Clinical research on oesophageal and upper gastrointestinal cancer

There are two main types of cancer of the oesophagus – adenocarcinoma and squamous cell carcinoma. All cancers of the oesophagus and of the junction of the stomach are often at an advanced stage by the time they are diagnosed, so treatment outcomes are poor. However, some patients with a condition called Barrett’s oesophagus – where the cells lining the base of the oesophagus are modified – go on to develop oesophageal adenocarcinoma. Researchers in Cambridge are making breakthroughs in detecting which patients with Barrett’s oesophagus are at risk of developing this cancer.
 
Early detection of oesophageal cancer
Survival rates in cancer are directly related to the degree of disease spread at the time of diagnosis. Cancer can become advanced before any symptoms are manifest. Oesophageal cancer is a prime example of this problem. We have developed a screening test for Barrett’s oesophagus which comprises a device, CytospongeTM, coupled to a molecular marker, which is a much less invasive and cost-effective alternative to endoscopy. In collaboration with our primary care colleagues we performed a study of approximately 500 individuals which highlighted the potential utility of this approach. Development of a micro-simulation model showed that the CytospongeTM biomarker test, followed by endoscopic based treatments such as radiofrequency ablation for high-risk patients could be cost-effective when compared with the current endoscopic method for diagnosis and surveillance. This was done in collaboration with colleagues from the Department of Public Health and Primary Care (DPHP) and the MRC Biostatistics Unit. 
 
BEST2 trial
Ongoing work includes studies evaluating the acceptability and effects on quality of life of those treated in this way compared with endoscopy (collaboration with Fiona Walter, DPHP). The Cancer Research UK (CRUK) funded multi-centre BEST2 study of over 1,000 individuals is well underway to test this approach further. 
 
Oesophageal and stomach cancer treatment – COUGAR-02 trial
This trial has established docetaxel as the second line standard of care for patients with advanced oesophageal and stomach cancers. The protocol for this trial is available here: COUGAR-02 trial protocol. The trial results were published online on 10 December 2013 in Lancet Oncology.
 
Improving imaging for Barrett’s oesophagus
Our researchers have found a clinical application for the use of fluorescently-labelled lectins during endoscopic visualisation of pre-cancerous areas in Barrett’s oesophagus.
 
Current open trials in Cambridge

The table below lists current open trials for upper gastrointestinal cancers coordinated by the Cambridge Cancer Trials Centre (last updated January 2016).
Trial name Trial description Contact
Evaluation of a NonEndoscopic Device for Barrett's Oesophagus - BEST 2 Evaluation of a Non-Endoscopic Immunocytological Device (Cytosponge) for Barrett's Esophagus Screening in a Case-Control Study (BEST2) Prof Rebecca Fitzgerald
Neo-AEGIS Randomised Clinical Trial of neoadjuvant and adjuvant chemotherapy (MAGIC regimen) vs. neoadjuvant chemoradiation (CROSS protocol) in adenocarcinoma of the oesophagus and oesophago-gastric junction. Dr Hugo Ford
OCCAMS Multicentre Study to determine Predictive and Prognostic Biomarkers and Therapeutic Targets for Oesophageal and Junctional Adenocarcinoma including whole genome sequencing Prof Rebecca Fitzgerald
RAINFALL (I4T-MC-JVCU) A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study of Capecitabine and Cisplatin With or Without Ramucirumab as First-line Therapy in Patients With Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma Dr Hugo Ford
Trimodal Imaging and Molecular Endpoints Feasibility study to assess utility of Trimodal Endoscopic Imaging in to direct molecular tests on tissue samples and thereby improve prediction of individual risk of cancer and diagnosis of dysplasia in patients with Barrett's oesophagus Prof Rebecca Fitzgerald

If you would like further information about how to take part in any of the clinical trials listed here that are open to recruitment, please talk to your cancer specialist as patients usually need to be referred by their doctor. 

Cambridge Cancer Trials Centre contact for upper gastrointestinal (upper GI) cancer trials: Dr Hugo Ford