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UK Research and Innovation, Cancer Research UK and industry are investing more than £11 million in an Oxford-led artificial intelligence (AI) research programme to improve the diagnosis of lung cancer and other thoracic diseases.
Professor Fergus Gleeson at the University of Oxford will lead on a programme of research focusing on accelerating pathways for the earlier diagnosis of lung cancer. Lung cancer is the biggest cause of cancer death in the UK and worldwide, with £307 million/year cost to the NHS in England. The earlier that lung cancer is diagnosed, the more likely that treatment will be successful but currently only 16% patients are diagnosed with the earliest stage of the disease. To address this clinical problem, NHS England is launching a £70 million lung cancer screening pilot programme at 10 sites*.
To improve patient care beyond the current screening guidelines, a team of academics from Oxford University, Nottingham University, and Imperial College London; NHS clinicians from Oxford University Hospitals NHS Trust, Nottingham University Hospitals NHS Trust, the Royal Marsden Hospital, the Royal Brompton Hospital, and University College London Hospitals NHS Foundation Trust; and the Roy Castle Lung Cancer Foundation will join forces with three leading industrial partners (Roche Diagnostics, GE Healthcare, Optellum).
Working with the NHS England Lung Health Check programme, clinical, imaging and molecular data will be combined for the first time using AI algorithms with the aim of more accurately and quickly diagnosing and characterising lung cancer with fewer invasive clinical procedures. Algorithms will also be developed to better evaluate risks from comorbidities such as chronic obstructive pulmonary disease (COPD). In addition, this programme will link to data from primary care to better assess risk in the general population to refine the right at-risk individuals to be selected for screening. It is hoped that this research will define a new set of standards for lung cancer screening to increase the number of lung cancers diagnosed at an earlier stage, when treatment is more likely to be successful.
Professor Fergus Gleeson, Chief Investigator for the programme, said
“The novel linking of diagnostic technologies, patient outcomes and biomarkers using AI has the potential to make a real difference to how people with suspected lung cancer are investigated. By differentiating between cancers and non-cancers more accurately based on the initial CT scan and blood tests, we hope to remove the delay and possible harm caused by repeat scans and further invasive tests. If successful, this has the potential to reduce patient anxiety and diagnose cancers earlier to improve survival and save the NHS money.”
This programme builds on the National Consortium of Intelligent Medical Imaging (NCIMI) at the Big Data Institute in Oxford, one of five UK AI Centres of Excellence. The funding, delivered through UK Research and Innovation’s (UKRI’s) Industrial Strategy Challenge Fund, is part of over £13m government investment in ‘data to early diagnosis and precision medicine’ for the research, development and evaluation of integrated diagnostic solutions. UKRI is also partnering with Cancer Research UK, which is making up to a £3m contribution to the cancer-focused projects. The Oxford-led project is one of six awarded from this competition.
Science Minister, Amanda Solloway MP, said:
“Our brilliant scientists and researchers in Oxford are harnessing world-leading technologies, like AI, to tackle some of the most complex and chronic diseases that we face. Tragically, we know that one in two people in the UK will be diagnosed with some form of cancer during their lifetime. The University of Oxford project we are backing today will help ensure more lives are saved and improved by using state of the art technology to identify cancerous tumours in the lung earlier and more accurately.”
Dr Timor Kadir, Chief Science & Technology Officer at Optellum Ltd, commented:
“Three industry leaders – Roche, Optellum and GE – have joined their expertise in molecular diagnostics, imaging and AI to help diagnose and treat lung cancer patients at the earliest possible stage. The programme results will be integrated into Optellum’s AI-driven Clinical Decision Support platform that supports physicians in choosing the optimal diagnostic and treatment procedures for the right patient at the right time.”
Ben Newton, General Manager, Oncology, at GE Healthcare, said:
“We are very pleased to be working with the University of Oxford via the NCIMI project on this important lung cancer research. By extending our existing NCIMI data infrastructure and creating innovative AI solutions to spot comorbid pathologies, we aim to help identify lung diseases earlier in the UK.”
Geoff Twist, Managing Director UK and Ireland and Management Centre European Agents at Roche Diagnostics Ltd, said:
“We are thrilled with this funding award, because it gives us the opportunity to work towards ground-breaking innovation in early diagnosis and because working in partnership is vital to achieve success in the health system. By bringing together the collective knowledge and expertise of these academic, medical and industry partners, this project has the potential to impact patient care globally through new diagnostic solutions in lung cancer.”
Dr Jesme Fox, Medical Director of the Roy Castle Lung Cancer Foundation, said:
“The majority of our lung cancer patients are diagnosed too late for the disease to be cured. We know that we need to be diagnosing lung cancer at an earlier stage, through screening. This innovative project has the potential to revolutionise lung cancer screening, making it more efficient and most importantly, saving lives. Roy Castle Lung Cancer Foundation is delighted to support this Programme”
Professor Xin Lu, co-Director of the CRUK Oxford Centre and Director of the Oxford Centre for Early Cancer Detection, commented:
“I am delighted that this national multi-site collaborative programme will be led from Oxford by Fergus Gleeson. Involving a world-class team of academics, clinicians, local and global industry, and patient representatives, this research is hugely important for accelerating lung cancer detection.”
