Press release posted 17 May 2023
A 54-year-old man with cancer of the unknown primary (CUP) – a rare cancer with a poor prognosis – is looking forward to a brighter future after taking part in two clinical trials at The Christie NHS Foundation Trust. His tumour has shrunk by more than half thanks to the treatment he’s received.
Chris Russell, a construction worker and father-of-four from Mayfield in Derbyshire, was diagnosed with CUP in early 2022 after nearly a year of specialists trying to find out what was wrong with him. He had initially gone to see his doctor after finding a lump on his shoulder. After many tests and investigations, he was told the lump was a secondary tumour, meaning that the cancer had spread from where it first originated. Chris is being treated at the National Institute for Health and Care Research (NIHR) Manchester Clinical Research Facility (CRF) at The Christie.
As part of the trials, doctors found a BRAF gene alteration that meant he could be matched to a targeted treatment. The tumour has now shrunk to more than half the original size, easing his pain and giving him a better quality of life. His primary cancer is now suspected to be melanoma (a type of skin cancer) which means more treatments are suitable. These include immunotherapy (a type of cancer treatment that works by helping the immune system recognise and attack cancer cells.)
Lack of research and funding into CUP has meant that outcomes for patients have traditionally been poor – CUP makes up 2% of cancer diagnoses but is the sixth most common cause of cancer death. There are no approved immunotherapies or targeted treatments for CUP outside of clinical trials.
Prognosis is usually poor because without knowing the location of the original tumour, doctors can only give a combination of chemotherapy drugs used to treat a broad range of cancers. This was the case for Chris – the team at his local hospital told him that chemotherapy was his only option, but they didn’t know whether it would work.
He was referred to The Christie where researchers are trying to improve outcomes for patients with CUP by looking for clues that reveal the location of the primary tumour and then using genetic information to ascertain which targeted therapies or immunotherapies will be effective in treating CUP.
In one trial, CUPCOMP, researchers use genomic sequencing – involving both tissue and liquid, blood-based biopsies – to identify gene alterations that act as clues as to the location of the primary tumour. The Christie NHS Foundation Trust, astronomers from Durham University, Roche UK and biotech company ConcR are working together on this after securing an almost £1m grant from the UK government via Innovate UK.
In Chris’s case, they found a BRAF mutation in both the tissue and the blood test, which was the first in a series of signs that his original cancer could be skin cancer.
Chris has been matched with a personalised treatment as part of the CUPISCO trial. The aim of this is to understand whether personalised treatment options, with either targeted treatments or immunotherapy, can improve outcomes for certain CUP patients. His tumour has shrunk by over half after just three months of the targeted treatment.
“My diagnosis has been a rollercoaster,” comments Chris. “I went from specialist to specialist to try and find out what was wrong. I then started to get really bad pains down one side of my body. They did another biopsy, and it came back as cancerous. When I got the CUP diagnosis, it was scary as I’d never heard of it before. It seemed like I had practically no options and the only glimmer of hope was the possibility of going on a clinical trial at The Christie. Now, not only do I have a treatment that’s working for me – my pain has pretty much gone – but I also know that my primary is probably skin cancer, which means more treatment options and more time with those I care about. Thanks to these trials, I’ve been able to do things like go on holiday and watch Derby County with my son. At one point, I didn’t think that’d be possible. Everyone at The Christie has been brilliant, I can’t thank them enough. They gave me hope when I thought there was none.”
Dr. Natalie Cook, consultant medical oncologist and principal investigator of the CUPCOMP and CUPISCO studies, comments: “Chris has responded really well to treatment, which is fantastic to see. Up until now, the amount of research and funding into CUP has been limited, so treating it has been a bit like doing a jigsaw puzzle where you do not have all the pieces to help you put everything together. By working with patients like Chris, we’re putting the pieces together and getting more clarity. The aim of these trials, and ones that follow on from them, is not only to ensure CUP patients have access to effective treatments but also to be able to reclassify them according to the probable primary tumour. It’s an exciting area to work in as the potential to improve patients' lives is massive.”
Both CUPISCO and CUPCOMP are no longer recruiting new patients. Any patients interested in taking part in clinical trials should discuss this option with their consultant or GP. Not all patients will fit the criteria for a specific trial. While clinical trials can be successful for some patients, outcomes can vary from case to case.