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Thursday 30 March 2023

A new blood test, which could prevent unnecessary chemotherapy in colorectal cancer patients, is being trialled by The Royal Marsden.

An innovative trial which aims to determine whether patients with colorectal cancer can be spared unnecessary chemotherapy has opened at The Royal Marsden NHS Foundation Trust.

The ‘Tracking mutations in cell free DNA to predict Relapse in eArly Colorectal Cancer’ (TRACC) Part C study aims to evaluate the opportunity to improve patient care and quality of life by reducing unnecessary use of chemotherapy and the associated side effects. 

This could spare patients from toxicity and has potential for huge cost savings for the NHS.

The study evaluates the use of circulating tumour DNA (ctDNA) to guide chemotherapy treatment decisions after surgery in patients with early-stage colorectal cancer.  

The test can detect microscopic molecular residual disease by measuring the DNA shed from tumour cells into the bloodstream. If ctDNA is not detected in a blood test following surgery, the patient’s treatment is de-escalated. De-escalated treatment may be chemotherapy in tablet form, which has fewer side effects than conventional chemotherapy, or no chemotherapy at all.

Royal Marsden patient Ben Cooke, 52, (pictured with his husband and two children) a hairdresser who lives in London with his husband and two children, was diagnosed with colon cancer in September  and, following surgery to remove part of his colon, joined the TRACC Part C trial at The Royal Marsden.

As a result of receiving a negative ctDNA test result after surgery, he was prescribed a three-month course of Capecitabine tablets, a de-escalated form of chemotherapy with fewer side effects which he was able to take at home. Ben finished his treatment last month. 

Ben said: “Since starting treatment I’ve felt absolutely fine, and I haven’t had to take a single day off work which is amazing.  

“I absolutely love my job as a hairdresser, and I split my time between working in my salon and working on photoshoots and red-carpet events. Working is my therapy and I still jump out of bed in the morning excited to go to work. Conventional chemotherapy could have put me at risk of nerve damage in my hands, which could affect my ability to do my job properly, so I’m particularly thankful that I’m not at risk of these side effects.”

Currently, many patients with high-risk stage II and stage III colorectal cancer are routinely offered chemotherapy after surgery to help reduce the risk of relapse.

Chemotherapy works by killing microscopic cancer cells that remain after surgery. If left untreated, this microscopic disease will cause the cancer to return, most commonly within the first two years after surgery. As a result, patients are recommended chemotherapy after surgery to help reduce the risk of future recurrence. 

However, approximately 50% of these patients are cured with surgery alone, and many may be over-treated because doctors have not been able to clearly advise patients on whether they are likely to benefit from the treatment. Chemotherapy can sometimes cause debilitating and life-long side-effects.  

Patients with a negative ctDNA test following surgery are less likely to see their cancer return within two years, compared to those with positive results.

These findings are now being investigated in the TRACC Part C study, which uses the Guardant Reveal blood test to detect microscopic molecular residual disease by measuring the DNA shed from tumour cells into the bloodstream. The trial aims to evaluate the use of ctDNA results from the blood test to guide chemotherapy treatment decisions over the next four years.

Helmy Eltoukhy, Guardant Health co-CEO said:

“With the Guardant Reveal test, a simple blood draw can be used to identify colorectal cancer patients who have residual disease and are most likely to benefit from adjuvant therapy.

“We’re pleased to partner with The Royal Marsden NHS Foundation Trust in the TRACC Part C study to enable the investigators to more accurately predict when cancer is unlikely to return, help guide chemotherapy treatment decisions and provide patients with a better quality of life.”

Professor David Cunningham, Director of Clinical Research at The Royal Marsden NHS Foundation Trust and Chief Investigator for the TRACC Part C study said: 

“Patients with high-risk colorectal cancer can benefit from chemotherapy after surgery but some patients will never relapse, even without chemotherapy, and this clinical trial is designed to use a blood test to identify the group of patients who need chemotherapy and those who will remain cancer free with surgery alone. 

“The results of this trial could help us tailor treatment decisions to benefit patients and reduce the side effects of chemotherapy, which will enable patients to have a better quality of life. There is also potential to realise significant cost savings for the NHS.”

TRACC Part C is funded by the Efficacy and Mechanism Evaluation (EME) Programme, a Medical Research Council (MRC) and National Institute of Health and Care Research (NIHR) partnership and supported by The Royal Marsden Cancer Charity.

posted by Radio Jackie News Team @ 1:17 pm  

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