone cancer diagnosis remain very limited and there’s still much we don’t understand. Research like this is vital to support in the development of new drugs and new methodologies for treatment options.

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