Bowel cancer breakthrough likely to improve cure rates

“Genetic signatures” found in bowel cancer cells will soon help identify the best treatments for those with the condition, according to international research led by Queen’s University Belfast.

The breakthrough is likely to improve cure rates and quality of life for patients who often have to undergo aggressive treatment.

For clinicians, treating patients with bowel cancer can be particularly challenging, as some treatments have no impact and can cause debilitating side effects. The use of tailored treatment for individual patients, which is likely to emerge from this research, will maximise its effectiveness while minimising potential side effects, explained Prof Mark Lawler, one of the lead researchers.

“A ‘one size fits all’ approach isn’t a viable option if we are to effectively tackle this disease,” he said.

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Currently patients with colorectal cancer are offered chemotherapy treatment. “While this treatment may be successful for some patients, for others it will have no effect on fighting the cancer, though the patients may suffer debilitating side effects such as nerve damage that can result in a loss of sensation or movement in a part of the body,” Prof Lawler added.

Mortality rates

According to the National Cancer Registry, there are 2,538 new cases of colorectal cancer every year in the Republic, causing 1,018 deaths. A number of treatment options are available but mortality rates remain high; it is the second most common cause of cancer death in the Republic.

Researchers at Queen's, in collaboration with teams at the University of Oxford and University of Leeds, have shown how defining precise "gene signatures within bowel cancer cells", also known as cancer subtypes, can allow the development of novel prognostic and predictive markers suggesting what treatments are likely to work for individuals and help to provide personalised treatment programmes. The study is published in the journal Nature Communications.

Prof Lawler, who is based at the Centre for Cancer Research and Cell Biology at Queen’s, said the research was an important step along the journey in improving bowel cancer treatments.

The next step would be to develop the technology to “stratify” tumours; to identity the subtypes of cancer present and to find out which treatment works best for each genetic signature so treatments can be tailored to each patient, and they have the best chance of beating cancer.

Quality of life

The resulting test would be brought to clinical trial stage, which he hoped would be within three years. He estimated that all going well, patients would be seeing better outcomes in terms of cure rate and quality of life within five years. Trials would be conducted in the UK but he hoped in time they would be done on an all-Ireland basis.

Dr Robert O'Connor, head of research with the Irish Cancer Society, said it was an important study, which meant treatment for bowel cancer was likely to follow a similar approach to treating breast cancer, where it was now accepted there were six to 10 subtypes. These were routinely identified and "scored", which determined customised treatments, and ensured better indication of the prognosis for a patient. This approach also helped determine the balance between aggressive and low risk, less invasive treatments.

Identify cancer type

While there would be no immediate change in treatment for bowel cancer patients, Dr O’Connor said he could envisage how routine identification would help identify cancer type and what would work best by way of personalised treatment.

While Irish people often ignored the early signs of bowel cancer, the prognosis and outcomes for patients would be improved if this form of treatment was available and people availed more of free bowel-screening services.

This latest research is part of a major cross-discipline research programme seeking to develop personalised treatments for bowel cancer patients known as S:CORT. Ed Goodall, a survivor of bowel cancer and a member of S:CORT, said: “In the past, a tumour was a tumour. Patients are offered chemotherapy and this may not be effective or necessary depending on the patient yet they will still endure all the horrors this treatment can cause including nausea and hair loss.

“If the oncologist knows more about the subtype of bowel cancer, they will know whether the treatment will be necessary or effective. From a patient point of view, discovering the subtypes of this cancer is really ground-breaking work because it will have massive implications for patient care and treatment.”