Opportunities for more personalised lung cancer care by Stefano Gortana

PUBLISHED: 13/03/2017

Bringing together parliamentarians and a wide range of experts from the clinical, academic and public sectors, the meeting of the All-Party Parliamentary Group on Personalised Medicine on 28 February 2017 examined patient needs and scientific opportunities for more personalised care for lung cancer.

As APPG Chair, Jo Churchill MP began the meeting by highlighting the challenge of lung cancer (which has much poorer survival rates than most cancers), including the fact that 46,000 people are newly diagnosed in the UK every year. Asking how we can make the patient journey and outcomes better, Jo suggested that personalised medicine, and promising new science and technology in particular, offered real opportunities to improve diagnosis and treatment of this disease.

In order to explore this complex topic, the APPG convened a panel of experts including Ms Janette Rawlinson, a lung cancer survivor and active member of her local CCG, Dr Sanjay Popat, a consultant thoracic medical oncologist and senior lecturer, and Dr Robert Rintoul, a consultant respiratory physician and lead clinician for cancer at Papworth Hospital.

Patients: one size does not fit all

As a non-smoker, Janette Rawlinson said she was shocked by her lung cancer diagnosis, particularly since health professionals had been telling her there was nothing to worry about. Drawing on her personal experience of searching for answers to her questions on the internet, she believes lung cancer patients need better mechanisms to discern what information is real and fake, and help to understand the reality of the situation. This of course requires a better patient-doctor relationship. 

Janette argued that lung cancer patients must be recognised as individuals; the disease has arisen for different reasons in different patients; tumours also vary between patients; and treatments should be offered with a view to the lifestyle of each particular patient, as well as the nature of their cancer. Following a diagnosis, lung cancer patients want to know whether they will live and what quality of life they can expect – it is not merely a question of treatment at any cost.

Personalised treatments and diagnostics for lung cancer

Whilst acknowledging there is still plenty of room for improvement, Dr Sanjay Popat stressed that lung cancer treatment has already come a long way in the last 15 to 20 years. From the early days of chemotherapy, the advent of genomic medicine and the emergence of tyrosine kinase inhibitors have led to earlier diagnoses, more targeted treatments and ultimately better lung cancer outcomes. He outlined the particular benefits of circulating tumour DNA (ctDNA) testing, which allows non-invasive analysis of small amounts of lung cancer tumour DNA circulating in the blood, as opposed to taking a tissue sample (biopsy) of the tumour. Ultimately, the goal is to facilitate the implementation of this technology so that it becomes part of routine NHS care for lung cancer patients.

The future of lung cancer care is more accurate, non-invasive diagnosis

Dr Robert Rintoul focused on the importance of early detection and the need for better screening strategies to improve lung cancer outcomes. Technology and science, he noted, are increasingly providing opportunities to improve the accuracy of diagnoses and the effectiveness of treatment. Rather than more scans, biopsies and bronchoscopies, Dr Rintoul argued that the future of lung cancer diagnosis lies in non-invasive tests like ctDNA testing, nasal swabs and the breathalyser test developed by Owlstone Medical, for which he has led promising early clinical trials. The next step is to carry out further trials in order to ensure accuracy and develop a larger screening programme that could potentially be rolled out across the NHS. 

Access, awareness and capacity, digitisation and leadership 

Jo Churchill concluded the meeting by chairing an extensive Q&A session spanning many diverse topics. With patient care and improved outcomes as the key driving factor behind all of their work, the attendees were confident lung cancer care would continue to improve.

They acknowledged the opportunity to improve diagnosis in primary care, stressing the need to provide more accurate information, offer more integrated care, and recognise when patients present multiple times with symptoms that could relate to lung cancer. The issue of funding for tests such as ctDNA analysis was noted, with a lack of commissioning mechanisms to support ongoing testing (as opposed to one-off diagnostic testing) to underpin the delivery of longer-term responsive targeted treatment.

The issue of NHS variation in access to the best care for lung cancer was another prominent theme, as attendees stated that the implications of a ‘postcode lottery’ and a poorly digitised NHS were visibly undermining lung cancer outcomes and exacerbating uneven survival rates. The question of clinical capacity came to the fore in this context. It was highlighted that the pace of innovation in lung cancer diagnosis and treatment was such that it was impossible for many hard-pressed specialist oncologists to keep up with new opportunities for better care; GPs were even further removed from the cutting-edge of highly specialist trialling and adoption of science-driven improvements in diagnosis, monitoring and treatment.

The APPG on Personalised Medicine will continue to explore topics in personalised medicine, providing a platform for rigorous debate and discussion of innovative science and technology that could foster a more effective and efficient NHS, and identifying cross-cutting issues where concerted action may be needed to ensure patients enjoy the benefits of innovation.