New biomarker trials to detect upper gastrointestinal cancers earlier 

17/08/2017 00:00 
UCLH Cancer Collaborative has launched two new biomarker trials with the aim of developing simple and affordable tests that can detect upper gastrointestinal cancers earlier to improve survival.

The trials are for cancer of the pancreas – a large gland behind the stomach and next to the small intestine, and cancer of the oesophagus – the tube that connects the throat to the stomach.

Around 20,000 people are diagnosed with upper gastrointestinal cancers each year in the UK, but survival rates are poor. Just 12 per cent of patients with oesophageal cancer and one per cent of patients with pancreatic cancer live more than 10 years following diagnosis. The main reason that these two cancers have such a high death rate is because they tend to advance to a very late, or incurable, stage before causing any obvious symptoms. Early stage diagnosis is associated with a far higher survival rate. 

A biomarker is a substance in a person’s blood, urine or saliva that scientists can search for and measure. In people with cancer, biomarker tests detect and quantify cells and proteins which have been shed from their tumour into the blood stream, saliva or urine. Analysis of biomarkers gives scientists the ability to see beyond the tumour itself, to the individual traits of the particular cancer. It is hoped that the development of biomarker tests will revolutionise our ability to diagnose and treat cancers much earlier.

The two new biomarkers studies, supported by the UCLH Cancer Collaborative, are known as SPIT and Transbil.

The SPIT study (saliva to predict risk of disease using transcriptomics and epigenetics) is led by Prof Laurence Lovat, professor of gastroenterology and biophotonics and consultant gastroenterologist, at UCL/UCLH and aims to develop a saliva test for oesophageal cancer.

Currently there is no effective screening test for oesophageal cancer and most patients with suspicious symptoms undergo an endoscopy where a thin flexible lighted instrument with a camera at the end is passed through the mouth into the oesophagus. This test is not only expensive for the NHS it can also be uncomfortable and invasive for patients.

The SPIT study aims to develop a cheap saliva test that can be used to predict a patient’s risks of developing oesophageal cancer, so that only high-risk patients will need to undergo invasive investigations in future.

A simple way to assess patients would be particularly beneficial for those who have Barrett’s oesophagus – a pre-cancerous condition. These patients currently undergo repeated endoscopies to check for cancerous changes.

The trial involves 240 patients who are being investigated for oesophageal cancer at UCLH and will aim to evaluate whether the characteristics of patients’ saliva, in combination with symptoms and other risk factors, can accurately predict the presence of the disease.

The Transbil project (TRANSlational research in BILiary tract and pancreatic diseases), led by Prof Steve Pereira, professor of hepatology & gastroenterology and consultant gastroenterologist at UCL/UCLH (supported by the University College Hospitals NIHR Biomedical Research Centre) is an early biomarker study which aims to detect pancreatic cancer in patients at a much earlier stage.

Trying to diagnose early pancreatic cancer is difficult, and mostly it is diagnosed at an incurable stage when it has already spread outside of the pancreas. Many patients have only vague symptoms and other patients may have non-cancerous or pre-cancerous growths in the pancreas that will not go on to become cancer.

Currently the best non-invasive tests for pancreatic cancer are MRI and CT scans, but they cannot accurately detect early cancer or reliably tell the difference between cancer and pre-cancerous growths.

Previous studies have identified biomarker molecules in blood and urine that could be used as a new diagnostic test to detect pancreatic cancer earlier or at a pre-cancerous stage. The Transbil study aims to validate these biomarkers through blood and urine tests with 600 pancreatic cancer patients at UCLH, the Royal Free and other hospitals. In addition, the study aims to assess whether combining this diagnostic tool with a symptom-based risk assessment questionnaire will help to detect pancreatic cancer earlier in high risk patients.

Prof Laurence Lovat said:

“Survival rates for upper gastrointestinal cancers are particularly poor and we desperately need new, less invasive tests to detect these cancers earlier when they are more treatable. If proved effective, these potentially simple and inexpensive diagnostic tools could be used in both primary and secondary care to screen high risk individuals and diagnose patients with symptoms suggestive of upper gastrointestinal cancerous growths.”

Prof Steve Pereira said:

“We hope that the development of biomarker tests for pancreatic and oesophageal cancers will mean that more people receive an early diagnosis, and get the right treatment at a stage when their tumour is potentially curable.”

UCLH Cancer Collaborative is also part-funding a biomarker study called UroMark, which uses cutting edge genomic sequencing to detect abnormal cancer DNA in a urine sample, to diagnose bladder cancer.

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