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Before 2010, there was no accepted standard treatment for patients with advanced biliary tract cancer. The ABC02 trial showed that the combination of two drugs (gemcitabine and cisplatin) significantly improves survival, with acceptable side effects. Consequently, national and international guidelines have been revised to recommend this regimen as a standard of care. Furthermore, in ongoing trials of novel therapies, gemcitabine/cisplatin has become the comparator group, and the aim is to improve survival above what this can already achieve.
Colorectal cancer is a common disease, which frequently causes death or morbidity, either because of failure to control the primary tumour or failure to prevent distant metastases. Leeds researchers have devised new treatment approaches using chemotherapy and radiotherapy and tested them in large randomised controlled trials which have led to major changes in clinical practice in the management of rectal cancer and advanced colorectal cancer (aCRC), driving clinical decision-making and improving outcomes for patients. This includes better-evidenced treatment for elderly patients and patient stratification on the basis of molecular biomarkers.
UCL has conducted a series of national lung cancer trials, which have led to wide-scale changes in clinical practice. Two trials compared different platinum based therapies, which led to centres switching from using chemotherapy with cisplatin to carboplatin-based chemotherapy instead. Carboplatin can be given as an outpatient, and has fewer side effects, and has been (and still is) recommended as an alternative to cisplatin in the UK and US.
Impact: Health and welfare; additional effective therapy for women with advanced, HER2+ breast cancer.
Significance: Allows approximately 10,000 patients a year, whose disease is no longer being controlled by trastuzumab, to receive a more effective therapy than chemotherapy with capecitabine alone.
Beneficiaries: Patients with incurable metastatic HER2+ subtype breast cancer; policy-makers; commerce.
Attribution: Cameron (UoE) was joint chief-investigator on the global pivotal registration trial that led to the marketing authorisation of the drug lapatinib in combination with capecitabine.
Reach: World-wide: the drug is approved in >100 countries and generated >£650M in sales for manufacturer GlaxoSmithKline.
Impact: Improved depression care for people with cancer.
Significance: Assessment of emotional distress and evidence-based intervention to manage depression has a direct effect on quality of life of cancer patients. It may also reduce suicide attempts among them.
Beneficiaries: Cancer patients, NHS and healthcare delivery organisations.
Attribution: The work was led by Sharpe (UoE), with UoE Cancer Research Centre colleagues and collaborators in Manchester and London.
Reach: International; this work directly affected NHS practices and clinical guidelines in Europe and North America. It also stimulated international debate and new research into psychological aspects of living with cancer.
Research within the Northern Ireland Barrett's oesophagus Register demonstrated that cancer risk in this disease was substantially lower than previously thought. It identified clinico-pathological characteristics and potential biomarkers that allow Barrett's patients to be stratified into those with higher and lower cancer risk. This research has influenced recommendations from Gastroenterological Associations in the UK and USA and resulted in altered clinical practice nationally and internationally, in which costly routine endoscopic surveillance is now targeted to Barrett's oesophagus patients with the highest cancer risk.
Research on professionals' discussions about clinical trials of cancer therapy has identified the major barriers to patient recruitment to clinical trials. This research was used to create an educational intervention to improve patient experiences and willingness to participate in a variety of clinical trials worldwide, resulting in increased participation in prostate, colorectal, renal and breast-cancer trials. It also involved educating members of UK cancer teams to the best ways to approach, communicate and maximise trial planning.
The HiLo trial has changed management for patients with well-differentiated thyroid cancer. Patients undergoing radioiodine ablation therapy are now given a low dose of radioactive iodine, which has fewer side effects, compared to the previous (standard) high dose. Also, to prepare patients for ablation they now have recombinant human TSH (thyrotropin alfa), which is associated with a better quality of life before and during ablation. The combination of low dose radioiodine and thyrotropin alfa means that patients can be treated as outpatients rather than inpatients. This is a more convenient treatment package, reducing health service and societal costs.
Collaborative research conducted by the Biological Sciences Research Group (BSRG) has brought considerable benefits for the treatment of cancer patients. Experimental research has shown that the shelf-life of the biological cancer drug Herceptin can be greatly extended thereby bringing significant economic benefit through cost savings. A clinical trial has demonstrated that yoga benefits the health and well-being of patients with gynaecological cancer leading to prospects of improved cancer survivorship. Sowter provides research-informed oncology training for NHS clinical trials staff throughout the National Institute of Cancer Research UK network (NCRN), and has supervised two senior registrars through their MD qualifications.
University of Glasgow research has led to the adoption of first-line chemotherapy for ovarian cancer, which has improved patient survival by 11% and has been used to treat 66% of women with ovarian cancer since January 2011 in the West of Scotland Cancer Care Network alone. These therapies are recommended by guidelines for ovarian cancer treatment in the USA, Europe and the UK. The USA guidelines are disseminated to 4.3 million people worldwide and the European guidelines reach 15,000 health professionals. The UK guidelines are used to identify those drugs that are funded by the NHS and used in NHS hospitals.