Oncology

Reflector-guided localisation of non-palpable breast lesions: A prospective evaluation of the SAVI SCOUT system on 137 patients (2024)

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Type of publication:
Conference abstract

Author(s):
Taj S.; Han S.; *Lefroy R.; Hajiesmaeili H.; Alamgir C.F.; Rahman E.; Khosla M.; Bowen N.; Troman P.; Vidya R.; Verma R.; Mylvaganam S.; Clarke D.; Ingle H.; Sircar T.

Citation:
European Journal of Surgical Oncology. Conference: The Association of Breast Surgery Conference 2024. Bournemouth International Centre, Bournemouth United Kingdom. 50(Supplement 1) (no pagination), 2024. Article Number: 108190. Date of Publication: May 2024.

Abstract:
Introduction: Traditionally, wire-guided localisation has been the gold-standard for localising non-palpable breast lesions. However, this method has some limitations, including patient discomfort, wire migration and scheduling radiology appointments on the day of surgery, causing delay in start of theatre list. Various wire-less alternatives have been developed. Therefore, the aim of this study was to evaluate the safety and effectiveness of the SAVI SCOUT localisation technique. Method(s): This was a prospective study of 137 consecutive patients with SAVI SCOUT reflector, deployed between December 2020 and November 2023. We studied the rate of successful localisation and retrieval of SCOUT, imaging modality used for localisation, re-excision rate, pathology, median weight of specimen and SCOUT-related complications. Result(s): A total of 137 SAVI SCOUT reflectors were deployed in 137 consecutive patients undergoing breast conserving surgery for non-palpable lesions which included malignancy 97% (n=133), high risk lesions 2.18% (n=3) and benign lesion in 0.72% (n=1). The rate of radiological localisation and retrieval of the reflector at surgery was 97.8% (n=134) and 100% (n=137) respectively. The most common modality for localisation was ultrasound 97% (n=133). The median specimen weight was 21.5gm. The mean duration between deployment day and surgery was 2 days (range 0-30). The re-excision rate was 8% (n=11). There was no specific technique-related surgical complication. Conclusion(s): Our study demonstrates that the SAVI SCOUT localisation system is a safe, effective, and reliable localization modality for non-palpable breast lesions with low re-excision rate.

Frequency of CLAR and JAK2 mutations in Sudanese chronic myeloid leukemia patients with Philadelphia-positive disease (2024)

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Type of publication:
Journal article

Author(s):
Yasin E.B.; *Yasin A.

Citation:
Asian Journal of Pharmaceutical and Clinical Research. 16(8) (pp 133-137), 2023. Date of Publication: August 2023.

Abstract:
Objective: It is well-established that myeloproliferative diseases coexist with CLAR and JAK2. In Ph+ chronic myeloid leukemia (CML), only a few case reports indicate the existence of CLAR, JAK2V617F, and JAK2 exon 12 mutations. Method(s): This study examined CALR and JAK2 mutation profiles in Sudanese Chronic Myeloid Leukemia patients with Philadelphia-positive patients. Blood samples were collected from 100 patients with Ph+ CML chromosomes. Results for the JAK2V617F mutation were confirmed using the TaqMan Mutation Detection Assay, and the four common mutations on exon 12 and CLAR mutations were confirmed using allele-specific PCR (AS-PCR) and Sanger sequencing. Result(s): CML patients with CALR frameshift mutations were detected in two patients (2%), patients with JAK2 exon 12 mutations were found in two patients (2%), and patients with JAK2V617F mutations made up 4 (4%) of the total CML patients. No significant relationships existed between mutations and age, WBC, RBC, Hb, HCT, or platelet parameters. Patients with CLAR, JAK2 exon 12, and JAK2V617F mutations have normal leukocyte counts and lower values compared to triple-negative Ph+ CML, but these differences are not statistically significant (p values for each 0.084, 0.173, and 0.072). Conclusion(s): It is conceivable for Ph+ CML and all mutations to coexist.

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Social Isolation and Lung Cancer: Does This Impact the Length of Time on The Lung Cancer Pathway Or Uptake Of MDT Recommended Treatments (2024)

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Type of publication:
Conference abstract

Author(s):
Anderson V.; Dalrymple P.; Crowley G.; Shephard P.; Holmes C.; *McAdams J.; Morley J.; Sarah E.; Ivey S.; Bentley K.; Bate G.B.; English P.; Russell G.; Bostock L.