* The 10 NHS England Lung Health Check sites are:
- North East and Cumbria Cancer Alliance – Newcastle Gateshead CCG
- Greater Manchester Cancer Alliance – Tameside and Glossop CCG
- Cheshire and Merseyside Cancer Alliance – Knowsley CCG and Halton CCG
- Lancashire and South Cumbria Cancer Alliance – Blackburn with Darwen CCG and Blackpool CCG
- West Yorkshire Cancer Alliance – North Kirklees CCG
- South Yorkshire Cancer Alliance – Doncaster CCG
- Humber, Coast and Vale Cancer Alliance – Hull CCG
- East of England Cancer Alliance – Thurrock CCG and Luton CCG
- East Midlands Cancer Alliance – Northamptonshire CCG and Mansfield and Ashfield CCG
- Wessex Cancer Alliance – Southampton CCG
Yang Shi, who joins Ludwig from Harvard University, is a world leader in the field of epigenetics, which explores how chemical modifications to chromatin—the combination of DNA and histone proteins—control the organisation and expression of the human genome. Aberrations in those processes are vital drivers of cancer and underlie many other diseases and disorders.
“Yang has an outstanding track-record of innovative research into the identity and mechanisms of action of chromatin modifiers. We are delighted that Yang is bringing his wealth of experience, international standing and collaborative spirit to lead our cancer epigenetics theme at Ludwig Oxford.”
~ Xin Lu, Director of the Ludwig Oxford Branch.
Shi is widely known for his discoveries regarding a chemical modification, methylation, made to the histone proteins. In 2004, Shi and his colleagues identified and characterised an enzyme, LSD1, that erases methyl marks from histones. Their discovery upended a 40-year-old dogma that considered such modifications irreversible, altering longstanding models of genomic regulation. Shi’s laboratory went on to identify many other histone demethylating enzymes with roles in a diverse array of biological processes. More recently, his group discovered several enzymes that methylate RNA and possibly influence the translation of gene transcripts into proteins.
Shi is applying these fundamental discoveries to the benefit of patients. His group’s work on LSD1 led to the development of LSD1-inhibitors now in clinical trials for the treatment of cancer. More recently, Shi and his colleagues demonstrated that inhibiting LSD1 might also help make otherwise non-responsive tumours susceptible to the checkpoint blockade immunotherapy. His lab is additionally studying the role and therapeutic manipulation of epigenetic modifiers in pediatric high-grade gliomas and acute myeloid leukaemia.
“Yang’s science is of the highest calibre—as rigorous and collaborative as it is original—and we are very excited to have him in the Ludwig community. I’m sure many of our researchers will benefit from his expertise, and that they will be equally generous with their own expertise and support as he explores the implications of his discoveries for cancer biology and the design of new therapies.”
~ Chi Van Dang, Scientific Director of the Ludwig Institute.
Shi obtained his PhD from New York University, completed his postdoctoral training with Thomas Shenk of Princeton University and joined the faculty of Harvard Medical School in 1991, where he was most recently C.H. Waddington Professor of Pediatrics. Shi has received many honours for his contributions to epigenetics and is a fellow of the American Association for the Advancement of Science and a member of the American Academy of Arts and Sciences.
Clinical trial research from Prof Sarah Blagden, Department of Oncology, was recently published in Lancet Oncology. This work was conducted as part of the larger ICON8 ovarian cancer study and found that ovarian cancer patients placed on a more-frequent chemotherapy treatment plan have the same survival rates but poorer quality of life than those receiving the standard, less-frequent treatment.
Chemotherapy can cause significant side effects which can impact on the day-to-day functioning of patients. Some of these are not necessarily definable symptoms but manifest in changes to their Quality of Life (QOL) – such as the ability to work or take part in family life.
QOL is of particular importance to cancer patients, especially those with advanced or terminal cancers. Investigators are increasingly encouraged to include measures of QOL, via specific questionnaires, into their clinical studies but it is often measured poorly (using the wrong questions or too infrequently).
ICON8 was a phase III clinical trial that randomised 1,540 patients with advanced epithelial ovarian cancer to three different chemotherapy regimens. Those in one arm received chemotherapy once every three weeks (the current standard treatment), whilst patients in the other two arms received chemotherapy weekly.
Although the study showed patients in the thee arms had the same survival outcome, suggesting the weekly or 3-weekly treatments were equivocal, the QOL analysis gave a very different picture. It showed that patients who on the weekly treatments had more fatigue and longer-lasting nerve damage. Sarah’s research concluded that the 3 weekly (standard) treatment was more tolerable for ovarian cancer patients and the different treatments were not equivocal after all.
Sarah Blagden, Associate Professor says;
To me, this study highlights how important it is to include the patients’ experience as a readout in clinical trials. The patients and study centres were fantastic at ensuring the QOL questionnaires were filled in and collected, and the data were carefully analysed by the MRC Trials team at UCL. The results completely changed our interpretation of the data. Not only that, but we can now confidently tell patients starting this treatment in the future what their experience is likely to be.
Whilst survival rates are often prioritised over QOL when interpreting study results, QOL is an important factor to consider when weighing up the benefits of one treatment over another. Patients and their wellbeing need to be at the forefront of this decision-making process.
To read more about this paper see here.
This research was funded by Cancer Research UK, Medical Research Council, Health Research Board Ireland, Irish Cancer Society and Cancer Australia.