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Cancer strategy to help NHS achieve world-class outcomes
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Patients treated in the National Health Service (NHS) in England should expect to receive cancer test results within 4 weeks of being referred by a general practitioner (GP) by 2020, as part of a strategy to improve cancer outcomes. Established by the UK Government body NHS England, the Independent Cancer Taskforce has published a report that sets out six strategic priorities for improving cancer services over the next 5 years to help the NHS achieve world-class cancer outcomes. Cancer services are under unprecedented pressure with cases of cancer on the rise, in part due to the UK’s ageing population. Cancer Research UK now estimates that one in two people will develop cancer over their lifetime. If the strategy is successfully implemented, an extra 30 000 patients
every year could survive cancer for 10 years or more by 2020; almost 11 000 of these lives would be extended through earlier diagnosis. To achieve its goals, the report states that a substantial increase is needed in diagnostic capacity, GPs must be given direct access to investigative tests, and new models must be tested to reduce the burden and reliance on GPs. Currently, patients urgently referred for suspected cancer by their GP need to be seen by a specialist within 14 days of referral, but no guidance exists for when patients can expect to get the results. Other recommendations in the report include an upgrade to prevention and public health programmes, including a new tobacco control strategy and a national action plan to tackle obesity.
Harpal Kumar (Independent Cancer Taskforce, London, UK) said: “The report recommends a fundamental shift in how we think about cancer services, with a much greater emphasis on earlier diagnosis and living with and beyond cancer. Our expectation is that the Government and NHS will now make the investments required and implement this strategy with commitment and speed.” Maureen Baker, of the Royal College of General Practitioners (London, UK), said that the college supported the aspiration to provide patients with their test results within 4 weeks. “Anything that can be done to lower patients’ anxiety and any undue distress when they have—or might have—cancer should be encouraged.”
Burger/Phanie/Phanie/Phanie Sarl/Corbis
Cancer strategy to help NHS achieve world-class outcomes
Published Online July 24, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00190-4 For the full report see http:// www.cancerresearchuk.org/sites/ default/files/achieving_worldclass_cancer_outcomes_-_a_ strategy_for_ england_2015-2020.pdf
Sanjay Tanday
Ibrutinib promising in subtype of DLBCL Patients with the activated B-celllike (ABC) subtype of diffuse large B-cell lymphoma were more likely to respond to ibrutinib than were those with the germinal centre B-celllike (GCB) subtype of the disease, according to results of a phase 2 study. Of 80 patients who had relapsed or had not responded to previous treatment, 37% of those with ABC diffuse large B-cell lymphoma had a complete or partial response to the drug, compared with only 5% of those with the germinal GCB subtype. Ibrutinib is an inhibitor of a key enzyme in B-cell receptor (BCR) signalling, Bruton’s tyrosine kinase, which is essential for the survival of ABC lymphoma cells by reducing NFκB pathway activity. “This is the first clinical study to demonstrate the importance of precision medicine in lymphoma”, said the first author, Wyndham Wilson
(National Cancer Institute, Bethesda, MD, USA). “It represents the first effort to really understand that specific mutations respond to targeted agents in lymphoma”, he added. Diffuse large B-cell lymphomas account for about 30% of all lymphomas in the USA. Patients with the ABC subtype have poorer overall survival than do those with the GCB subtype. The two molecularly distinct subtypes were discovered in 2000 by Louis Staudt (National Institutes of Health, Bethesda, MD, USA), a co-author of the new study. “These results confirmed our hypothesis that ibrutinib would be active in the ABC subtype but not in the GCB [subtype], based on genetic evidence that B-cell receptor signalling is critical to the development of this [subtype of the] disease”, said Staudt. The ABC gene signature has been used to select patients to be treated with ibrutinib plus R-CHOP
www.thelancet.com/oncology Vol 16 September 2015
in a 900-patient phase 3 study that is nearly accrued and will investigate whether ibrutinib can increase the proportion of cured patients. According to study author John Gerecitano (Memorial Sloan-Kettering Cancer Center, New York, NY, USA), the researchers found unexpectedly that most responses to ibrutinib occurred in ABC lymphomas that lacked BCR mutations, suggesting that BCR oncogenic signalling in these tumours does not require BCR mutations. “The future impact of this discovery is enormous, as the use of ibrutinib can be focused on patients with ABC diffuse large B-cell lymphoma, who are genetically wired to respond to ibrutinib while sparing other patients unnecessary exposure to the drug”, said Asher Chanan-Khan (Mayo Clinic, Jacksonville, FL, USA).