Citation:
Lung Cancer. Conference: 22nd Annual British Thoracic Oncology Group Conference 2024. Belfast United Kingdom. 190(Supplement 1) (no pagination), 2024. Article Number: 107683. Date of Publication: April 2024.

Abstract:
Aims "Bridging The Gap" report by UKLCC (2022) suggested addressing health inequalities in lung cancer has a significant impact on patient outcomes. LCNUK investigated a possible correlation between social isolation (lack of social contacts and having few people to interact with regularly) and time on pathway. Methods A Literature review conducted, highlighted a lack of UK research in this area. LCNUK members were surveyed for feedback and data was collected on 90 patients across 9 regions in the UK. Results 56 completed surveys were received from LCNUK members. 50% of responders felt that social isolation impacted patient progress on the pathway & 41% believed it influenced uptake of treatment. [Formula presented] Conclusion 50% of lung cancer nurses felt social isolation would negatively impact upon the length of the pathway, this project found that to be unproven. Data suggested a possible link between social isolation and uptake of MDT recommended treatment. This is a small sample size and may not be representative of the national picture and therefore more research is needed. Disclosure: No significant relationships.

The magnetic effect: sustainability of patient centric outcomes, time and cost saving following 5 years of Magseed experience (2024)

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Type of publication:
Conference abstract

Author(s):
*Lake B.; *Wilson M.; *Deane L.; *Cielecki L.; *Thomas G.; *Usman T.

Citation:
European Journal of Surgical Oncology. Conference: ESSO 42 2023. Florence Italy. 50(2) (no pagination), 2024. Article Number: 107333. Date of Publication: February 2024.

Abstract:
Background: Magseed has transformed the conventional guided procedures for impalpable breast cancer. In an initial service evaluation, we described "the triple effect of Magseed": reducing re-excision rates, reducing costs, and providing high patient satisfaction, with our cost saving analysis described in NICE guidance MIB236. Our change of practice service evaluation demonstrated that Magseed localisation for breast cancer promotes a patient-centric approach by reducing need for further surgery and ensuring high patient satisfaction. Other advantages are improved patient flow, as placement can occur prior to surgery, and cost saving in theatre and radiology. The aim of this study was to see if this described triple effect is sustainable in terms of patient outcomes and cost saving after 500 Magseeds and following 5 years of experience. Material(s) and Method(s): A 5-year service evaluation was conducted at Shrewsbury and Telford Hospital of all patients who had image-guided wide local excision for impalpable breast cancer from July 2017 to June 2022. Outcomes recorded included re-excision rate, theatre cost-saving analysis, radiology time and patient satisfaction. Result(s): 907 cases were performed, 501 Magseed guided procedures, and 406 coventional guided procedures. Significantly lower re-excision rates were maintained post-Magseed compared to pre-Magseed of 12.9% v 22.4% (chi2=11.1377 P<0.000846). Cost was saved in terms of surgery and radiology time. 94,321 was saved per year, with 58.6% fewer further operations, with an overall saving of 471,605. Significantly less radiology time with Magseed insertion average of 36 minutes, compared to wire insertion of 52 min (t-value =-2.24215, p-value<0.01854.) High patient satisfaction was maintained with the Magseed service described as "completely comfortable" and "quick and straightforward". Conclusion(s): Magseed continues to be the technique of choice for the detection of impalpable breast cancer, and its benefits of reducing re-excision rates, cost saving in surgery and radiology and high patient satisfaction are sustainable: the magnetic effect.

The additive effect of Magtrace: improved theatre efficiency, operative capacity and patient experience (2024)

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Type of publication:
Conference abstract

Author(s):
Lake B.; Wilson M.; Appleton D.

Citation:
European Journal of Surgical Oncology. Conference: ESSO 42 2023. Florence Italy. 50(2) (no pagination), 2024. Article Number: 107518. Date of Publication: February 2024.

