Our plan to improve genetic testing for cancer patients in the UK

By looking at a patient’s genes, doctors can now decide on the best cancer treatment

You may have seen in the news today that Cancer Research UK is forming a partnership to change the way cancer treatment is delivered in the UK. This will be a chance for the charity to combine great research and patient care.

In a way, it’s why we’re here: as Professor Sir Paul Nurse remarked when Cancer Research Campaign and Imperial Cancer Research Fund merged to form Cancer Research UK in 2002, “combining forces will give us the impetus to turn the potential of the genetic revolution into the reality of new drugs and treatments”.

Eight years later, we’re making this promise a reality.

Stratified medicine is when doctors treat different groups of patients differently, based on the genetic nature of their disease. This is particularly relevant in cancer, because cancer cells have recognisable genetic changes (or mutations) that cause them to grow out of control and eventually cause harm to the patient. Researchers are identifying exactly which genes can become faulty in cancer – and they make more discoveries almost every month.

Now, they are in the process of linking each mutation – or pattern of mutations – to a treatment that targets it.

Currently, in most cases, doctors diagnose cancer by looking at it, scanning it, taking a sample of it, looking at it under a microscope and finally sending a biopsy off to the lab for a chemical test. This means that they have a good idea of the size of the tumour, its position, what the individual cells looked like, and what chemicals are on the outside of the cells. All this information can help decide how best to treat the patient’s disease.

But now that genetic testing is becoming become much cheaper, down from $2.7bn for the first genome in the year 2000 to £200 for a single mutation test in the NHS now, doctors will soon be able to add genetic analysis into the mix. This will potentially be a game-changer.

The era of genomic medicine

Genetic analysis can give much more information on how likely the tumour is to grow or to react to certain treatments. For example, certain genetic types of prostate cancer grow more quickly, and certain types of lung cancer are more likely to respond well to targeted ‘next generation’ drugs like gefitinib and erlotinib. Importantly, tests could also predict whether certain drugs won’t work – sparing patients potentially unnecessary treatment and making things more cost-effective. With some treatments this is already happening.

Sounds exciting? It is, but it’s not yet routine practice in the UK. This isn’t surprising, as the technology has only recently become affordable, and, importantly, there aren’t yet many treatments where there’s clear evidence that a genetic test will help.

But Cancer Research UK believes that, as new tests and treatments emerge, we can make genetic testing routine practice, and – crucially – link it to great research to make sure we are delivering better treatments all the time, all over the UK.

A partnership to beat cancer

We’ll do this by building a partnership between patients, the research community, the NHS, the pharmaceutical and diagnostics industry, and the government. Patients who might benefit will be asked if they want to be part of the programme, and if so they will get the appropriate genetic tests on their tumours and their results will be kept for research.

This means that, as well as helping the patients, we will be creating valuable research information on which genetic types of cancers are linked to better or worse response to treatments.

Everyone will have a role to play in this partnership.

• The research community will help define the genes we should be looking for, and link us to the latest advances around the world.
• The NHS will identify and treat the patients based on the genetic information.
• The pharmaceutical and diagnostic industry will help fund the testing, and use the research results to develop better tests and better treatments.
• And the government will support the programme by funding technical innovations in analysis and medicine, as well as ensuring that we are creating a programme that can be used in other disease areas such as heart disease or arthritis.

It will be a strong team, and we’re really pleased by the initial positive reaction to our plans.

We’re also building an excellent team of experts across Cancer Research UK to help us bring this partnership together. Professor Peter Johnson, our chief clinician, is leading our scientific advisory board, which includes leading scientists and clinicians in the field. Dr Louise Jones, the charity’s expert on stratified medicine, is leading the clinical and research work stream, while our expert on informatics Dr Fiona Reddington is working on the data questions, and Dr Fiona Hemsley from our research strategy team is looking into the technologies available for genetic testing.

Over the summer, we’ll be developing more detailed plans, and learning from other examples around the world, so that in September we’ll be able to bring all the partners together to agree on exactly what we’re going to do: how many patients, what cancers, what genes, which hospitals, which testing labs, and how much it will cost will all be under discussion.

If our initial pilots involving a few thousand patients are successful, this could trigger a step-change in how we research cancer testing and treatment in this country. And if everything goes according to plan, we would like to work with the NHS to roll this out across the country, starting in 2012. This is, truly, what we mean when we say “Together, we will beat cancer”.

James

James Peach is Cancer Research UK’s director of stratified medicine

More information:

• Hear our CEO, Harpal Kumar, on the BBC Radio 4 Today Programme (after 54mins)
• The Times – Making cancer history: Killing tumours (may require registration)