Published Online July 24, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00192-8 For the study by Wilson and colleagues see Nat Med 2015; published online July 20. DOI:10.1038/nm.3884
Vicki Brower e428
Patients treated in the National Health Service (NHS) in England should expect to receive cancer test results within 4 weeks of being referred by a general practitioner (GP) by 2020, as part of a strategy to improve cancer outcomes. Established by the UK Government body NHS England, the Independent Cancer Taskforce has published a report that sets out six strategic priorities for improving cancer services over the next 5 years to help the NHS achieve world-class cancer outcomes. Cancer services are under unprecedented pressure with cases of cancer on the rise, in part due to the UK’s ageing population. Cancer Research UK now estimates that one in two people will develop cancer over their lifetime. If the strategy is successfully implemented, an extra 30 000 patients
every year could survive cancer for 10 years or more by 2020; almost 11 000 of these lives would be extended through earlier diagnosis. To achieve its goals, the report states that a substantial increase is needed in diagnostic capacity, GPs must be given direct access to investigative tests, and new models must be tested to reduce the burden and reliance on GPs. Currently, patients urgently referred for suspected cancer by their GP need to be seen by a specialist within 14 days of referral, but no guidance exists for when patients can expect to get the results. Other recommendations in the report include an upgrade to prevention and public health programmes, including a new tobacco control strategy and a national action plan to tackle obesity.
Harpal Kumar (Independent Cancer Taskforce, London, UK) said: “The report recommends a fundamental shift in how we think about cancer services, with a much greater emphasis on earlier diagnosis and living with and beyond cancer. Our expectation is that the Government and NHS will now make the investments required and implement this strategy with commitment and speed.” Maureen Baker, of the Royal College of General Practitioners (London, UK), said that the college supported the aspiration to provide patients with their test results within 4 weeks. “Anything that can be done to lower patients’ anxiety and any undue distress when they have—or might have—cancer should be encouraged.”
Burger/Phanie/Phanie/Phanie Sarl/Corbis
Cancer strategy to help NHS achieve world-class outcomes
Published Online July 24, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00190-4 For the full report see http:// www.cancerresearchuk.org/sites/ default/files/achieving_worldclass_cancer_outcomes_-_a_ strategy_for_ england_2015-2020.pdf
Sanjay Tanday
Ibrutinib promising in subtype of DLBCL Patients with the activated B-celllike (ABC) subtype of diffuse large B-cell lymphoma were more likely to respond to ibrutinib than were those with the germinal centre B-celllike (GCB) subtype of the disease, according to results of a phase 2 study. Of 80 patients who had relapsed or had not responded to previous treatment, 37% of those with ABC diffuse large B-cell lymphoma had a complete or partial response to the drug, compared with only 5% of those with the germinal GCB subtype. Ibrutinib is an inhibitor of a key enzyme in B-cell receptor (BCR) signalling, Bruton’s tyrosine kinase, which is essential for the survival of ABC lymphoma cells by reducing NFκB pathway activity. “This is the first clinical study to demonstrate the importance of precision medicine in lymphoma”, said the first author, Wyndham Wilson
(National Cancer Institute, Bethesda, MD, USA). “It represents the first effort to really understand that specific mutations respond to targeted agents in lymphoma”, he added. Diffuse large B-cell lymphomas account for about 30% of all lymphomas in the USA. Patients with the ABC subtype have poorer overall survival than do those with the GCB subtype. The two molecularly distinct subtypes were discovered in 2000 by Louis Staudt (National Institutes of Health, Bethesda, MD, USA), a co-author of the new study. “These results confirmed our hypothesis that ibrutinib would be active in the ABC subtype but not in the GCB [subtype], based on genetic evidence that B-cell receptor signalling is critical to the development of this [subtype of the] disease”, said Staudt. The ABC gene signature has been used to select patients to be treated with ibrutinib plus R-CHOP
www.thelancet.com/oncology Vol 16 September 2015
in a 900-patient phase 3 study that is nearly accrued and will investigate whether ibrutinib can increase the proportion of cured patients. According to study author John Gerecitano (Memorial Sloan-Kettering Cancer Center, New York, NY, USA), the researchers found unexpectedly that most responses to ibrutinib occurred in ABC lymphomas that lacked BCR mutations, suggesting that BCR oncogenic signalling in these tumours does not require BCR mutations. “The future impact of this discovery is enormous, as the use of ibrutinib can be focused on patients with ABC diffuse large B-cell lymphoma, who are genetically wired to respond to ibrutinib while sparing other patients unnecessary exposure to the drug”, said Asher Chanan-Khan (Mayo Clinic, Jacksonville, FL, USA).
Published Online July 24, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00192-8 For the study by Wilson and colleagues see Nat Med 2015; published online July 20. DOI:10.1038/nm.3884
Vicki Brower e428