Abstract:
Background: Magtrace is a non-radioactive magnetic tracer designed specifically for Sentinel Lymph Node biopsy, with multiple benefits including a flexible injection window up to 30 days prior to surgery, no requirement for nuclear medicine and has been statistically proven non-inferior to Technetium and Blue Dye, the current gold standard. The "conventional" patient pathway at the Shrewsbury and Telford Hospital involved the patient travelling to the Nuclear Medicine Department at the Royal Shrewsbury Hospital the day before or morning of surgery for Technetium injection. Surgery takes place at Princess Royal Hospital, necessitating two journeys for the patient. NICE Guidance GID-MT568 recommends Magtrace as an option to locate sentinel lymph nodes for breast cancer in hospitals with limited or no access to radio-pharmacy and thus eliminates patient travel and nuclear medicine resources. Magtrace can be injected either in outpatients or on the day of surgery. Magtrace also has the potential to reduce cost as described by NICE MTG72, with an expectation that its usage would lead to an additional sentinel node biopsy per week due to improved theatre utilisation. The aim of this study was to evaluate the use of Magtrace and its impact on theatre efficiency and patient experience. Material(s) and Method(s): A 4-month trial of Magtrace for sentinel node biopsy was conducted at the Shrewsbury & Telford NHS Trust from November 2022 to March 2023. Outcomes recorded were theatre utilisation, numbers of sentinel node biopsies performed per week and patient satisfaction. Result(s): 62 patients had Magtrace as the technique for SLNB combined either wide local excision or mastectomy during the trial period. Theatre utilisation improved from 77% to 85%, due to reduction in theatre delays due to waiting for patients to have radioisotope and improved theatre flow. Significantly more sentinel node biopsies were performed per week, increasing from 6.48 per week (Pre Magtrace 2022) to 8.52 per week (Post Magtrace November 22 to March 23) (t-value = -3.03541 p-value <0.00208), with a resultant net increase of 2 patients per week. High patient satisfaction was found with 100% finding injection more convenient on day of surgery and 100% would recommend technique if needed to friend or relative. Conclusion(s): Magtrace for sentinel node biopsy gives an "additive effect" by improving theatre utilisation, increasing the number of sentinel node biopsies per week and improving patient experience.

A hypoxia biomarker does not predict benefit from giving chemotherapy with radiotherapy in the BC2001 randomised controlled trial (2024)

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Type of publication:
Randomised controlled trial

Author(s):
Smith, Tim A D; West, Catharine M L; Joseph, Nuradh; Lane, Brian; Irlam-Jones, Joely; More, Elisabet; Mistry, Hitesh; Reeves, Kimberley J; Song, Yee Pei; Reardon, Mark; Hoskin, Peter J; Hussain, Syed A; *Denley, Helen; Hall, Emma; Porta, Nuria; Huddart, Robert A; James, Nick D; Choudhury, Ananya.

Citation:
EBioMedicine. 101:105032, 2024 Feb 21.

Abstract:
BACKGROUND: BC2001 showed combining chemotherapy (5-FU + mitomycin-C) with radiotherapy improves loco-regional disease-free survival in patients with muscle-invasive bladder cancer (MIBC). We previously showed a 24-gene hypoxia-associated signature predicted benefit from hypoxia-modifying radiosensitisation in BCON and hypothesised that only patients with low hypoxia scores (HSs) would benefit from chemotherapy in BC2001. BC2001 allowed conventional (64Gy/32 fractions) or hypofractionated (55Gy/20 fractions) radiotherapy. An exploratory analysis tested an additional hypothesis that hypofractionation reduces reoxygenation and would be detrimental for patients with hypoxic tumours. METHODS: RNA was extracted from pre-treatment biopsies (298 BC2001 patients), transcriptomic data generated (Affymetrix Clariom-S arrays), HSs calculated (median expression of 24-signature genes) and patients stratified as hypoxia-high or -low (cut-off: cohort median). PRIMARY ENDPOINT: invasive loco-regional control (ILRC); secondary overall survival. FINDINGS: Hypoxia affected overall survival (HR = 1.30; 95% CI 0.99-1.70; p = 0.062): more uncertainty for ILRC (HR = 1.29; 95% CI 0.82-2.03; p = 0.264). Benefit from chemotherapy was similar for patients with high or low HSs, with no interaction between HS and treatment arm. High HS associated with poor ILRC following hypofractionated (n = 90, HR 1.69; 95% CI 0.99-2.89 p = 0.057) but not conventional (n = 207, HR 0.70; 95% CI 0.28-1.80, p = 0.461) radiotherapy. The finding was confirmed in an independent cohort (BCON) where hypoxia associated with a poor prognosis for patients receiving hypofractionated (n = 51; HR 14.2; 95% CI 1.7-119; p = 0.015) but not conventional (n = 24, HR 1.04; 95% CI 0.07-15.5, p = 0.978) radiotherapy. INTERPRETATION: Tumour hypoxia status does not affect benefit from BC2001 chemotherapy. Hypoxia appears to affect fractionation sensitivity. Use of HSs to personalise treatment needs testing in a biomarker-stratified trial.

