News from Around the Globe

Research is constant.  Every day we are learning more about how to fight cancer in all of its forms.  Here are the latest news articles from some of the leading cancer organizations.  Check back often to stay up to date.

news from around the world

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Stronger Than Cancer has shared these news articles for information purposes only.  It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

 

Transgender women have increased risk of breast cancer compared to cisgender men

1 week 1 day ago

News report

Transgender women undergoing hormone treatment have an increased risk of breast cancer compared to cisgender men, new research suggests. 

According to a study carried out by researchers from the University Medical Centre in Amsterdam, trans women (individuals assigned male sex at birth who identify as women) are around 47 times more likely to develop breast cancer than cis men (individuals assigned male sex at birth who identify as men).

But Dr Amar Ahmad, Cancer Research UK’s principal statistician, said that while this might sound like a huge increase, it’s important to remember that breast cancer in cis men is rare.

 “This means a small increase in the number of breast cancer cases diagnosed in trans women, as found in this study, is enough to give a large increase in breast cancer risk compared to cis men,” he said.

The study, published in the British Medical Journal, found that trans women were less likely to develop breast cancer than cis women (individuals assigned female sex at birth who identify as women).

It also showed that trans men (individuals assigned female sex at birth who identify as men) have a lower breast cancer risk than cis women.

Under-researched population

Researchers studied 2,260 trans women and 1,229 trans men who received gender affirming hormone treatment between 1972 and 2016.

Out of the 2,260 trans women, seventeen developed breast cancer. And around 8 in 10 cancers were driven by the female sex hormones oestrogen and/ or progesterone.

Previous studies have shown hormone replacement therapy (HRT) increases the risk of breast cancer in postmenopausal cis women, causing the researchers to suggest there may be a similar increase in risk for trans women taking hormone treatment.

Dr Alison May Berner, a Cancer Research UK-funded registrar in Medical Oncology and a specialist in gender identity from the Gender Identity Clinic, said this study was a great step forward as “cancer risk in transgender people has been under-researched for a number of years.” 

She said the new data would help doctors better advise patients on appropriate screening programmes to take part in.

A UK study is needed

Berner was cautious about applying this Dutch data to UK patients, or to those who are starting hormones now. 

“The typical hormones used, particularly for trans women, have changed over the years and some are not the standard used by gender identity clinics in the UK.”

She said work is currently underway to perform a similar study on cancer risk for transgender people in the UK and that NHS screening for transgender people is currently being reviewed.

Lastly, Berner adds that those who took part in the study were fairly young and so there may be more trans women in this group who develop breast cancer later on in life, at a more typical age for cis women. 

“Further work is now needed to see how a longer time on hormones impacts the breast cancer risk of trans women,” she said.

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Clearing up chemo options for frail and elderly patients with advanced oesophageal and stomach cancers

1 week 2 days ago

Science blog

The older you are the more likely you are to develop cancer. And more than a third of all cancer cases in the UK each year are diagnosed in people aged 75 and over. But ageing poses a challenge beyond just raising our risk.

As we age, we get frailer. This means that daily tasks, which may seem minor to someone fitter, can really affect those who aren’t as strong as they used to be.And if you bring a diagnosis of advanced cancer and treatment into the picture, it leaves doctors with some difficult decisions to make.

According to Professor Matthew Seymour, from the University of Leeds, there are two options – you either risk potentially making a frail and elderly patient sicker by giving them chemo, or you advise against cancer treatment that could give them precious extra time.

Until now, there’s been little evidence to reassure doctors either way. But new, unpublished results from a Cancer Research UK-funded trial may give some much-needed comfort.

Less treatment, but a better life

Some cancer treatments can be adapted for those not strong enough for a full dose. “But until now that’s usually been done in a somewhat haphazard way,” says Seymour, adding that it’s normally clinical experience, rather than scientific evidence, that guides these decisions.

“There’s a worry that if you give low dose treatment, you’re giving inferior treatment,” he says. But the new, unpublished data, soon to be presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in the US, suggests otherwise.

The study included 514 people all over the UK, at an average age of 76, who had advanced stomach or oesophageal cancer. Their doctors knew they wanted to offer chemo, but they weren’t sure of the best dose.

“We randomly allocated patients one of three different doses of chemo,” says Seymour. Instead of the usual trio of chemotherapy drugs that fitter patients receive, people on the trial were given two of the three drugs at the different doses.

The team had previously shown that oxaliplatin and capecitabine were the most effective duo from three standard-of-care chemotherapies. Patients were randomly allocated to receive these two drugs at either full strength, medium-dose or low-dose.

