Concepts in Development
The AGITG research development strategy and prioritisation framework outline the process by which concepts progress from embryonic ideas to funded trials. The concepts listed below have been identified as a research priority for AGITG by the Working Parties, Consumer Advisory Panel and Scientific Advisory Committee, and are currently seeking funds to commence the trial.
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TUMOUR: Small Bowel
Small bowel cancer is a rare cancer. The current best method of curing this disease is surgery with the aim of completely removing the tumour. In view of the rarity of this disease, there are no studies regarding the benefit of chemotherapy after the patient undergoes surgery. In studies of large bowel cancer, results show that surgery followed by chemotherapy reduces the chance of the disease returning.
BALLAD hopes to see whether giving chemotherapy decreases the disease from returning and improves survival. In addition, it will assess which chemotherapy group works better.
TUMOUR: Gastro-Intestinal Stromal Tumour (GIST)
Three years of imatinib is considered the standard duration of post therapy for patients with operable high-risk GIST. Yet, many patients are still at a high risk of GIST recurrence after completion of three years of adjuvant imatinib, and might benefit from further adjuvant imatinib therapy. The aim of SSGXXII is to compare the effect of giving imatinib for 5 years against 3 years, in patients who have undergone surgery for GIST, with the intent to prevent the tumour from coming back. The trial will look at the effect of the efficacy and safety of 5 years of treatment compared to 3 years.
PET scan of cell death to predict response to neoadjuvant therapy in rectal & oesophageal carcinoma
TUMOUR: Rectal & Oesophageal
An important role of medical imaging in oncology is the assessment of treatment response, i.e. tumour cell death in as a consequence of treatment. Cell Death Indicator (CDI) is a non invasive treatment response following treatment, representing a new paradigm for assessing treatment response. Measurement of tumour cell death soon after commencement of therapy (within hours or days) is expected to give useful information regarding the effectiveness of therapy as greater amounts of cell death would likely translate to better response over multiple cycles of chemotherapy or fractions of radiotherapy. Patients will receive CDI-PET CT scans 24 and 48 hours after commencement of treatment to assess early cell death. A potential advantage of CDI is that it should report on cumulative cell death following some period of treatment.
TUMOUR: Pancreatic Cancer
Pancreas cancer continues to be a challenging cancer to diagnose, with a 5-year survival rate of 8.9%. Neo-IMPACT is a pilot study to treat people with early stage pancreas cancer chemotherapy with immunotherapy before surgery. In the last 12 months, there have been several advances that indicate that the manipulation of the microbiome, the make-up of the individual’s gut bacteria, may be critical to the success of future research programs in pancreas cancer. Immunotherapy has been shown to be effective across multiple cancers but is yet to show effect in pancreas cancer.
TUMOUR: Pancreatic Cancer
Pancreatic cancer is a rare cancer with a poor prognosis. It is associated with a high prevalence of weight loss and malnutrition. Identifying and treating this early, through improved assessment techniques, could lead to improved outcomes for patients with Pancreatic Cancer. A simple measurement of weight, or body mass index (BMI), is currently commonly used, although it does not accurately identify those at most risk, or changes in muscle tissue. The most accurate way to measure body composition is using CT scans, however, this requires skilled staff and is time consuming. Malnutrition and loss of muscle mass can be identified with a quick-to-use tool called the Patient Generated Subjective Global Assessment (PG-SGA).
The PG-SGA is commonly used by dietitians when completing nutrition assessments in patients with Pancreatic Cancer. The relationship between the PG-SGA malnutrition diagnosis and CT-diagnosed low muscle mass has not yet been investigated in Pancreatic Cancer. Given the PG-SGA tool is widely accessible and low cost, comparing its use to the gold standard CT-assessed body composition is warranted. This may improve the management of patients with Pancreatic Cancer in the future.