Greater Manchester Cancer – The cancer programme of …



lefttop00righttop0089979572390Greater Manchester Cancer HPB Pathway BoardGreater Manchester Cancer HPB Pathway BoardHPB Pathway Board Meeting at Stepping Hill Hospital, StockportDate of Meeting:Tuesday 26th September 2017Chair: Mr Derek O’ReillyAttendanceRepresentationDerek O’ReillyGMC HPB Pathway clinical directorRebecca Price GMC Pathway Manager Juan ValleThe Christie ConsultantAngela Lamarca The Christie ConsultantMairead McNamaraThe Christie ConsultantVicki Stephenson Hornby Wigan Macmillan HPB CNSNeil Bibby CMFT Macmillan specialist HBP dieticianGanesh RadakrishnaThe Christie ConsultantClaire NewtonCMFT CNSHans Ulrich Laasch The Christie Consultant Radiologist Ramasamy Saravanan East Cheshire Hospital Consultant GastroenterologistLynne McCallumPCUKGeorgia PapacleovoulouPCUKMel AtackUser Involvement ManagerSteve Sawyer User Involvement Sue SykesGMC Commissioner Rafik FilobbosCMFT & PATDebbie ClarkCNS PATZahid MahmoodConsultant SHHLuke WilliamsSalford Royal Infirmary ConsultantApologiesClaus JorgensenMCRCGraham WardUser Involvement1. Welcome and introductionsWelcome, introductions and apologies DOR welcomed all to the meeting and noted the apologies received. Minutes of last meetingThe minutes of the last meeting were reviewed and approved without ammendment. These will be uploaded to the Greater Manchester website 2. Matters arisingDiscussion summaryThe HPB Pathway audit presented by Dr Tom Wilson: interventions to improve the patient pathway and speed to diagnosis and treatment were discussed. Future audit to be presented in 2018. Tertiary investigations and subsequent follow-up /communications Feedback has been provided to Dr. Ramasamy Saravanan by CMFT.3. Biobanking & the 100,000 genomes project – Jane RoganDiscussion summaryDr Jane Rogan explained the background to the 100,000 genomes project, whose aim is to sequence 100K Genomes in Cancer and Rare Diseases. CMFT was selected as a pilot centre. Subsequently, MCRC Biobank to deliver the study And CMFT as lead Genomics Medicine Centre. She described the transition from pilot to full programme; with the need for this to be delivered through NHS service departments & clinical teams. She described involvement of other site as part of the project delivery in Manchester: CFT – (August 2016), UHSM – (December 2016), SRFT – (January 2017), Sample collection supported by MCRC Biobank, Stockport – expect to be open for cancer Q4 2017 and other sites in discussion – Tameside & PAT. Success to date: Patients have been recruited from 13 solid tumour types across GM; there has been a willingness and engagement from Histopathology to embrace transformation; the introduction of telephone consent; and the raised awareness of genomic and personalised medicine among patients and staff. Future challenges include the fact that GM are still 12th (out of 13) nationally for cancer recruitment; that sample collection is happening at a faster rate than patients can be consented; the Competition for tissue locally from other research projects; a 40% rate of cases targeted being ineligible for samples reasons; and Informatics requirement . ConclusionOpportunities exist to improve the success of the 100,000 genomes project in Manchester through changing patient pathways to include research biopsies and the HPB Pathway board is already engaged with this.Actions & responsibilityJane Rogan, HPB Pathway Board.4. Precision Radiotherapy for HPB cancers - Ganesh RadhakrishnaDiscussion summaryGanesh Radhakrishna explained ‘Precision radiotherapy’ as a means of more accurately delivering an effective dose to a target volume, while minimising the dose to surrounding structures. He outlined the indications in locally advanced unresectable pancreac cancer post induction chemotherapy and in Borderline resectable pancreatic Cancer based on careful Patient selection using CT-PET to identify truly non metastatic pancreatic cancer. He outlined results from the key trials: LAP07, SCALOP 1; SCALOP 2, which is Investigating role of dose escalation of RT and novel radiation sensitisers; his own “real –life” practice in Leeds (2009 - 11); and current and upcoming trials (ESPAC 5F, SPARC & PRIMUS-002). He discussed Stereotactic Ablative Radiotherapy (SABR) in the liver, which can be considered in non-surgical patients with larger tumours and in proximity to vascular structures. This is currently available in Christie Commissioning through Evaluation (CtE) for liver mets and a small number of sites throughout the country for HCC. In cholangiocarcinoma, consolidation SABR post induction chemotherapy is provided as part of the ABC 07 trial. He described future technological advances will be achieved with Proton Beam Therapy and MR-Linac. Early results are encouraging with this highly sophisticated technology; there is a need to support and further research and innovation in these areas and our pathway needs to incorporate use of precision RT where indicated.ConclusionDOR welcomed GR to the HPB Pathway board and described it as a great acquisition for Manchester. We look forward to greater use of precision radiotherapy in GM, as part of our research protocols and standard patient pathways. Actions & responsibilityGR5. PRECISION Panc & the HPB Patient PathwayDiscussion summaryProf Juan Valle informed the meeting that Precision Panc had :1. Obtained CRUK Funding 2. That is elements include: a. Master protocol b. PRIMUS001 – phase III (FOLFOX-A VS GemAbx) for patients with metastatic disease c. PRIMUS002 - FOLFOX-A and chemo-RT (single arm phase II) d. PRIMUS03/EVEREST MEDI4736 (anti PD-L1) + AZD5069 (CXCR-2 