Lowering the dose of treatment didn’t make the chemo any worse at controlling the cancers, or affect how long the patients lived. And when the researchers investigated patients’ experience of treatment, considering factors like the side effects or impromptu hospital visits, and the patients’ own view of how worthwhile their treatment was, the lowest dose chemo group fared best of the three.

“What this trial says is that to give substantially lower dose is not only okay, but it’s absolutely the right thing to do,” says Seymour.

“It means doctors can confidently know that they’re not compromising their patient’s survival and are actually giving them a kinder treatment, which will improve their quality of life.”

These results haven’t yet been critiqued by the scientific community, but Seymour says this unpublished work could quickly start to help doctors tweak the treatment they prescribe their elderly patients.

“Doctors will be able to change their practice based on this trial alone. They will now feel confident to prescribe the lower dose of chemo used in this trial immediately for some patients.”

Where did these results come from?

The ASCO annual meeting is the largest gathering of clinical cancer experts in the world.

Researchers share preliminary and more advanced results. These come from small, early stage studies through to large randomised clinical trials.

In some cases, the results will go on to change how patients are treated. But most of the results are yet to be published in a scientific journal, so only offer an early glimpse of what these trials may later confirm.

Redesigning trials for the elderly

Dr Alastair Greystoke, from Newcastle University, also faces treatment dilemmas with his older or frailer patients. He agrees this trial could be practice changing and believes these new data are important for two reasons.

The first is how patients were assessed before taking part. In most cases, cancer doctors use a fitness rating called ‘performance status’ to decide if a patient will be able to tolerate toxic treatment.

“In general, most clinical trials are aimed at people with performance data of 0 to 1 and we normally wouldn’t offer chemo to people who are a 3 or 4,” says Greystoke.

A performance status of 0 means that, apart from having cancer, patients are fit and well. The less active and independent a person is the higher their performance status, with a rating of 4 meaning the person is bed bound.

But Greystoke says this poses a problem.

“The boundaries are often not clear. If someone says: ‘I have to take a quick power nap for 20 minutes a day and then I’m off walking the dog for miles’, how do you grade that?”

For their study, Seymour and the team used frailty scales, as well as performance status, to assess patients. The scales incorporate many different things, not just how active or physically strong someone is. It also isn’t necessarily to do with age, more of a measure of how age has affected someone.  Using measures of frailty may be a better measure of how strong someone is for treatment.

“This study shows that there is benefit in identifying patients who are frail, because you can adjust their treatment to be more tolerable,” says Greystoke, adding that frailty may be a better prediction of how someone will handle cancer treatment overall.

Improving the end of life

The study’s second unique element, says Greystoke, is its focus on quality of life.

“The team asked the patients: ‘Did this treatment go well? Would you take this treatment again if you had the chance?’”

We know when we talk to older cancer patients, survival may not be their top priority.

– Dr Alastair Greystoke, Newcastle University

This study is about patients with incurable cancer who may be in the last months of life. And when you’re supporting people looking for a few extra months with their loved ones, getting these balances right is vital.

“We know when we talk to older cancer patients, survival may not be their top priority,” says Greystoke. In this case, survival or cancer control might, therefore, not be the most important thing for trials like this to measure. Greystoke says this is starting to happen, but it’s early days.

“It’s great that Cancer Research UK funded this trial and that the international community is now accepting the value of studies like this,” he adds.

Leaving a legacy

Seymour hopes that other teams will consider these factors as they design trials for other cancers.

“Hopefully these results will also stimulate similar research for patients with different cancers and using different drugs, to see whether more people in the future could benefit from gentler treatment,” says Seymour.

“A study like this will mean in the future we don’t just assess people’s performance status we assess their frailty as well,” says Greystoke.

And willingness to take part certainly doesn’t seem to decrease with age.

“One of the things we found in this trial was that the prevailing attitude of patients was that they were very pleased to have been asked to be part of research,” says Seymour, who wrote to all the loved ones of patients that took part in the trial to thank them.

In reply, the wife of one man wrote back:

“My family and I would like to say thank you. It’s so good to know that you’re not forgotten. I lost my dear husband of nearly 60 years in May 2015. When he was asked if he would like to take part in the trial, he already knew he was terminally ill. He said: ‘It’ll be too late for me but if it will help others I’ll be very pleased.’ And we hope this too.”

“It’s quite touching,” says Seymour. “Patients who are frail or elderly often think they’re on the scrapheap, so when a researcher says they’re actually very interested in them and would they like to be part of a research trial, we get very positive feedback.”

