In what are seen as giant steps in cancer treatment, experts have hailed an inexpensive blood test which could help diagnose even inaccessible brain tumours earlier, while a potentially “ground-breaking” vaccine to treat early bowel cancer will shortly be trialled in England and Australia.
Brain tumours, which affect hundreds of thousands of people worldwide each year, are notoriously difficult to diagnose, but now a British research team has designed a simple, inexpensive blood test that could help diagnose patients with even the deadliest forms of brain cancer, much faster, potentially sparing them from invasive and high-risk surgical biopsies.
The breakthrough was reported in the International Journal of Cancer.
Experts told The Guardian the liquid biopsy could also lead to earlier diagnosis, and speed up treatment and potentially increase survival rates. The test would be particularly beneficial for those with “inaccessible” brain tumours, who could benefit from starting treatment as soon as possible.
Researchers at the Brain Tumour Research Centre of Excellence (BTRCE), run by Imperial College London and Imperial College Healthcare NHS Trust, found the test could accurately diagnose a range of brain tumours, including glioblastoma (GBM), the most commonly diagnosed type of high-grade brain tumour in adults, astrocytomas and oligodendrogliomas.
The test had “high analytical sensitivity, specificity and precision”, the team reported.
Scientists are already planning further studies to validate the results, and if successful, patients could benefit from the new test in as soon as two years.
The TriNetra-Glio blood test, developed with funding from Datar Cancer Genetics, works by isolating glial cells that have broken free from the tumour and are found circulating in the blood. The isolated cells are then stained and can be identified under a microscope.
Dr Nelofer Syed, who leads the BTRCE, said: “A non-invasive, inexpensive method for the early detection of brain tumours is critical for improvements in patient care. There is still some way to go, but this solution could help people where a brain biopsy or surgical re-section of the tumour is not possible, due to the location of the tumour or other constraints.
“Through this technology, a diagnosis of inaccessible tumours can become possible through a risk-free and patient-friendly blood test. We believe this would be a world-first as there are currently no non-invasive or non-radiological tests for these types of tumours.”
Kevin O’Neill, consultant neurosurgeon at Imperial College Healthcare NHS Trust and honorary clinical senior lecturer at Imperial College London, who leads the BTRCE with Syed, said: “This test is not just an indicator of disease, it is a truly diagnostic liquid biopsy.
“It detects intact circulating tumour cells from the blood, which can be analysed to the same cellular detail as an actual tissue sample. It’s a real breakthrough for treatment of brain cancers that rarely spread around the body.
“This could help speed up diagnosis, enabling surgeons to apply tailored treatments based on that biopsy to increase patients’ chances of survival.”
Dan Knowles, chief executive of the charity Brain Tumour Research, said the findings were significant as less than 1% of patients with GBM live for more than 10 years and, for many, the prognosis is as little as 12 months.
“We have to find a cure for this devastating disease. It is scandalous to think that there have been no improvements to treatment options in two decades and the standard of care for GBM patients – surgical resection followed by radiotherapy and chemotherapy – remains unchanged.”
Meanwhile, in a collaborative venture, a vaccine to treat early bowel cancer is to go on trial at the Royal Surrey NHS Foundation Trust in the UK and Queen Elizabeth Hospital in Adelaide.
The Independent reports that doctors plan to administer the vaccine to patients before surgery, in the expectation that it will cause the body to attack the cancer.
It would make any surgery less invasive, they say, and could support the immune system to respond if there is a relapse and the cancer returns later on.
Dr Tony Dhillon, chief investigator of the trial and Surrey’s consultant medical oncologist, proposed the idea for the trial and has worked with Professor Tim Price in Australia for four years to develop the shot.
“This is the first treatment vaccine in any gastrointestinal cancer and we have high hopes that it will be successful. We think that for many patients, the cancer will have gone completely after this treatment.”
The trial will be run by the Cancer Research UK Southampton Clinical Trials Unit at the University of Southampton in collaboration with Surrey and the Queen Elizabeth Hospital.
There will be 10 sites for patients to be enrolled – six in Australia and four in the UK, with 44 patients to be enrolled in the study over an 18-month period.
Patients will have an endoscopy, then a tissue sample will be tested to see if they are eligible for the trial. If they are, they will have three doses of the vaccine before having surgery to remove the cancer.
The trial will be available for just 44 patients around the world.
The vaccine has been designed by Imugene Ltd, a clinical stage immuno-oncology company.
Dhillon said: “I feel as if we are on the edge of something really big here. The vaccine makes the immune system go after the cancer… it means that potentially, patients may not need to have surgery – they may just have the vaccine.”
Bowel (colorectal) cancer is the third most common cancer, with a worldwide annual incidence of more than 1.2m cases and a mortality rate of 50%.
Study details
Profiling of circulating glial cells for accurate blood-based diagnosis of glial malignancies
Kevin O’Neill, Nelofer Syed, Rajan Datar, et al.
Published in International Journal of Cancer on 26 December 2023
Abstract
Here, we describe a blood test for the detection of glial malignancies (GLI-M) based on the identification of circulating glial cells (CGCs). The test is highly specific for GLI-M and can detect multiple grades (II–IV) and subtypes including gliomas, astrocytomas, oligodendrogliomas, oligoastrocytomas and glioblastomas, irrespective of gender and age. Analytical validation of the test was performed as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Real-world performance characteristics of the test were evaluated in four clinical (observational) studies. The test has high analytical sensitivity (95%), specificity (100%) and precision (coefficient of variation [CV] = 13.7% for repeatability and CV = 23.5% for within laboratory precision, both at the detection threshold) and is not prone to interference from common drugs and serum factors. The ability of the test to detect and differentiate GLI-M from non-malignant brain tumours (NBT), brain metastases from primary epithelial malignancies (EPI-M) and healthy individual donors (HD) was evaluated in four clinical cohorts. Across these clinical studies, the test showed 99.35% sensitivity (95% confidence interval [CI]: 96.44%–99.98%) and 100% specificity (95% CI: 99.37%–100%). The performance characteristics of this test support its clinical utility for diagnostic triaging of individuals presenting with intracranial space-occupying lesions (ICSOL).
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