antagonist) – study already open (industry-sponsored)3. Progress to date includes:-29th June -REC for Master protocol and PRIMUS001-24th July - Kick-off meeting (Glasgow)-1st August - Project Manager started (Kate Vaughan)-7th September first milestone report to CRUK-meeting with Caroline Dive; Ged Brady and Claus planned 12th October- (members to date:); any new members welcome.ConclusionPrecision-Panc Greater Manchester pathway working group will meet on 19th October.Actions & responsibilityKathryn Simpson, Ged Brady, Sumitra Mohan, Hans-Ulrich Laasch, Derek O'Reilly, Joe Geraghty, Claire Newton, Vicki Stevenson-Hornby, Claus Jorgensen, Juan Valle, Konstantinos (Kostas) Georgiadis6. Pancreatic cancer NICE guidelinesDiscussion summaryDOR updated the meeting on the progress of the NICE guidelines committee on pancreatic cancer, of which he is a member. The draft pancreatic cancer guideline is now out for consultation with stakeholders. The guideline can be accessed at: publication date is?24 January 2018?and a full discussion of its implications for the Pathway Board will take place after that. Actions & responsibilityDOR7. Biliary Drainage sub-group reportDiscussion summaryDOR informed the meeting that the Biliary Drainage sub-group had met and discussed preferred region-wide approach to relieving biliary obstruction according to its Terms of Reference (see Appendix 1). ConclusionFurther discussion was deferred pending completion of its conclusions.Actions & responsibilityDOR & biliary drainage sub-group (Ajith Siriwardena, Rishi Sethi, Vinotha Nadarajah, Harry Kaltsisis, Javaid Iqbal, Alistair Makin, Richard Hubner, Luke Williams, Ben MCIntyre)7. Regional variation in pancreatic cancer in the UK - Georgia PapacleovoulouDiscussion summaryDOR welcomed Georgia Papacleovoulou, Policy and Intelligence Manager from Pancreatic Cancer UK, to the meeting. GP gave a presentation on the geographic variations pancreatic cancer incidence and survival within the geographic borders that each of the 23 HPB units in England, undertaken by PCUK and collaborators. Cancer registrations were obtained from the Office for National Statistics (ONS) and linked to Hospital Episode Statistics (HES) records and Cancer Analysis System (CAS) data to derive treatment, comorbidity and stage information (period 2010-2013). Age-standardised incidence rates have been increasing steadily since 1995 for all adults, and the incidence rate is higher amongst men than women. Incidence rates were 4.97 per 100,000 in women and 6.81 in men during 1995-1999, increasing to 5.85 and 7.37, respectively, during 2010-2014. For both sexes, age-specific incidence rates rise sharply from around age 50-54 and peak in the 85+ age group. Age-standardised incidence rate varied between 4.8 and 15.0/100,000. 1-year, 2-year, 3-year and 5-year survival for patients diagnosed with pancreatic cancer has improved in recent years. Net survival varies between territories of the 23 HPB centres. The frequency of curative surgery for PDAC varied widely among HPB unit territories; from 5.8% to 12.2%. A trend towards better survival with higher proportion of surgery exists between resection rates and 5-year net survival for PDACs. ConclusionThe presentation of the data was warmly welcomed by the meeting and thanks expressed to GP and PCUK. The regional variation in resection rates and survival is of national concern. It was noted that the Manchester results for both was at the higher (i.e. better) end of the spectrum. Actions & responsibilityNot applicable.AOB & dates of future meetings:Discussion summaryWeds 24 Jan 10.00-12.00Macclesfield Hospital6 March 14.00-16.00, Salford Royal Infirmary, May, Christie Hospital Date TBC13th September 2018, 14.00-16.00 MRINovember 2018North Manchester General Hospital Date TBCAppendix 1 Greater Manchester Cancer Sub-group on Malignant biliary ObstructionTerms of ReferencePurpose:To devise guidelines for the optimal approach to drainage of malignant biliary tract obstruction to ensure that every patient in the Greater Manchester region receives optimal and equal treatmentMethod:To provide evidence-based consensus guidelines for a set of clinical scenarios. For each scenario, provide answers to the following questions:Is biliary drainage or surgery without prior drainage preferable?If drainage, which approach is preferred: PTC, ERCP, or EUS?What are the second and third-line approaches in the event of failure?Describe the optimum drainage strategy.If a stent is to be used, specify if plastic or metal, covered or uncovered and its length.What is the antibiotic prophylaxis regimen for each approach?In which hospitals should these procedures take place?Should the MRI HPB surgical unit become compliant with AUGIS recommendation that “For those highly specialised and infrequent procedures (examples might include Klatskin tumour resection and resection for chronic pancreatitis), it would be expected that only two nominated members of the surgical team would be involved”.If the answer is ‘Yes’ to question 8, nominate the two surgical sub-specialists who will undertake resection for perihilar cholangiocarcinoma.Clinical Scenarios:Proximal biliary obstruction due to perihilar cholangiocarcinoma (patient inoperable)Proximal biliary obstruction due to perihilar cholangiocarcinoma (patient operable)Biliary obstruction due to extrinsic compression, e.g. portal lymph nodesDistal Biliary obstruction due to pancreatic or periampullary tumours(patient inoperable)Distal biliary obstruction due to pancreatic or periampullary tumours(patient operable) ................
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