Patient experience is central to measuring the quality of care in the NHS, and government policy encourages the use of patient-reported outcomes (PRO) to facilitate patient-clinician communication. However, patients with sarcoma may have experiences which are not reflected accurately with standard or generic PRO measures (PROMs). The aim of this project is to develop a sarcoma-specific PROM (S-PROM) and a strategy to incorporate this into clinical practice.
Patients with inoperable or metastatic soft tissue sarcoma have a poor prognosis with overall survival rates (of approximately a year) when treated with current first line palliative chemotherapy. There has been no change in the standard of care for over 20 years. Improved outcomes could be achieved by identifying biomarkers that can select soft tissue sarcoma patients most likely to benefit from current and novel therapies.
Sarcomas can return in the same place between 13% to 26% of the time and the treatment options for this local recurrence includes surgery, ablative therapies or radiotherapy.
Magnetic resonance-guided focused ultrasound (MRgFUS) has recently become an accepted treatment for metastatic bone carcinomas and benign uterine fibroid tumours without reports of the adverse events that other treatments can cause. The treatment uses the accuracy of Magnetic Resonance Imaging (MRI) scans to focus high intensity ultrasound waves at tumours to cause thermal ablation.
Myxofibrosarcomas are cancers that most commonly develop in the limbs. Surgery is the main treatment but because of the way these cancers grow, it is a challenge to successfully remove them. Unlike other cancers that are easily visible to the surgeon, myxofibrosarcomas often infiltrate nearby tissues making it difficult to accurately assess how much cancer is present. There is a risk that some cancer is left behind after surgery, and this may result in a poorer outcome for the patient.
Cancer is caused by mutations (or mistakes) in DNA – a person’s biological instruction manual. Some of these mutations are specific for certain cancer types and are therefore useful to make specific diagnoses and in some instances to determine the likelihood of a cancer becoming more aggressive in behaviour. There have been recent studies, albeit in small sample numbers that have discovered a spectrum of specific mutations in a rare form of cancer called malignant peripheral nerve sheath tumours (MPNSTs).
Sarcomas are difficult to treat and there is an urgent need to develop more effective therapies. Like other cancers, sarcomas, develop blood vessels that ‘feed’ them with oxygen and nutrients, and allow their growth and spread. Several drugs have been developed that specifically target and damage these blood vessels and some of these drugs are now being used to treat sarcoma. While some patients clearly benefit from this type of therapy others don’t, making it difficult to tailor treatments to the needs of individual patients.
There is a need to develop new therapies for primary, recurrent and metastatic sarcoma which don’t respond to standard surgical, radio- or chemotherapy treatment.
Recently there has been interest in the use of magnetic hyperthermia for the treatment of a number of solid tumours including brain cancers, with initial studies showing potential. Magnetic hyperthermia is based on the observation that when magnetic iron nanoparticles (MNPs) are exposed to an alternating magnetic field, energy is rapidly released as heat.
Rhabdomyosarcoma is a devastating muscle cancer that occurs in infants and children. In our previous work that was part funded by Sarcoma UK we have shown that a protein termed YAP is present and active in this type of cancer. When we artificially activate YAP in mouse muscle stem cells, all mice developed rhabdomyosarcoma. Additionally, when we reduced YAP levels in human rhabdomyosarcoma cells then they switched from cancer cells into cells that resemble normal muscle.
Sarcomas are rare tumours that account for approximately 1% of all cancers in the UK. They represent a challenge to treating clinicians as diagnosis is often delayed and the tumours are commonly in an advanced stage or have spread to other parts of the body. Current treatment approaches for these advanced tumours have shown only modest response rates of 12-24% and are associated with significant toxicity in patients.