A ground-breaking breast cancer programme pioneered at Addenbrooke’s Hospital, which decodes the genetic sequence of a patient’s cancer is to expand in the East.
Breast cancer patients taking part in the Personalised Breast Cancer Programme (PBCP) are offered whole genome sequencing, where their DNA is read like a barcode, to help inform their cancer treatment and care.
The programme, which started at Addenbrooke’s, is now opening in Norfolk and Norwich University Hospital. The milestone means Norfolk and Norwich will be the fourth site in the East and the fifth site to open nationally after the programme was rolled out from Cambridge to Ipswich, Colchester and Oxford.
More than 1,500 patients have been enrolled in the Personalised Breast Cancer Programme so far. The whole genome sequencing, the results of which are returned within six to 12 weeks, allows patients to have more precise and personalised cancer treatment. At this stage in the programme, for many patients their results have confirmed they are receiving the best treatment available for their disease, whilst over a third have had a change in clinical management.
Professor Jean Abraham, who leads the research programme explained that for every patient on the programme DNA and RNA readouts from their tumour cells are compared with those of their healthy cells to study which genetic mistakes are causing the disease, and which weaknesses could be targeted with cancer drugs.
The beauty of this sequencing project is we get the data faster and can act on it. The benefits are various and depend on the stage of the cancer. If it’s at an advanced stage, the genetic information we get from the whole genome might push us towards a different treatment or you might find a specific mutation that means the patient could take part in a certain clinical trial.
Professor Abraham, oncology consultant at Cambridge University Hospitals NHS Foundation Trust and Director of the Precision Breast Cancer Institute
Professor Abraham added: "Some tumours have clustered regions of excessive amounts of mutations. These tumours are said to be hypermutated. Hypermutations are thought to respond better to immunotherapy and so we can push for an immunotherapy trial. Ultimately, these findings can help direct clinicians to using more novel and targeted drugs that have the best chance of helping individual patients."
The expansion of the Personalised Breast Cancer Programme – which comes during Breast Cancer Awareness Month – means more people in the East are set to benefit from personalised cancer treatment.
Every year, around 5,700 women, as well as a small number of men, are diagnosed with breast cancer in the East of England, whilst around 1,100 women in the region die from the disease.
Julia Beeden, 42, from Cambridge, was diagnosed with breast cancer a year ago. By taking part in the PBCP, Julia discovered her cancer was linked to a faulty BRCA2 gene. It meant she was eligible to receive a drug post-surgery called olaparib, which has been shown to reduce the risk of cancer recurrence for people with alterations in their BRCA genes.
At the beginning of the cancer journey, you lose control of everything. I knew I would lose my hair, my freedom, everything was going to change. However, by taking part in the Personalised Breast Cancer Programme and finding out about my genetics early on, this informed my decisions about surgery and it gave me access to these targeted drugs, so it gave me a little more control. Ultimately, the results informed my doctors – so it helped them, help me.
Julia Beeden
The results also impacted Julia’s family, as they were able to find out the BRCA gene mutation was from her father’s side of the family.
It explained why my father and my grandfather had prostate cancer. Most people think of the actor Angelina Jolie when they hear about the BRCA genes, I had no idea men could also be affected by this gene mutation. Now we know it affects my family, my brother is aware and can find out if he is at risk in the future.
Julia Beeden
The pilot phase of the Personalised Breast Cancer Programme began in November 2016. It was a collaboration between Cancer Research UK and Addenbrooke’s Charitable Trust, with over 250 patients from the Addenbrooke’s Breast Unit taking part and becoming the first NHS breast cancer patients to have whole genome sequencing of their tumour as part of their routine treatment in a clinically impactful timeframe. A further £1 million of funding from Cancer Research UK, plus more from The Mark Foundation for Cancer Research, was announced in 2018 to enroll a further 2,000 patients.
Dr Clare Hannon and Dr David Maskell are overseeing the study at Norfolk and Norwich University Hospital (NNUH). Dr Hannon said: "It is very exciting to be able to bring the programme to NNUH as part of a national drive for better cancer treatments and personalised medicine.
"Longer term, this study will help us to predict which patients will or won’t benefit from a particular treatment. It leads us to much more effective and personalised care which increases survival rates and reduces the side effects of treatments."
A lot of patients won’t see their treatment plan change, but it might offer hope and faster access to the most appropriate treatment if there’s a relapse. Having the genetic information of the tumour will give us a better idea of what to do should a patient relapse. It becomes an armoury of knowledge, and it could reveal weakness we can target. That can be very reassuring to patients. In addition, establishing an individual doesn’t carry any high-risk hereditary genes is a relief to both the patient and their family.
Professor Abraham
Professor Abraham and her precision breast cancer research team will move into the Cambridge Cancer Research Hospital (CCRH) when the new specialist hospital for the East of England opens on the Cambridge Biomedical Campus. The new hospital will change the story of cancer, breaking down barriers between laboratory and clinic, and enabling patients to benefit from the latest innovations in cancer science.
The programme is currently running at five sites: Addenbrooke's Hospital in Cambridge, Oxford, Colchester, Ipswich, and now Norwich, where it hopes to help hundreds more women and some men.
"I think it will save the NHS money as we won’t give treatments that aren’t effective and cause toxicity. We can speed up people’s time in hospital and, actually, in the end, we hope it’ll effect how well they do overall in terms of surviving their cancer," said Prof Abraham.
Dr Clare Hannon, programme lead at the Norfolk and Norwich University Hospital, said, for patients who are eligible: "The DNA will be analysed from the same routine biopsy and blood tests, meaning that there are no more tests or appointments than usual and no delays in starting treatment."