Cancer
New treatment avenue emerges from work on breast cancer diagnostic test
New findings have provided further evidence that anti-fibrosis drugs could improve outcomes from breast cancer.
They come out of the progress of a new diagnostic test that could better predict breast cancer outcomes; building on a recent research breakthrough in identifying a connection between fibrosis and advanced stages of the disease.
The link between breast cancer progression and fibrosis – the development of fibrous connective tissue as a reparative response to injury or damage – was first described in a 2021 study from the University of Arizona.
Researchers at the same institution later developed the MeCo Score diagnostic to potentially predict the likelihood of relapse or recurrence among patients with early-stage breast cancer.
And now a new study from the Spanish National Cancer Research Center has tested the invention, providing further evidence that tissue stiffening in the most common types of breast cancer, HER2-negative, can directly cause disease progression and metastasis, leading to detrimental outcomes for patients.
When standard chemotherapy alone was prescribed, high MeCo Scores were associated with much worse survival compared with low MeCo Scores; however, this difference in survival was minimised in patients who received antifibrotic therapy in addition to chemotherapy.
Among high MeCo Score patients, antifibrotic therapy reduced the risk of recurrence by 62 per cent, with an average follow-up period of 9.7 years after therapy.
The link between breast cancer progression to bone metastasis and fibrosis was first described in a 2021 study published in Cell Reports and authored by Ghassan Mouneimne, an associate professor of cellular and molecular medicine at the University of Arizona’s College of Medicine.
On this latest development, Mouneimne says: “We’re hopeful that additional clinical confirmation of this discovery will firmly establish a new way to determine which patients may benefit from this fundamentally new therapeutic modality.
“As a generic-emergent drug, [fibrosis drug] nintedanib is set for a substantial drop in price in the next couple of years, which may help mitigate the rising cost of treating breast cancer. It’s all about seeking new ways to personalise care and find more cost-effective treatments.
“We are in the initial stages of planning a prospective, multi-centre trial using the MeCo Score to guide nintedanib treatment in patients with luminal, ER-positive breast cancer.”
Mouneimne’s previous work identifying the link between fibrosis and advanced stages of breast cancer provided the mechanistic basis for developing the MeCo Score and led to the launch of MeCo Diagnostics LLC, a startup working to advance the technology so it can be used in the clinic.
A vaccine trial will test whether an mRNA jab can help stop precancerous cells developing into bowel and ovarian cancer in people with Lynch syndrome.
The first stage is due to launch this summer and will assess whether the jab can train the immune system to recognise and eliminate precancerous cells before cancer develops.
Around 175,000 people in England have Lynch syndrome, but only five per cent, or around 10,000 people, know they have it.
The inherited condition increases the risk of developing bowel cancer by 80 per cent and is linked to around 1,100 bowel cancer cases each year.
Lynch syndrome is also linked to a far higher risk of bowel, womb and ovarian cancer, alongside other types including stomach, pancreatic, kidney and skin cancer.
While the syndrome does not directly cause cancer, the genetic changes can lead to more abnormal cells developing, which then multiply and increase the risk of cancers such as bowel, prostate and endometrial cancer.
It is caused by an alteration in a mismatch repair gene. Carriers do not have any symptoms.
The new Intercept-Lynch trial is part of a scientific collaboration between the University of Oxford and Moderna, while Cancer Research UK has backed the vaccine’s development.
Once patients receive the new mRNA-4194 jab, experts will analyse their immune responses, assess the best dose and check whether the jab is safe.
The second phase of the study will include multiple centres across the UK, including Oxford, and is expected to begin in 2027.
The aim of the trial is to train the immune system with a vaccine to recognise abnormalities and stop them developing into cancer.
Professor David Church, Cancer Research UK senior cancer research fellow in the University of Oxford’s centre for human genetics and lead investigator of the trial, said: “People with Lynch syndrome are at risk of cancers over their entire lives.
“So, it’s very common, for instance, a woman to have a first cancer of her womb, and then some years later have a bowel cancer, or vice versa.
“The targets we’ve chosen for the vaccine were chosen based on their sharedness across multiple cancer types in Lynch syndrome, so we think they should provide broad protection, if the vaccine works.”
In people with Lynch syndrome, mutations can build up, making the cells containing them more likely to turn into cancerous cells.
However, those mutations can be made visible to the immune system and, with enough stimulation, the immune system can attack the abnormal cells and stop cancer from forming.
Professor Church said the mRNA jab acts as “an instruction manual” for the body to attack precancerous cells.
He added that, as with many vaccines, patients may need a booster jab at some stage.
On whether similar approaches could help prevent cancers not caused by Lynch syndrome, Professor Church said: “In terms of proof of principle that we can train the immune system to recognise these cancer-associated alterations and enhance the immune response against them to prevent these pre-cancers or prevent the progression of pre-cancer to cancer, that proof of principle should give us insights that are generalisable.”
David Berman, chief development officer at Moderna, said: “By applying mRNA technology earlier in the patient journey, we aim to harness the immune system when it can have the greatest impact.
“We are proud to bring this innovation to the UK, building on our long-standing collaboration with leading UK institutions to advance mRNA research and development.”
Changes in lymph nodes may help show which breast cancer patients face higher or lower risk of the disease spreading, researchers have found.
The findings could support more tailored care, new treatments and help more people avoid unnecessary treatment.