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A UK prospective multicentre decision impact, decision conflict and economic evaluation of the 21-gene assay in women with node+ve, hormone receptor+ve, HER2-ve breast cancer (2024)

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Type of publication:
Journal article

Author(s):
Holt, Simon; Verrill, Mark; *Pettit, Laura; Rigg, Anna; Hickish, Tamas; Archer, Caroline; Dent, Jo; Dillon, Marianne; Nathan, Mark; Barthelmes, Ludger; Rehman, Shazza; Sharaiha, Yousef; Innis, Paige; Sai-Giridhar, Priya; Khawaja, Saira.

Citation:
British Journal of Cancer. 2024 Feb 02.

Abstract:
BACKGROUND: For a tumour profiling test to be of value, it needs to demonstrate that it is changing clinical decisions, improving clinical confidence, and of economic benefit. This trial evaluated the use of the Oncotype DX Breast Recurrence Score R assay against these criteria in 680 women with hormone receptor-positive (HR+), HER2-negative early breast cancer with 1-3 lymph nodes positive (LN+) in the UK National Health Service (NHS). METHODS: Prior to receipt of the Recurrence Score (RS) result, both the physician and the patient were asked to state their preference for or against chemotherapy and their level of confidence on a scale of 1-5. Following receipt of the RS result, the physician and patient were asked to make a final decision regarding chemotherapy and record their post-test level of confidence. RESULTS: Receipt of the RS result led to a 51.5% (95% CI, 47.2-55.8%) reduction in chemotherapy, significantly increased the relative and absolute confidence for both physicians and patients and led to an estimated saving to the NHS of 787 per patient. CONCLUSION: The use of the Oncotype DX assay fulfils the criteria of changing clinical decisions, improving confidence and saving money.

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Pre-treatment plasma proteomics-based predictive biomarkers for immune related adverse events in non-small cell lung cancer (2023)

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Type of publication:
Conference abstract

Author(s):
Naidoo J.; Reinmuth N.; Puzanov I.; Bar J.; Kamer I.; Koch I.; Moskovitz M.; Levy-Barda A.; Agbarya A.; Zer A.; Abu-Amna M.; Farrugia D.; Lotem M.; Price G.; Harkovsky T.; Hassani A.; Katzenelson R.; *Chatterjee A.; Yelin B.; Sela I.; Dicker A.; Elon Y.; Harel M.; Leibowitz R.

Citation:
Journal for ImmunoTherapy of Cancer. Conference: 38th Annual Meeting of the Society for Immunotherapy of Cancer's, SITC 2023. San Diego, CA United States. 11(Supplement 1) (pp A1356), 2023. Date of Publication: November 2023.

