Since 2013 there have been 4 research grants awarded through funds raised by the NET Patient Foundation and UKINETs. The objective of these grants is to offer support for NET research groups to obtain pilot data leading to larger comprehensive studies. To date, all recipients have achieved this objective.
For each grant call there has been an enthusiastic response from NET research groups throughout the UK. The quality of the applications to date has been extremely high, and following external peer review, four applications have been funded. The projects funded to date are summarized below and have furthered our knowledge of NET epidemiology, early diagnosis and biology.
The TransNETS committee was replaced by the UKINETs Research Committee in early 2016, this committee will now oversee the application process and award of the new NET Patient Foundation grants.
Dr Chrissie Thirlwell, Chair, UKINETS Research Committee
Professor Mark Prichard led a team aiming to understand the cause of genetic changes that result in neuroendocrine tumours of the stomach. Prof Prichard is Professor of Gastroenterology at the Institute of Translational Medicine, University of Liverpool.
Neuroendocrine tumours (NETs) of the stomach occur most commonly in patients who have pernicious anaemia. In this condition, patients can no longer produce stomach acid. This means that they cannot absorb vitamin B12 from their food and this leads to the development of anaemia.
Patients with pernicious anaemia also produce too much of a hormone called gastrin and in these individuals high levels of gastrin can usually be detected in a fasting blood sample. In people without pernicious anaemia, gastrin stimulates the stomach to produce acid. However, patients with pernicious anaemia cannot produce stomach acid, and therefore, gastrin stimulates another cell type in the stomach (called the ECL cell) instead. Gastrin makes these ECL cells divide and grow more quickly than normal and in some cases this can lead to the development of NETs.
If these so called ‘type I gastric NETs’ are small (less than 1cm in diameter), patients usually require no treatment. Doctors normally recommend that such tumours are regularly monitored by 1-2 yearly camera tests (endoscopies). However type I gastric NETs that measure more than 1-2cm in size may cause problems and they are therefore usually removed (by endoscopy or surgery).
We have recently conducted a clinical trial in eight patients with type I gastric NETs to see whether a new tablet called Netazepide can be used instead of surgery to make these tumours shrink. Netazepide is a gastrin receptor antagonist, meaning that it is a drug that blocks the effects of gastrin. We showed that netazepide caused some type I gastric NETS to shrink in size and importantly this medication caused no significant side effects. Further longer trials involving larger numbers of patients are needed to assess how effective this new treatment really is, but netazepide may turn out to be an effective alternative to the more invasive surgical treatment options for this type of tumour.
We plan to use the current grant funding from the NET patient foundation and TransNETS to analyse how the expression of several thousand genes changed in the stomachs of our eight trial patients during and after netazepide treatment. Biopsy samples are already available for these studies. The results of this research may eventually enable us to develop tests to monitor whether netazepide treatment is effective in an individual patient and may also help us to decide whether we should add in treatment with an additional second drug to make netazepide therapy more effective.
Dr Davlinder Mandair is a trainee gastroenterologist who is currently undertaking a PhD under the supervision of Prof Tim Meyer, Prof Martin Caplin and Dr Chrissie Thirlwell at the UCL Cancer Institute in London.
The project builds on previous work conducted in Prof Meyer’s Lab which demonstrated, for the first time, that circulating tumour cells (CTCs) were detectable in the blood of patients with a range of NETs, and that their presence indicated an adverse prognosis. Technology has now advanced to the extent that detailed molecular characterisation can be conducted on single cells and this project will compare the genetic changes seen in primary tumour tissue with that of CTCs and also with cfDNA (pieces of DNA that arise from the tumour and can be found circulating in the blood stream).
If we can show that CTCs and cfDNA does indeed accurately represent the tumour, then we will be able to track how the tumour evolves over time and during treatment. This may allow clinicians treating patients with NETs to select the appropriate therapy and to anticipate the emergence of resistance. As cancer therapy becomes increasingly personalised, it is important that we can undertake this type of analysis so that patients can benefit fully from the new drugs that target specific cancer pathways.
Prof Ramage is a Consultant Physician in Gastroenterology and Hepatology, and lead clinician for the Neuroendocrine Tumour Service at King’s College Hospital NHS Foundation Trust.
The project will study the NETs that were identified in the Colorectal NET and the Bowel Cancer Screening Programme (BCSP). The aim is to understand how these were identified, how they were investigated and how they were treated.
The Bowel Cancer screening programme has screened 1 million people using faecal occult blood (FOB -blood in the stool) testing and 17,500 colonoscopies have been performed. Overall, 7.8% ( women) and 11.6% (men) of the colonoscopies detected a colorectal (CR) cancer. However the data regarding the NET tumours that were identified has not been analysed.
The incidence of CR NET in the general population is thought to be 1.3 per 100,000. The incidence in patients with positive FOB is unknown but CR cancer incidence is 46 per 100,000 in England and thus NET incidence might be 46/1.3 times less likely to be found than CR cancer. This would be 35.4 times less likely which would equate to 1772/ 35.4= 50 cases. It is also possible that some ileal carcinoids will have been found during colonoscopy, and these are twice as common as CR NET.
This study will identify how many CR and ileal NET were found by screening if screening has any value for earlier diagnosis. It will also establish how many of these were seen by NET specialists.
Jorge Barriuso who works with Prof. Juan Valle at the Christie Hospital was awarded £30,000. The aim of the project is to identify predictive genetic markers of exceptional response to targeted therapies, therefore allowing treatment stratification. Samples from the Christie NET biobank would be used for this pilot study.
This year the £30,000 grant will be funded solely by the NET Patient foundation, the details and timeline for applying will be posted on the UKINETs and NET Patient Foundation websites in July 2016. The successful application will be invited to present their project and results at the UKINETs annual meeting.
Congratulations to Christodoulos Pipinikas, the recipient of our 2016 award, which will be funding this exciting project:
Using an integrated approach combining data generated through the use of different, advanced molecular tools, we have previously demonstrated that neuroendocrine tumours of the pancreas and gastrointestinal tract are highly epigenetically dysregulated and have identified several altered biological pathways and genes that may form the basis for the development of novel therapeutic targets. In addition, our group has identified specific molecular disease subtypes associated with a significant impact on patients’ survival, indicating that these may benefit from different treatments. Using a similar approach, we would like to extend our understanding of the key molecular events involved in the development and progression of bronchopulmonary neuroendocrine tumours (BP-NETs). BP-NETs represent a significant disease burden with socioeconomic extensions due to their increased incidence and decreased 5-year survival rates. BP-NETs comprise approximately 20-25% of all lung cancers and represent a spectrum of tumours arising from neuroendocrine cells of the bronchopulmonary epithelium. Tumour classification into the correct histological sub-group is strongly predictive of patients’ prognosis but relies on few, difficult to reproduce pathological parameters which are often affected by a high inter-observer variability. Therefore, the aim of this project is to identify novel and accurate molecular tools in order to improve the classification of these tumours. This in turn will provide better prognostic information and help with choosing more appropriate treatments. In addition, we aim to study the underlying pathogenic mechanisms involved in disease development and progression through the use of large-scale integrated omics analyses.