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EMPIRIC study gets underway

A gift left to us by a supporter in her Will is helping to fund a new research collaboration with Mount Vernon Cancer Centre.

A gift left to us by a supporter in her Will is helping to fund a new research collaboration with Mount Vernon Cancer Centre 

Around 3,200 cases of cervical cancer are diagnosed in the UK every year, with women in their early thirties at greatest risk.

Every year, hundreds of women in the UK undergo successful treatment for cervical cancer, only to later see cancer return, often in a different part of the body. With the help of our very advanced MRI techniques, a new study by Mount Vernon Cancer Centre and supported by Paul Strickland Scanner Centre seeks to identify those patients early on, which could one day lead to their survival chances being drastically improved through personalised treatment and follow-up plans.

Senior Clinical Research Fellow Dr Mohammed Abdul-Latif is currently looking for 40 cervical cancer patients to take part in the EMPIRIC study at Mount Vernon over two years. The study’s principal investigator is Consultant Radiographer Dr Yatman Tsang. Prof Peter Hoskin and Dr Hannah Tharmalingham, both consultant oncologists at Mount Vernon Cancer Centre where Dr Abdul-Latif works, are co-investigators.

Dr Mohammed Abdul-Latif
Dr Mohammed Abdul-Latif

The study aims to determine whether advanced MRI scanning at Paul Strickland Scanner Centre, in combination with tissue samples and blood tests, could be used to predict how effective combination radiotherapy and chemotherapy treatment for cervical cancer might be for individual patients and how they might be at greater risk of their cancer coming back or metastasing (spread to other parts of their body).

As well as holding clinics with Prof Hoskin at Mount Vernon Cancer Centre, since the beginning of the year Dr Abdul-Latif has recently been preparing for the study to begin recruitment, in liaison with teams at Paul Strickland Scanner Centre and Mount Vernon Cancer Centre. He has also been making connections with teams at Brunel University and Manchester University, who will be responsible for blood tests and tumour biopsies respectively. He said: “In most cases, cervical cancer is treated with a combination of radiotherapy and chemotherapy, coupled with brachytherapy (internal radiotherapy). Treatment is highly successful in most cases: In 95% of cases, 5 years after it was first observed in the cervix it hasn’t progressed locally.

“If you look at cases where cervical cancer has spread following treatment, it’s generally not to tissue surrounding the local area where the cancer first occurred, which seems to be managed really well by our treatment including radiotherapy, but to another part of the body altogether (metastasis). We need better ways of assessing which patients are more likely to metastasise, progress or not respond to our treatment in the first place. We need to do that based not only on their biopsy or the initial MRI scan, but by looking at the actual tumour – how it responds to treatment and how we can link that to the biology of the tumour, which we obtain through methods like blood tests. “As part of the EMPIRIC study, the team at Paul Strickland Scanner Centre won’t do standard MRI scans but three different, highly complex sequences of MRI scans which are designed to look at different properties of the tumour – not just the shape of the tumour but the actual structure of it, for example how blood flows through the tumour. This may allow us to establish links to certain response rates to our treatments.” 

“For instance, we may image a patient throughout their treatment and then notice that the cancer isn’t shrinking. This would raise the question about whether there may be something different about this particular patient’s cancer which means it isn’t responding. “Once we have enough data, we may then be able to tell in advance whether, or how well, a patient might respond to a particular treatment based on their tumour type. This could lead to a patient’s treatment being personalised based on their individual tumour, which would optimise it considerably. “We would also be able to identify which patients might be more likely to see their cancer coming back or spread to other parts of the body, and tailor our treatment approach or follow-up for those patients, monitoring them much more closely for example.”

Dr Abdul-Latif suggests that one day scientists may even be able to make the scans and other diagnostic data available to artificial intelligence software, which could then use it to analyse and even recommend personalised treatment and follow-up plans for patients. He said: “We’re quite excited about a possible role for machine learning to pick up any patterns that have been identified. You’d just plug your images into the system and it would tell you what the risk of relapse or metastasis might be for a particular patient.”

“As far as I know, EMPIRIC is the first time someone has looked at whether, in combination with blood tests and tissue samples, multiple MRI techniques can identify those patients at higher risk of relapse or metastasis.

“If we show that it’s possible to determine in advance who might be at bigger risk, this will pave the way for bigger studies which will seek to determine whether we can apply our findings in a clinical setting.”

“High-quality MRI imaging, which Paul Strickland Scanner Centre excels at, is the only non-invasive way of doing it and is becoming increasingly more important in virtually all tumour types, not just to diagnose and monitor disease but also to predict how a cancer might develop. “I’ve worked at many hospitals so far, and Paul Strickland Scanner Centre is a brilliant place. The staff are very open and patient focussed.”

Our team at Paul Strickland Scanner Centre is grateful to the Arcobaleno Cancer Trust, the Sir Samuel Scott of Yews Trust, the Frognal Trust and the Chapman Charitable Trust for their financial contributions, as well as a legacy donation of £10,440, which helps to cover a significant portion of the costs we are incurring by supporting this important clinical research study.

Empiric explained

Patients with cervical cancer that has not spread to other parts of the body can be cured with radiotherapy. One of the reasons radiotherapy can fail is because there are areas within the tumour that have a poor oxygen supply, which makes them resistant to radiotherapy.

The EMPIRIC study aims to assess if it is feasible using a special type of MRI scan called multi-parametric MRI (mpMRI) to identify areas of low oxygen within the tumour, so a higher dose of radiation can be given specifically to these areas. The higher dose of radiation may overcome the resistance and potentially improve cure rates without increasing side effects.

It has been shown that blood samples can be examined to inform a patient’s medical team about the possible response that a patient may be having from their cervix cancer treatment. Recently developed techniques allow the examination of the actual circulating cancer or tumour cells (CTCs) or sometimes just “free” cancer DNA in a patient’s blood. The EMPIRIC study aims to explore the feasibility of examining blood for such circulating cancer cells and DNA using new techniques. In addition, this study will examine any circulating cancer cells in your blood stream for the expression of certain genes in order to evaluate if these can be used to predict the outcome of cancer treatment for individual patients earlier than we currently are able to do with scans and cancer markers.

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