Gabi

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Less chemotherapy better for older or frail patients with advanced stomach and oesophageal cancers

1 week 2 days ago

Press release

Less chemotherapy is as effective at controlling disease for elderly or frail patients with advanced cancer of the stomach or oesophagus (food pipe), and leads to fewer side effects such as diarrhoea and lethargy. These are the results of a Cancer Research UK funded study, presented prior to the ASCO conference today (Wednesday).

"Increasingly we’re realising it’s not just age that affects how well someone can tolerate their treatment and we need to do more work to understand how other conditions or aspects of frailty might play a role." Dr Peter Hall, Cancer Research UK Edinburgh Centre

Results from the GO2 trial could change the standard of care for patients who can’t have full dose chemotherapy due to their age, frailty or medical fitness.

The study, which ran at hospitals all over the UK, coordinated from the University of Leeds, involved 514 people with stomach or oesophageal cancer. Their average age was 76 and the oldest was 96 years old. All were either frail, elderly or medically unfit, and for those reasons would be unlikely to tolerate full-strength treatment, which involves three chemotherapy drugs.

Patients went through a careful medical assessment, then went onto chemotherapy with just two drugs* and were allocated at random to receive them at either full-strength, medium-dose or low-dose. They were then carefully monitored to see how well the cancer was controlled, whether they had symptoms and side-effects, whether they felt their treatment was worthwhile, and what overall effect it had on their quality of life. 

The researchers reported that the medium and lower doses of chemotherapy were as effective as the full-strength dose for controlling the cancer. But when the researchers looked at the overall effect of treatment, including quality of life, they reported that it was the lowest dose treatment that came out best.**

Around 15,800 people in the UK are diagnosed with stomach and oesophageal cancers every year***. Almost half (45%) of these people are 75 and over****. By 2035, this proportion is projected to rise to 55%*****, because of the UK’s ageing population. This study, is one of few phase III trials in the country that seek to address how to best care for and treat this increasing population of elderly or frail cancer patients.

These findings also open up the possibility of more older and frail patients being able to take part in clinical trials.

Professor Charles Swanton, Cancer Research UK’s chief clinician, said: “These valuable results reduce fears that giving a lower dose chemotherapy regimen is inferior and could make a huge difference for patients with stomach or oesophageal cancer who can’t tolerate intensive courses of treatment.

“Older or frail patients are often not considered for new drug trials or standard of care therapy as they’re less able to tolerate combination chemotherapy. These trials are critical to provide much needed evidence on the effectiveness of new therapies and combination approaches, helping us develop new treatments for this growing group of patients.”

The researchers also assessed whether there were differences for the patients in the study who were under 75, or less frail, who might be expected to benefit from stronger treatment; but will be reporting that the lowest dose treatment gave the best results for them as well.

Professor Matt Seymour, co-chief investigator at the University of Leeds and Leeds Teaching Hospitals NHS Trust said: “When we’re treating people who are elderly or frail, we are especially conscious that treatment can have harmful as well as beneficial effects. Doctors often prescribe reduced doses of drugs, or sometimes no chemotherapy at all, based on their clinical experience, but until now there has been little hard evidence to help them in those decisions. Our results provide that evidence, so doctors can confidently give people a lower dose of chemotherapy, sparing them side effects without worrying that it’s compromising their chance of survival.

“We hope this approach can be applied in other disease types so that more work can be done to improve both survival and quality of life for elderly and frail patients.”

Liz Chipchase, from Cambridge, was diagnosed with oesophageal cancer in 2017 at 69 years old. She had two non-invasive surgeries under sedation to remove the cancerous cells and didn’t require any additional treatment.  

She said: “When I was diagnosed with oesophageal cancer, I was lucky that it was caught early enough that I didn’t need chemotherapy. I was offered the choice between two different surgeries, giving me the opportunity to select the treatment I thought was best for me.  

“Trials like this are important to empower people with choices that give them control over how they’re treated – something I was fortunate to have. Any research that can help improve the quality of life for other patients is essential, so it’s great to see results like these doing exactly that.”

Dr Peter Hall, co-chief investigator from the Cancer Research UK Edinburgh Centre, said: “Increasingly we’re realising it’s not just age that affects how well someone can tolerate their treatment and we need to do more work to understand how other conditions or aspects of frailty might play a role.

“We should now look beyond chemotherapies, at some of the newer targeted therapies or immunotherapies to understand how we can tailor different treatments to patients based on their individual circumstance.”

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Clinician scientist training: ‘You’re trying to carve out your own path with few examples to follow’

1 week 4 days ago

Science blog

“We are in a unique position,” says Dr Jessica Okosun, from Barts Cancer Institute in London. “We act as a bridge between the clinic and laboratory research.”