Dr Simon Vincent is chief scientific officer at Breast Cancer Now, which funded the research:
He said: “These findings suggest that changes to the structure of the lymph nodes are more than just a consequence of the cancer. They can also play an active role in helping breast cancer progress.
“With one person tragically dying from breast cancer every 45 minutes in the UK, we urgently need research like this so that we can better understand who is most at risk of their cancer progressing and becoming incurable. Only then we can find ways to stop it.
“With a better understanding of how lymph nodes change as breast cancer spreads, we could find new targets for future treatments for types of breast cancer that are harder to treat.”
Lymph nodes, a key part of the immune system, help the body fight infections and cancer. In breast cancer, the lymph nodes in the armpit are often the first place the disease spreads to.
At the moment, everyone with invasive breast cancer has to undergo surgery to remove lymph nodes so doctors can check for cancer cells.
Invasive breast cancer means cancer that has spread beyond where it first developed in the breast into nearby tissue.
While this is effective, it can lead to long-term side effects such as swelling of the arm, known as lymphoedema, and may be unnecessary for some patients, particularly those with early-stage disease or those whose cancer responds well to treatment.
The study analysed 331 lymph node samples from people with different types of breast cancer and compared them with healthy lymph nodes from people free from the disease.
It found that breast cancer could change the structure of a network that supports the lymph nodes.
Crucially, some of these changes could occur before doctors were able to spot any cancer cells in the network.
Some changes were linked to a better chance of survival, while others were associated with a poorer prognosis.
Dr Amy Llewellyn and Dr Kalnisha Naidoo from King’s College London, together with professor Sophie Acton at University College London, compared the 331 samples with healthy lymph nodes in people free from the disease.
They looked at fibroblastic reticular cells, known as FRCs, a group of cells in lymph nodes that provide their structure, control fluid flow and activate different immune cells.
The study showed that the structure of this FRC network could change before the cancer had spread and differed depending on the type of breast cancer, any spread and whether someone had received chemotherapy.
Chemotherapy uses medicines to kill cancer cells or slow their growth.
The researchers said the findings could help doctors better understand who is most at risk of breast cancer spreading.
Dr Llewellyn said the first large-scale analysis of FRC in human lymph node tissue from breast cancer patients was addressing the “urgent need” for a better understanding of the area’s biology.
A new ovarian cancer drug has been approved for NHS use in England, offering hundreds of women with hard-to-treat disease a life-prolonging treatment.
Elahere is the first new drug for chemotherapy-resistant ovarian cancer to be approved by the NHS for more than 20 years.
Ovarian cancer is the 18th most common type of cancer globally, affecting more than 300,000 women a year.
More than three-quarters of patients are diagnosed at an advanced stage, making the disease harder to treat.
Prof Ruth Plummer, national clinical lead for cancer drugs at NHS England, said: “This represents the most significant breakthrough in NHS treatment for these hard-to-treat ovarian cancers in over two decades – and we’re delighted it will now offer hundreds of women much-needed hope of precious extra time with their loved ones.”
Standard treatment for ovarian cancer usually involves surgery and chemotherapy, but about 80 per cent of patients with advanced disease relapse and most eventually develop resistance to chemotherapy.
According to the National Institute for Health and Care Excellence, patients with folate receptor-alpha-positive platinum-resistant epithelial cancers have until now had limited options when their tumours stop responding to standard chemotherapy.
Now NICE has approved mirvetuximab soravtansine, also known as Elahere, for patients with epithelial ovarian, peritoneal or fallopian tube cancer that has become resistant to platinum-based chemotherapy and whose tumours contain the FRα protein that the drug targets.
FRα is a protein found on the surface of some cancer cells.
NHS England said up to 400 women a year in England could benefit, in what it described as a major milestone for treatment.
Mirvetuximab soravtansine is given through a drip once every three weeks.
A global clinical trial involving eight NHS hospitals found that the treatment delayed cancer progression and prolonged survival by an average of four months, compared with chemotherapy alone, with more manageable side-effects.
Cancer progression means the disease is growing, spreading or worsening.
In 37 per cent of patients, tumours shrank by at least 30 per cent, compared with 16 per cent of those given chemotherapy.
The drug, made by AbbVie, combines a “homing” antibody, which seeks out the FRα protein on the surface of cancer cells, with a cancer-killing molecule that destroys the cell from within.
Experts said the decision was a seminal moment and could significantly improve the quality of life of affected patients.
Rachel Downing, head of policy and external affairs at Target Ovarian Cancer, said: “This is a hugely important moment for women with platinum-resistant ovarian cancer and their families, who have faced limited effective treatment options for far too long. Today’s announcement offers real hope of improved quality of life.”
Victoria Clare, chief executive of the charity Ovacome, said: “Today marks a landmark moment. Being told that platinum-based chemotherapy is no longer working can bring anxiety and uncertainty, particularly when the disease is at an advanced stage, where time and options are limited.
“This recommendation is the first in over 20 years to offer the ovarian cancer community an additional choice at a critical stage, with the potential to make a real difference to patients and their families.”
Helen Knight, director of medicines evaluation at NICE, said: “We heard clearly from patients and clinicians about the very limited options available at this stage of the disease and the substantial burden that chemotherapy places on women’s lives.
“We are pleased that, following a robust process and a new commercial arrangement with AbbVie, we are now able to recommend this treatment for NHS use.”
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