What is the future of cancer?

birds eye view of people. The future of cancer

4 February is World Cancer Day.

It’s a commonly discussed disease with well-publicised media campaigns around causes and symptoms, but it still affects more than 300,000 people in England each year. What are the latest developments in cancer treatments and what does the future hold?

“NHS England is introducing new diagnostic tests to increase uptake of screening, aid early detection and prevent cancers”

Diagnosis and screening

Although diagnosis can take time and symptoms can present themselves differently in individuals, once a GP arranges for a referral, the aim is to get the patient seen as quickly as possible. In England, urgent referrals mean someone should see a specialist within two weeks.

NHS England is introducing new diagnostic tests to increase uptake of screening, aid early detection and prevent cancers. It has already introduced a new bowel cancer screening test. The faecal immunochemical test for haemoglobin (FIT) replaces the faecal occult blood test and NHS England hopes it’ll increase uptake of bowel cancer screening by around 7%. The recent NHS Long Term Plan also announced that the starting age for the Bowel Cancer Screening Programme will be lowered from 60 to 50.

The latest cervical screening rates were recently published by NHS Digital and show that current rates are at a 21-year low. Screening uptake is 71.4% in England and 76.1% in Wales, concerning statistics at a time when cervical cancer rates are increasing. However, a new cervical cancer screening programme will be introduced this year. See overleaf for information on cancer screening, diagnosis and treatment in the NHS Long Term Plan.

Cancer vaccines

Vaccines are a type of immunotherapy, and although still at an early stage, researchers are looking at vaccines as a possible treatment for cancer. Therefore, vaccines are currently mainly available as part of clinical trials. More research is needed before it will be known how well these treatments work, and which cancers could be prevented with their use.

Although there are no specific vaccines for cancer on the market, there have been developments in vaccines against viruses that can cause cancer – for example the human papilloma virus (HPV) vaccine which protects against the types of HPV (16 and 18) that cause most cervical cancers. The vaccine also helps to protect women from rarer HPV-related cancers, such as anal cancer, genital cancers, and cancers of the head and neck.

In July 2018, the Department of Health and Social Care accepted the recommendation by the Joint Committee for Vaccination and Immunisation to extend the HPV vaccination programme to boys in England. The HPV vaccine can protect boys from an early age from other cancers that can affect men – such as cancer of the anus, penis, head and neck – which are also linked to infection with HPV types 16 and 18.

Cancer drugs fund

To advance treatments for cancer, the Cancer Drugs Fund (CDF) is available for funding cancer drugs in England. Designed to fast-track access to cancer drugs, the National Institute for Health and Care Excellence (NICE) states that it:

• Provides patients with faster access to the most promising new cancer treatments

• Helps to ensure more value for money for taxpayers

• Offers pharmaceutical companies (who price their products responsibly) a fast-track route to NHS funding.

Being part of the CDF means that the NICE appraisal process for newly-referred drugs can start earlier, to enable draft guidance to be published by NICE before the drugs receive approval and final guidance to be received within 90 days of that date.

NHS England says that ‘patients also benefit from new cancer drugs at least four months earlier under the reformed CDF than was previously the case. All cancer treatments recommended by NICE, whether for routine commissioning or the CDF, are now available to patients as soon as positive draft guidance is published by NICE’.

Recent NICE approvals via the CDF

• Novartis’ Tafinlar® (dabrafenib) + Mekinist® (trametinib), the first BRAF-targeted therapy for adjuvant treatment of most aggressive form of skin cancer. The drugs received appraisal by NICE and were made immediately available through the CDF whilst Novartis awaited the NICE Technology Appraisal.

• In December 2018, patients were given access to Yescarta, manufactured by Kite, a Gilead company, via the CDF while more data is collected. The CAR T-cell therapy is recommended for adults with some types of non-Hodgkin lymphoma.

• Bristol-Myers Squibb announced in November 2018 that NICE had issued a Final Appraisal Document recommending the reimbursement within the CDF of the immunotherapy Opdivo® (nivolumab) as adjuvant treatment after surgery for melanoma patients in England. The recommendation made nivolumab available immediately to NHS patients in England via the CDF. It was recommended for use on the CDF to allow longer-term data to be collected.

• MSD’s KEYTRUDA was also made available on the CDF as an option for some people with melanoma.

Cancer in the NHS Long Term Plan

The NHS Long Term Plan was published in early January and cancer features highly. It focuses on prevention, screening, diagnosis, treatment and follow up. The plan includes:

• A focus on prevention to help reduce the risk of cancer

• Offering all children with cancer whole genome sequencing to enable more comprehensive and precise diagnosis, and access to more personalised treatments

• A commitment that from September 2019, all boys aged 12 and 13 will be offered vaccination against HPV-related diseases

• Raising greater awareness of cancer symptoms, lowering the threshold for GP referral, accelerating access to diagnosis and treatment and maximising the number of cancers identified through screening

• Modernising the Bowel Cancer Screening Programme

• Reviewing the current cancer screening programmes and diagnostic capacity

• Implementing a new timed diagnostic pathway for specific cancers

• Overhauling diagnostic services for patients with suspected cancer

• Investing in new equipment which can deliver faster and safer tests

• Speeding up the path from innovation to business-as-usual, by spreading proven new techniques and technologies and reducing variation

• Ensuring safer and more precise treatments including advanced radiotherapy techniques and immunotherapies will continue to support improvements in survival rates

• Extending the use of molecular diagnostics and, over the next 10 years, routinely offer genomic testing to all people with cancer for whom it would be of clinical benefit,
and expand participation in research.

Sources:
https://www.cancerresearchuk.org/health-professional/cancer-statistics/risk#heading-Zero
https://digital.nhs.uk/data-and-information/publications/statistical/cervical-screening-programme/england—2017-18
https://www.cancerresearchuk.org/sites/default/files/fundingacrosspipeline_twit_pic.png?itok=xr5dvEEQ
https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/immunotherapy/types/vaccines-to-treat-cancer | https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/
https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/#hpv-vaccination-for-men-and-boys
*NHS Long Term Plan https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan.pdf