Oesophagogastric Cancer Centre of Excellence

Of the most common types of cancer, people with oesophagogastric (oesophagus and stomach) cancers have amongst the worst clinical outcomes with an overall 10-year survival rate of only 12% for oesophageal and 16% for stomach cancer, compared to 50% for all other cancers combined. Every year there are around 12,500 new oesophagogastric cancer cases and 11,400 oesophagogastric cancer deaths in the UK.

What makes oesophagogastric cancer so lethal is the fact that it is difficult to detect and does not respond well to treatment. Most people with oesophagogastric cancer are diagnosed when their cancer is at a later stage, and as a result, a cure is not possible.  While the average detection rate for all cancers at Stages 1 and 2 is 38.7% in the UK, less than 15% of oesophageal cases are detected this early.

Even if all cases of oesophagogastric cancer were diagnosed early, most people would still have outcomes significantly worse than that of most common cancers. While around 85% of people with breast, prostate, colorectal and melanoma cancer survive for over 5 years after detection at stage 2 or earlier, fewer than 50% of people with oesophagogastric cancer can hope to survive this long. While early detection efforts will hopefully yield clinical results in the coming years, Oxford’s approach to improving treatment for people with oesophagogastric cancer will focus on improving the quality of treatments available for the majority of oesophagogastric cancer patients, who have more advanced cancer. 

In 2017 Xin Lu and Mark Middleton identified Oesophageal cancer as a strategic development opportunity for Oxford Cancer. In establishing our Oesophageal Cancer Centre of Excellence, we have cultivated an Oxford-based community of clinicians to take the field forward. Through our Centre of Excellence, Oxford’s patient advocacy team in partnership with our internationally respected clinical researchers are developing new treatments to enable healthier and happier lives, and possibly new cures. This is being achieved by putting Oxford’s world-leading scientific insights and a global network of academic and commercial collaborators to good use by working on our key programmes for patient benefit.

The overarching clinical aim of this initiative is to improve perioperative clinical options for people with cancer, for example, we will ensure that people who would benefit from surgery receive the combination of drugs, immunotherapy and surgery that will provide them with the best possible lasting high-quality of life. Below summarises some of our flagship programmes delivering these clinical improvements:

New Drugs and Immuno-therapies

New drugs and the introduction of immunotherapies (treatments that harness the patient’s immune system) have revolutionised outcomes for many different cancer types. 10 years ago, almost no late-stage melanoma cancer patient survived more than 5 years, today combination immunotherapy has shown over 50% five-year survival with a third of patients having no cancer progression at all. Immunotherapies are also impacting therapies for other cancers like triple-negative breast cancers, where combined with chemotherapy doubles progression-free survival time in trials.

In our Centre, projects led by our team of experts will ensure that these innovative new therapies benefit oesophagogastric cancer as much and as soon as possible. Eileen Parkes’ group focuses on better understanding the makeup of the oesophagogastric cancer microenvironment to develop new treatments. At the same time, Elizabeth Smyth and Richard Owen’s teams are analysing samples from the clinic to understand which treatments work best, in which combination and in which patients.

Better Biomarkers 

It is challenging to know which is the best treatment option for individual patients due to the limited number of suitable biomarkers to guide decision-making. We know some patients benefit from chemotherapy treatment before surgery while proceeding straight to surgery is the best option for others.  Immunotherapy and targeted therapy are also being investigated in this area.   Additional drug and immunotherapy treatments are needed after surgery for some patients but the side effects of these mean it is important that patients who won’t benefit are not treated. Today we have more treatments available for oesophagogastric cancer patients than ever before, but we have yet to understand which patient would best benefit from which treatment. Through a series of clinical studies led or co-led by Sheraz Markar (SARONG), Richard Owen (LUD2015-005, TransSARONG) and Lizzy Smyth (DECIPHER, TIRAGA, VESTIGE), we are seeking to develop new ways of tailoring therapy to individual patients.

Translational Biomarker Research Programme

This programme aims to establish advanced pathology assessments as standard practice in the NHS, enabling more targeted therapies and enhancing recruitment to clinical trials. This seeks to develop a high-throughput assay/readout that surpasses current models and will be adaptable to accommodate emerging biomarkers. This programme will integrate standard NHS biomarker assessments, bespoke immunofluorescent panels that explore novel biomarkers and characteristics of the tumour microenvironment and patient health data to identify predictors that could point to the best possible treatment.

Better Surgery

Removing oesophagogastric tumours requires a long and challenging surgery and is associated with significant physical and digestive side effects that permanently impact patients' quality of life. Because little is understood about the symptoms associated with surgery, how they interact with the side effects of chemotherapy, new immunotherapies and how these change over time, Sheraz Markar will run a study that collects and analyses patient-reported outcomes to identify patients who need additional support. This information will also be critical in comparing new treatments to ensure those that extend the quality and the length of life are prioritised.

Oesophagogastric cancer surgery is a major and complex operation, and the quality of the surgery itself significantly impacts patient outcomes. New methods and techniques are often introduced in the clinic by surgeons in an effort to improve outcomes. Part of Sheraz Markar’s research will involve making sure that these innovations are properly tested and rapidly implemented to offer the best possible care.