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The Royal Marsden Healthcare experts

One size does not fit all

Our research into gastrointestinal cancers is advancing our understanding of how different patients respond to treatment.

10 August 2020

TAILOR-MADE TREATMENT Professor David Cunningham

The Royal Marsden offers a comprehensive specialist service for the diagnosis, treatment and care of patients with gastrointestinal (GI) cancers. In particular, upper GI cancers have some of the poorest survival rates of all solid cancers, so these are a prime focus of our research.

A key aim of GI cancer research is to improve cure rates, as well as reducing complications and avoiding over-treatment, by making treatments more precise and tailored to the needs of individual patients.

An important part of tailoring treatments is recognising that a one-sizefits- all approach may not be suitable. A recent study, which included more than 3,000 patients with upper GI cancers treated with chemotherapy, found that female patients had a better response to treatment than males, but were more likely to experience side effects.

“This is a significant finding and furthers our understanding of two types of cancer that affect almost 16,000 people each year in the UK alone,” says Professor David Cunningham, Consultant Medical Oncologist and Head of the GI Unit at The Royal Marsden, Director of the NIHR Biomedical Research Centre (BRC) at The Royal Marsden and The Institute of Cancer Research, London (ICR), and lead for the BRC’s GI Cancers research theme.

“There is a growing body of evidence that suggests gender can be an important factor in cancer treatment, and that clinicians need to be aware of such differences. For example, knowing that female patients are more likely to experience side effects such as nausea and vomiting, or diarrhoea, may allow consultants to provide patients with tailored chemotherapy support in order to optimise the management of these common problems.”

Understanding which patients will benefit from specific drugs and their risk of tumour progression is also vital if personalised and adaptive treatments are to be given. A recent study jointly led by Professor Andrea Sottoriva, Deputy Director of the Centre for Evolution and Cancer at the ICR, discovered that patient outcomes in colorectal cancer can be predicted by analysing tumour DNA in blood and tissue biopsy samples, in combination with mathematical modelling.

“The genetic makeup of cancer is highly complex and ever-changing,” says Professor Sottoriva. “Understanding how tumours evolve in response to treatment is key to combating drug resistance.”

An exciting new test, developed by scientists at The Royal Marsden and the ICR, analyses seven key genes to identify gastro-oesophageal cancer patients who are at risk of relapse following chemotherapy and surgery. Dr Anguraj Sadanandam, Team Leader in Systems and Precision Cancer Medicine at the ICR, says: “Our test could help select patients who are at high risk of relapse after surgery, allowing new therapies to be developed with the potential to change the future standard of care for this subset.

“If it works on a wider scale, this approach to treating gastro-oesophageal cancer could personalise standard clinical treatment and improve quality of life after treatment.”

Understanding how tumours evolve in response to treatment is key to combating drug resistance.

Professor Andrea Sottoriva, Deputy Director of the Centre for Evolution and Cancer at the ICR