Abstract:
Background Immune-related adverse events (irAEs) resulting from immune checkpoint inhibitors (ICIs) can substantially affect patient quality of life and treatment trajectory. Currently, there are no reliable pre-treatment biomarkers for predicting the development of irAEs; hence, there is a clinical need for irAE predictive biomarkers. Methods Plasma samples were obtained at baseline from 426 non-small cell lung cancer (NSCLC) patients treated with ICIs as part of an ongoing multi-center clinical trial (NCT04056247; approved by local IRB committees from each site) with irAE-related information. Proteomic profiling of plasma samples was performed using the SomaScan assay (SomaLogic Inc.), enabling deep coverage of approximately 7000 proteins in each sample. A machine learning-based model was developed to predict significant irAEs arising up to 3 months from treatment initiation; significant irAEs were defined as irAEs with CTCAE grade >=3 or irAEs that induced treatment discontinuation. Using the model, we identified a set of plasma proteins, termed Toxicity Associated Proteins (TAPs), that serve as indicators of irAEs depending on their plasma level in the individual patient. Bioinformatic analysis was performed to decipher the biology underlying immunerelated toxicity implied by the TAPs. Results Overall, 60 patients experienced significant irAEs at early onset; 197 patients had low grade irAEs, irAEs at late onset or AEs that are not immune-related; and 169 patients did not display any adverse event. A computational model was generated to predict significant irAEs, showing a strong correlation between the predicted probability of significant irAEs and the observed rate of such events (R2= 0.92; pvalue <0.0001), implying good prediction capabilities. The prediction was based on a set of 449 TAPs. Interestingly, nearly half of these TAPs were previously identified as proteins associated with clinical benefit from ICI therapy, suggesting a close relationship between irAEs and clinical benefit, in accordance with previous reports. A detailed examination of the TAPs revealed some key findings. Patients who experienced irAEs had a larger number of TAPs related to neutrophils, inflammation, and cell death resistance, while the number of lymphocyte-related TAPs was low in these patients. Patients who did not experience irAEs displayed higher levels of extracellular matrix-related proteins. Conclusions We describe a novel computational model for predicting significant irAEs in patients with NSCLC based on proteomic profiling of pre-treatment plasma samples. The TAPs provide insights into the biological processes underlying irAEs. Early prediction of irAEs could enable personalized management plans and mitigation strategies to reduce the risk of irAEs in NSCLC.

Counselling and management of women with genetic predisposition to gynaecological cancers (2024)

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Type of publication:
Journal article

Author(s):
*Malik, Naushabah; *Sahu, Banchhita

Citation:
European Journal of Obstetrics, Gynecology, & Reproductive Biology. 294:44-48, 2024 Mar.

Abstract:
OBJECTIVE: To review the literature with reference to counselling and management of women with genetic predisposition to gynaecological cancers. METHODS: Histochemical analysis, ultrasound, blood investigations, genetic testing, screening and risk-reducing surgery (RRS) are important tools for the management of gynaecological cancers and mortality reduction. Counselling can assist in timely management of gynaecological cancers. Systematic reviews, review articles, observational studies and clinical trials on PubMed, published in the English language, were included in this review. RESULTS: The management of women with genetic predisposition to gynaecological cancers through screening tests and RRS has led to a significant decrease in the risk of malignancy through RRS in cases with BRCA1 and BRCA2 gene mutations. RRS and screening have also been found to reduce the mortality rate and increase the survival rate in women with BRCA1 and BRCA2 gene mutations. The efficacy of endometrial cancer surveillance in women with Lynch syndrome is still unproven. RRS has not been reported to be effective in women with Cowden syndrome. The risk of ovarian malignancies in individuals with germline mutations remains minimal in the general population in comparison with genetic mutations. CONCLUSION: Genetic testing and RRS should be implemented in addition to genetic counselling for proper management and mortality reduction of women predisposed to gynaecological cancers.

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Biomarkers in Prostate Cancer: A Review (2024)

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Type of publication:
Journal article

Author(s):
Ahmadieh, Nizar; Zeidan, Toufic; Chaaya, Celine; *Cain, David; Aoude, Marc; Abouchahla, Anita; Kourie, Hampig Raphael; Nemer, Elie.

Citation:
The Gulf Journal of Oncology. 1(44):81-93, 2024 Jan.

Abstract:
BACKGROUND: Prostate cancer (PC) is the second most common cancer in men worldwide. It's the second leading cause cancer men in death. Prognostic tests based on molecular and biomarker analysis of tumor tissue may improve risk stratification of prostate cancer 2. MATERIALS AND METHODS: After a search on Pubmed for PC biomarkers, 72 papers responded to the objectives and will be included in the review. RESULTS: A plethora of biomarkers are predictive for the prognosis of PC and its response to certain therapies, while others, once thought to be indicative of prognosis in PC, were not. CONCLUSIONS: This study can help in the development of diagnostic and prognostic tests of PC and contribute to the ongoing research into already existing tests.