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How chemotherapy impacts the body

Current standard cancer treatments, such as chemotherapy and radiotherapy, can have lasting effects on the body. Chemotherapy for example is associated with many side effects, such as nausea and anaemia, due to the impact of the toxins on healthy tissue as well as the tumour.

Neoadjuvant therapy, whereby therapies are administered before the main treatment, to help reduce the size of a tumor or kill cancer cells that have spread, has previously been suggested to contribute to changes in the composition of a patient’s body. This includes reduction in muscle mass (or ‘sarcopenia’) which is a natural result of aging, but in those with cancer it can lead to some post-operative complications and other diseases further down the line.

A new study from Mr Nick Maynard, Oxford University Hospitals Trust, has assessed the changes in muscle mass in gastro-oesophageal cancer patients, to better understand the long-lasting impact therapies have on the body and if it can be used to predict the risk of post-op complications. From a sample of 199 patients, they observed a decrease in skeletal mass in all individuals, with 91 participants losing more than 5% of their original skeletal mass. Those with a high rate of muscle mass depletion were generally male and significantly older, i.e. over the age of 67 years old.

50% of patients in the study experienced post-operative complications, such as pneumonia, with 13% having severe complications. However, Nick and the team observed that this was not related to the patient’s loss of skeletal mass.

Fortunately, this means that patients undergoing surgery for oesophageal cancer with large reductions in muscle mass are not necessarily at an increased risk of post-operative complications. Whilst these results do not produce any new method for predicting post-op complications, as sarcopenia did not determine the frequency of post-op complications in the sampled patients, they provide a deeper understanding of how neoadjuvant therapies can impact the body. This is important as post-operative loss of muscle mass has been previously associated with a lower survival rate for oesophageal cancer patients, so this will help to inform clinicians which patients may need to be more closely monitored.

Therapeutic potential for breast cancer found in the matrix

Work currently underway in the laboratory of Prof Kim Midwood is investigating the therapeutic anti-cancer potential of tenascin-C, a molecule found in the extracellular matrix of breast cancer

Understanding clonal haematopoiesis for COVID and cancer

Prof Paresh Vyas and team have been investigating how a better understanding of clonal haematopoiesis can be applied to both cancer and to care of COVID patients

Balancing the benefits and risks of radiotherapy for Hodgkin lymphoma

Dr Rebecca Shakir is devising a tool to allow some blood cancer patients to make more informed decisions about the risks and benefits of their radiotherapy treatment

Epigenetic markers for melanoma patient response to ICB therapy

Development fund winners Rosalin Cooper & Ben Fairfax are investigating the epigenetic landscape of melanoma patients and how it can impact patient sensitivity to ICB therapy

Harnessing immune cell therapy in cancer

Prof Paresh Vyas and his team are investigating how to harness the power of T cells as therapies for patients with a range of blood cancers

Using DNA & RNA to treat cancers

Cancer research UK Oxford Centre Development Fund Awardees Ysobel Baker and Tom Brown investigate the potential of DNA and RNA molecules as precision cancer treatments

Researchers discover cell communication mechanism that drives cancer adaptation

DPAG and Oncology researchers have uncovered a new mechanism by which cancer cells adapt to the stresses they encounter as they grow and respond to therapies

Researchers discover mutation that determines treatment efficiency

Weatherall Institute of Molecular Medicine researchers have recently discovered why a class of cancer drugs is beneficial only in a subset of patients

Power of the patient voice

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.