Aberdeen scientists have identified a new test that could allow clinicians to predict whether or not a lung cancer patient will respond to chemotherapy.
The University of Aberdeen led research team has discovered a new pathway within tumour cells that was not previously suspected to be involved in lung cancer. It was discovered, by examination of the lung cancer patients’ tumours, that this pathway causes resistance to chemotherapy, thus preventing the anti-cancer drugs from killing the cancer cells.
One key molecule in this pathway, in particular, is strongly predictive both of how the patient will respond to the standard chemotherapy drugs and also the likely prognosis of the lung cancer patient.
This finding has led to the development of a new test by the Aberdeen scientists that may allow clinicians to predict whether or not a lung cancer patient will respond to chemotherapy and help in decision-making about how the patient could best be treated, therefore, moving lung cancer patients closer to personalised treatments.
This finding could also pave the way for the development of new drugs to target this pathway, which could subsequently lead to more effective treatments for lung cancer.
New drugs are urgently required for lung cancer since recent clinical research has suggested that a ‘plateau’ may have been reached for responsiveness to conventional treatments. The identification by the researchers of a previously unexploited pathway may therefore provide the means to allow this ‘plateau’ to be overcome with improved outcomes for lung cancer patients.
Dr Elaina Collie-Duguid, Research Fellow at the University, led the research team, whose findings appear this week in the Journal of Clinical Oncology.
She said: “Lung cancer is a significant healthcare problem in the UK accounting for approximately 34,000 deaths each year. Non-small cell lung cancer accounts for 75% to 80% of all lung cancer cases in the UK and these cancers have a poor response rate to standard chemotherapy, with at best only half of patients benefiting from the drugs.
“Yet current tests don’t allow doctors to accurately predict a patient’s response to chemotherapy. This results in many patients receiving ineffective and toxic drugs.
“We have developed a new test that can predict whether a non-small cell lung cancer patient will respond or not to platinum based chemotherapy. Validation of the test in a large group of patients not used in the initial development phase of the test, would allow this test to be used in routine clinical practise. This could lead to a tailored approach to the choice of treatment in the management of this kind of cancer.
“The development of personalised treatment for non-small lung cancer would provide significant health benefits for patients by saving them from unnecessary, toxic and expensive treatments and allow instead immediate treatment with new drugs. Early treatment with an effective therapy is essential to limit the risk of progression of the disease. On top of that, exposure to multiple chemotherapy drugs can result in the tumour acquiring resistance to all drugs of this type, which then limits the effectiveness of subsequently administered chemotherapy.
“This would provide individual patients with the best chance of successful treatment.
“There would also be considerable savings for the NHS if there was less use of ineffective treatments. This would allow the savings to be utilised on newer, potentially more effective therapies in these patients.
“The key to lung cancer therapy remains early diagnosis and treatment and under these circumstances many patients can be cured with surgery. Chemotherapy can improve cure rates with surgery for patients with more advanced disease. Optimised use of chemotherapy and other anti-cancer drugs, ideally guided by a molecular diagnostic test to personalise treatment selection, is likely to improve outcomes for patients further. New more effective anti-cancer drugs are also required and our research suggests an exciting new avenue for drug development in lung cancer that had previously been unrecognised.
“Prevention of lung cancer by not starting smoking or stopping smoking remains vital and the risks of passive smoking will be minimised by the recent ban on smoking in public places in Scotland.”
Dr Collie-Duguid, Dr Russell Petty, Specialist Registrar and Friends of ANCHOR Clinical Research Fellow, Consultant Oncologists Dr Marianne Nicolson and Dr Donald Bissett, Consultant Pathologists Dr Keith Kerr and Professor Graeme Murray, and Dr Patrick Rooney, Research Fellow, were involved in the research, which formed part of Dr Petty’s PhD studies. The research spanned three years and received £150,000 funding from Aberdeen charity Friends of ANCHOR. Grampian University Hospitals NHS Trust and Tenovus Scotland also provided financial support for this work and The Association of International Cancer Research supports Dr Collie-Duguid.
Around 300 lung cancer patients from the North of Scotland were involved in the study. The researchers now hope to carry out a larger study to further refine their findings.
At this stage it is not known whether other cancers could benefit from the new test or whether the identified pathway is important in patients with other cancers receiving different drugs.
Dr Collie-Duguid added: “We don’t know yet whether other cancers could benefit from our findings although preliminary data suggest that bowel cancer may not.”
· The University of Aberdeen is involved in a major collaboration, which will strive to develop personalised medicines for the treatment of a wide range of serious illnesses. Last week the Universities of Aberdeen, Dundee, Edinburgh and Glasgow announced their partnership with leading drug company Wyeth Pharmaceuticals and Scottish Enterprise to achieve this aim.