North East and Yorkshire pioneer new ways to tackle bowel cancer

Pathology Lead for our Genomic Laboratory Hub explains how the North East and Yorkshire is leading the way in which we identify people at risk of bowel cancer and deliver the most appropriate treatment.

Dr Nick West is an Honorary Consultant in Gastrointestinal Pathology at The Leeds Teaching Hospitals NHS Trust, and Associate Professor of Pathology at the University of Leeds.

As the second leading cause of cancer death, bowel cancer is a huge challenge.  How is genomics helping us to address this?

Dr Nick West, LTHT and University of Leeds

Dr Nick West, LTHT and University of Leeds

We know that people with the genetic condition, Lynch syndrome (LS), have a 50-80 per cent higher risk of developing bowel cancer.  The national LS screening programme, tests patients for LS at the point of diagnosis, helping to inform their treatment options.

It also gives other family members the opportunity to get tested and enables us to put in place strategies to reduce their risk of bowel cancer (e.g. taking aspirin and regular colonoscopy).   The screening programme is already improving outcomes for patients and their families.

In Leeds, we have recently become one of the first NHS Trusts to adopt a new type of genomic test (MSI-Plus), developed by Sir John Burn, Professor of Clinical Genetics at Newcastle University, who leads international research in Lynch Syndrome.

The MSI-Plus test streamlines the LS screening process and also provides information about which treatments are most likely to work for the individual based on their cancer genetic makeup, should they develop metastatic bowel cancer (where cancer cells spread to other parts of the body).

So, the new test could help us to drive efficiencies and get a few of steps ahead of bowel cancer?

Yes, if the MSI-Plus test detects LS, we would offer risk reducing strategies and bowel cancer screening for the patient and any affected family members.  Bowel cancer screening aims to detect bowel cancer at an early stage, when surgery can be more effective.

But, we know that around 40% of patients who are diagnosed with bowel cancer develop metastatic disease within 5 years.

This is where the results from the novel MSI-Plus test come in, helping us to rapidly match the patient to a treatment that is most likely to work for them.

Nick: “We’re already making progress with improving outcomes for patients with bowel cancer, and genomics is key to developing new tests and treatments.”

What else are we doing to improve care for patients with bowel cancer?

We’re also very active in research into bowel cancer, working with Yorkshire Cancer Research, Cancer Research UK, the National Institute for Health and Care Research (NIHR) and other national and international partners.

At the Leeds Clinical Trials Unit, we’re recruiting patients with locally advanced disease but potentially curative tumours into a study to see whether chemotherapy before surgery to shrink the tumour (neoadjuvant therapy) followed by chemotherapy after surgery will help stop the cancer coming back.

Using the MSI-Plus test at the point of bowel cancer diagnosis is helping us to identify patients who may be eligible to take part in the FOxTROT platform trial.

We also have novel arms to the FOxTROT platform coming up to help further develop personalised medicines investigating:

  • The use of immunotherapy in bowel cancer. Immunotherapy is designed to boost the body’s natural defence to fight cancer by triggering the immune system.  The MSI-Plus test is used to predict an individual’s likely response to immunotherapy and inform treatment options.
  • HER2, a protein found to be over-expressed in a proportion of breast cancer, can also be present in around five per cent of bowel cancers, so we are investigating whether drugs that target HER2 could be beneficial to patients with bowel cancer.

 In terms of basic research into the causes of bowel cancer, we are involved in delivering one of the CRUK Grand Challenges, OPTIMISTICC, an international research programme with additional funding recently announced to investigate the microbiome’s impact on science and treatment in colorectal cancer.  Professor Phil Quirke, Professor of Pathology at the University of Leeds is one of the co-investigators.