New research has developed a tool that can help predict the risk of bowel cancer coming back

A new test has been developed to help understand and predict the risk of cancer coming back in people with stage 2 and stage 3 bowel cancer by looking into how much the body's own immune system is working to fight the cancer.

Using this test, combined with other staging measures, could help doctors decide how much chemotherapy is best for each patient. The test is called Immunoscore® and the ongoing study will help fully understand how chemotherapy interacts with a patient's immune system. The test is not currently available for patients on the NHS.

We spoke to Consultant Medical Oncologist, Dr Tony Dhillon at the Royal Surrey NHS Foundation Trust, and Medical Director of HalioDx, Dr Marjane Le Bagousse, to find out more about this new test.

What is cancer staging?

Staging a cancer involves describing its size, where it is and whether it has spread. Knowing the stage of cancer helps doctors decide on the best treatment.

Some people with the same stage cancer can respond differently to treatment. This is because everyone's cancer is a bit different. Knowing more about how cancer varies between people could help make treatments more personal and specific to the individual. Research into precision medicine is growing to fill this unmet need.

What is Immunoscore®?

Immunoscore® is a new test that helps identify how likely it is for bowel cancer to come back. It could also be used to identify which patients will react best to different doses of chemotherapy. Researchers have found that looking at how the body's immune system attacks the cancer could help doctors work out how much chemotherapy to give to patients after surgery (also called adjuvant chemotherapy).

Currently after surgery, people with stage 2 bowel cancer may or may not receive chemotherapy and those with stage 3 are recommended to receive either three or six months of chemotherapy. How long a patient is treated for is based on a range of factors that are considered by the healthcare team, but sometimes patients receive too much or too little.

Using tests such as Immunoscore® could help personalise treatment for people with stage 2 and stage 3 bowel cancer to ensure they get the amount of chemotherapy that's right for them following surgery. Anyone who could benefit from having more chemotherapy would get enough to help ensure the cancer doesn't come back. Those who don't need as much could have less and avoid some of the toxic side effects of the treatment.

How do you take the test?

The Immunoscore® test is carried out after surgery and doesn't require any additional appointments or procedures.

1. After the tumour has been removed, a small piece of it is preserved and sent to a laboratory to be analysed.
2. The laboratory team look at how many a particular type of white blood cell are in and around the tumour. This is a measure of the 'immune response' and the patient will be given a score called an 'Immunoscore'. The more of these specific white blood cells there are, the higher the Immunoscore.
3. A high score means the cancer is less likely to return, and the patient may be able to have a lower dose or avoid chemotherapy altogether. A lower score may suggest a person needs a higher dose of adjuvant chemotherapy.
4. The results are returned to the hospital after a couple of weeks, allowing the healthcare team time to work with the patient to devise the best plan for treatment and care.
   
   

What is the future for Immunoscore®?

HalioDx, who manufacture Immunoscore®, are in the process of having the test evaluated for use in the NHS, so it isn't currently available routinely as part of NHS care. They expect to hear about decisions from the National Institute for Health and Care Excellence (NICE) in 2022. NICE will consider if Immunoscore® brings benefits to patients' quality and length of life and how much it will cost.

Some patients have been able to access the test through a few NHS hospitals as part of ongoing clinical trials in the UK, and it has been available for use in some UK private hospitals. If you are interested in finding out if you would be eligible for the Immunoscore® clinical trial, please speak to your clinical team or contact HalioDx directly.

Dr Lisa Wilde, Director of Research and External Affairs at Bowel Cancer UK, says: "This is exciting research and it's great to see the progress in the development of cutting edge tools in personalised medicine.

"This adds further to the growing evidence supporting the importance of investigating how the immune system interacts with bowel cancer. Being able to classify cancers more precisely can help personalise and optimise treatments so that patients get the amount of chemotherapy they need and help avoid some of the toxic side effects from treatment. This would ultimately improve survival for people affected by bowel cancer.

"However what is still unclear is if Immunoscore® will be able to do this for patients in the UK so more research is necessary to fully understand how it can be used to help guide clinical decisions around treatment."