As a clinician scientist, Okosun splits her time between studying a type of blood cancer and working as a doctor who diagnoses and treats blood conditions at St Bartholomew’s Hospital.

It’s an 80/20 split between the lab and the hospital. And the mix, Okosun says, gives a chance to see the key challenges in treating and caring for patients with blood cancer first hand, which drives her research.

“You recognise the problems in the clinic and then you try and take those problems to the bench in the lab and attempt to solve them. You wear two hats I guess, straddling both worlds.”

This unique perspective means that clinician scientists play a vital role in cancer research. But gaining this valuable mix of skills is a long and often challenging path, with many clinicians not continuing in research after completing the first major bit of scientific training, their PhD.

This is particular true for women. A report by the Medical Research Council found that while around half of junior clinical fellowships were awarded to women between 2007 and 2011, only 1 in 10 senior fellowship holders were women.

We want to make sure that clinician scientists get the right support, enabling them to stay and work in both the lab and the clinic. So we’ve changed the programmes we offer to train clinician scientists, adding more options and making the programme more flexible.

Okosun says the changes are a positive start.

‘It’s a balancing act’

Okosun’s interest in research sparked when she first was studying to become a doctor.

“I was always very scientifically minded – during medical school I would take any opportunity to be in the lab,” she says.

After finishing her medical degree, Okosun began training to become a haematologist but paused it halfway through to do a PhD. After completing her PhD and her specialist training, she now splits her time between the clinic and the lab, supported by a Cancer Research UK Clinician Scientist fellowship.

Looking back, one of the biggest challenges for Okosun was figuring out how to become a clinician scientist. She says that it wasn’t very clear when or how to do things.

“If you’re a non-clinical scientist there’s a more traditional and streamlined pipeline – you do a PhD, then a post doc and then you look to become an independent researcher by seeking out a group leader or faculty position. The route is a bit more meandering for clinician scientists.”

The lack of senior clinician scientists that Okosun saw during her training was a barrier. And that shortage is more acute for women. Out of about 50 academics at Okosun’s institute, only 2 are female senior clinician scientists.

“It’s a challenge when you’re trying to navigate how to get somewhere but you can’t see that many people who have successfully done it, so you’re always trying to carve out your own path with few examples to follow.”

She thinks that mentoring has a key part to play.

“Having very focused mentorship programmes is very, very important. It’s something that Cancer Research UK have taken on board and are actually doing very well.”

The new programme will offer support before, during and after training, including support and mentorship from senior clinician scientists. The hope is that this network will help clinician scientists make the leap into a research role after their PhD, rather than returning to a full-time clinical role.

“You have to make the clinician scientist career journey attractive so that people will want to continue down that road,” says Okosun.

And that means considering more than just jobs.

‘You can’t just uproot in the same way’

“As clinician scientists, we can be up to a decade older than non-clinical scientists who are finishing their PhD, we’re usually in our 30s. And you can’t just uproot in the same way because you have your clinical training and may have other personal factors like mortgages and family to consider.”

Jessica says this is something people haven’t always appreciated in the past. Clinician scientists already have a career, so it’s difficult to up sticks and move for the next research job after they’ve finished a PhD. Funding during this period is also another barrier.

And by the time Okosun was ready to apply for a fellowship she also had a family to consider as well.

“When I was applying for my fellowship from Cancer Research UK, I was applying knowing that I was about to have my son. And I was looking to see if there was any flexibility in terms of undertaking the fellowship part time, but at the time that option did not seem to be available. And that might put people off.”

To make sure everyone knows what options are available, the new programme will feature our flexible working policies more prominently. These include providing support during parental leave as well as helping people return to work after time off.

The new programme will also provide a more diverse range of training options. This includes the option to combine medical training with a PhD, which first became popular in the US. But it’s gathering momentum in other places too, including the UK.

‘There are multiple paths to the same goal’

Jessica says she knows several colleagues and friends who did a combined training programme, often called an MB-PhD, whilst studying in Cambridge.

“I have to say that the majority of them have stayed very strongly in academia – so I think the model works because you’re getting people into research from that very early stage of their training.”

The figures look encouraging too. A recent survey of graduates who combined medical training with a PhD in the US found that 6 in 10 were in full-time academic roles. And almost 8 in 10 were still active in research.

“I’ve always been a big fan of the principle of equifinality – the idea that there are multiple paths that lead to the same goal. And I think that’s why it’s important to have several and flexible training options so that people can step onto a clinician scientist route at different timepoints.”

“Everyone approaches their career in different ways so giving people options means that you’ll attract different people, which can only be a good thing.”

Katie

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