Blood test could detect recurrent melanoma up to a year before scans

·5-min read

A 72-year-old man has become the first patient to enrol in a UK trial to detect recurrent melanoma up to a year before it can be picked up by scans.

Paul Smith, from Bury in Greater Manchester, has had the skin cancer behind his ear removed but experts want to see if they can pick up any signs of the disease coming back before it would cause problems.

Their final-stage clinical trial, run by the Christie NHS Foundation Trust in Manchester and the Cancer Research UK Manchester Institute, will involve 1,050 patients in the UK and Australia.

Scientists will take blood samples from people with early-stage melanoma and look for circulating tumour DNA (ctDNA) – tiny fragments known to be shed by tumours into the blood.

The hope is that by detecting these fragments early, patients can be given immunotherapy drugs which offer some people with recurrent melanoma the chance of a cure.

Mr Smith told the PA news agency: “I noticed a lump behind my left ear during lockdown but wanted to avoid going to the doctors.

“I couldn’t see it, I could only feel it, and it wasn’t even the size of a five pence piece, it was more raised.

“I could sense the lump was getting larger throughout the first lockdown but it was only when I started socialising again that two friends suggested I should get it looked at.

“When I went to my GP, he said he hadn’t seen one so large and immediately sent me for tests.”

Mr Smith, who developed skin cancer despite saying he has mostly worn a hat in the sun and prefers the shade, underwent surgery at Salford Royal Hospital last July and had further surgery at The Christie in October.

A lab sample is analysed (Christie NHS Foundation Trust/PA)
A lab sample is analysed (Christie NHS Foundation Trust/PA)

“I was told there was no evidence of any further spread of the melanoma but I’d be kept under observation for the next five years, which I thought demonstrated a superb level of care,” he said.

“I asked if there were any clinical trials I could participate in as a way of saying thank-you and fortunately the Detection trial had just opened and was ready to recruit.

“To be the first patient recruited on to this clinical trial is amazing and I’m delighted to help.

“I’m aware melanoma is a type of cancer that can easily recur so it’s reassuring that anything could be picked up by the blood test sooner than the scan.”

Around 80% of people with early-stage melanoma need no further treatment after surgery, but for some patients tumours will go on to develop in other parts of their body.

The new blood test should be able to predict with high accuracy those patients who are at risk of the cancer coming back, making them ideal candidates for immunotherapy drugs.

Oncologists at The Christie will compare patients having the blood test with those whose new tumours are picked up during a routine scan.

The hope is that if successful, the trial could pave the way for the NHS to offer a simple blood test to determine which patients need treating early for recurrent melanoma.

Professor Paul Lorigan, consultant medical oncologist at The Christie who is leading the trial, said: “Not only does this simple blood test tell us if the cancer is returning, but also could give reassurance to patients who don’t have further signs of cancer after surgery that they don’t need further treatment.

“If our hypothesis is proved to be correct, this will undoubtedly be a step-change in how we treat patients in the future.

“This study focuses on patients with melanoma but potentially the blood test could be used for other cancers, in particular lung and kidney as they also respond well to immunotherapy.”

Dr Rebecca Lee, clinical lecturer in medical oncology at the University of Manchester, said: “We are constantly exploring better ways to treat patients with melanoma.

“What we’re trying to do with this trial is see if immune drugs could actually be even better when we treat at this really early stage.

“That’s different from other trials and other tumours (using ctDNA) because we’re trying to see whether early treatment with immune therapy is a good idea.

“Not only are we trying to pick up relapse early, but also how we can use the immune system to fight cancer.”

Patients on the Detection trial will be monitored by having blood tests for up to five years after surgery.

Scientists are looking at overall survival rates among the patients, which means it could be eight or nine years before the full results are in, though earlier findings will be available.

Michelle Mitchell, chief executive of Cancer Research UK, said: “Early detection of cancer is a key driver in improving outcomes for people with cancer.

“The earlier we can detect cancer, the easier it is to treat. If the Detection trial shows that a simple test can pick up evidence of cancer before scans, it will make a huge difference for patients.”

Professor Caroline Dive, director of the Cancer Research UK Manchester Institute Cancer Biomarker Centre, said: “I am excited to see that after the research to develop our new blood test (a liquid biopsy), the test is now being used in real-time to support our colleagues’ clinical decision-making to optimise the care of their patients with melanoma.”

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