Brain tumours
Brain tumours can be benign (non-cancerous) or malignant (cancerous). While benign tumours can often be cured with surgery, the required brain surgery has the risk of neurological harm including stroke and loss of important senses like hearing and sight.
In some, the damage caused by surgery would be too severe and therefore they cannot be completely removed. Other treatments such as radiotherapy then become important, although they have their own side effects.
Improving research into brain tumours
Benign brain tumours receive very little funding because they are not cancer, but they have a massive impact on the quality of patients’ lives. These tumours include the most common primary brain tumour called meningioma, as well as other tumours such as vestibular schwannoma and pituitary neuroendocrine tumours.
At the other end of the spectrum, brain tumours are the biggest cancer killer of children and adults under 40. Around 12,000 people are diagnosed each year with a primary brain tumour – equivalent to 33 people every day.
They have been described as a cancer of ‘unmet need’, reflecting their disproportionate socioeconomic impact and in particular the failure to achieve comparable improvements in outcomes, to those seen in other cancer types.
A 2018 Department of Health report on brain tumour research highlighted that despite accounting for only 3% of cancers in the UK, brain tumours account for more deaths in men aged under 45 than prostate cancer, and more than breast cancer in women under 35.
We want life expectancy for even the most aggressive tumours to be better, but there has been very limited improvement for the past 6 decades. Research offers the only real hope of dramatic improvements in the management and treatment of brain tumours.
In Manchester, we treat the most brain tumour patients in the UK, and we are the only centre to be able to offer all modalities of treatment, including proton beam therapy.
Neurofibromatosis type 1 and 2
Brain tumours can also be part of a genetic (inheritable condition). Two of the more common (but still rare) conditions are NF1 and NF2.
Although the names are very similar, they are very different and produce entirely different sorts of brain tumours.
Neurofibromatosis tumours are related to mutations in genes that play key roles in suppressing cell growth in the nervous system. These mutations keep the genes NF1 and NF2 from making normal proteins that control cell production.
Manchester is one of two NF1 specialist centres in England. For NF2, it is the lead centre for the NF2 service. Globally, five of the top NF2 25 experts in the world are in Manchester.
The world-leading NF2 research in Manchester has led to investment from the international charity NF2 BioSolutions, which has funded the Geoffrey Jefferson Brain Research Centre to host two PhD students. Read more on the NF2 BioSolutions blog.
Our research
To demonstrably improve survival and quality of life in patients with brain and skull base tumours, we need to discover better treatments and rapidly translate basic science findings into healthcare benefit.
We aim to do this by:
- developing a leading centre for clinical and pre-clinical trials;
- establishing a Phase 0 study centre;
- developing a leading centre for radiobiology and quality of life;
- leading a multicentre Phase III study from our candidate agents targeted at the inflammatory microenvironment.
Research projects
Molecular profiling of gliomas using tear fluid
Funder: Brain Research UK
Local researchers: Professor Petra Hamerlik, Professor Marloes Peeters, Professor Alex Casson Clinical researchers: Dr David Coope and Professor Maria Castro
Researchers are working on a new way to detect brain tumours using tear fluid. This could help doctors diagnose brain tumours earlier and more accurately, leading to better, personalised treatments.
Low-grade gliomas are slow-growing brain tumours that mostly affect teenagers and young adults. Current treatments include surgery, radiotherapy, and regular MRI scans. Unfortunately, these tumours often progress to a more aggressive form, with a poor prognosis of about two years. Some of these tumours have specific gene mutations (IDH) that can help predict how well a patient will respond to treatment. Detecting these mutations early can help doctors choose the best treatment.
Currently, detecting these mutations requires invasive procedures like biopsies or collecting cerebrospinal fluid, which can be risky. Blood tests for cancer markers exist but don’t work well for brain tumours because the brain doesn’t release these markers into the blood.
Researchers are developing a device to detect a substance called D-2HG in tears, which is produced by tumours with the IDH mutation. This approach is based on promising early data.
This non-invasive device could make diagnosing brain tumours easier and more precise. It could help doctors understand the prognosis better and choose the best treatment earlier, improving patient outcomes and advancing personalised medicine.
Researchers are working closely with clinical colleagues to ensure the research can be quickly applied in clinical settings.
Interleukin-1 in Vestibular Schwannoma (IL-VS): A biomarker development study
Funder: Confidence for Translation (C4T) award.
Clinical researchers: Professor Andrew King and Dr David Coope
In vestibular schwannoma (VS), inflammation is associated with tumour growth and studies have shown that one chemical mediator of inflammation called interleukin-1 (IL-1) is increased in patients with growing VS. Targeting IL-1 through drugs such as Anakinra (Kineret ©) could reduce inflammation and growth in these tumours. The first step and this study aim though is to understand the best tests or biomarkers that can evaluate whether targeting Il-1 is having an effect within VS.
For this study, ten patients due to undergo surgery for a growing sporadic or NF2-related Schwannomatosis VS at Salford Royal Hospital will be recruited. Participants will first undergo a research MRI scan for evaluation of tumour imaging biomarkers. Blood samples will also be collected so that levels of circulating pro-inflammatory chemicals (cytokines) can be evaluated. Following these tests, participants will receive a once-daily subcutaneous dose of an established, safe IL-1 targeting drug called Anakinra (Kineret ©). This drug will be given for 14 days at home by a trained member of the research team, and at the end participants will then undergo the same MRI scan and blood tests described above so that changes can be measured. During planned surgery, excess tissue from the tumour (VS) will be taken and specialised tests used to look for changes in the expression of inflammation related genes and changes in the number of inflammatory cells. To better understand how well these imaging, blood and tissue tests can detect the effects of IL-1 targeting, a separate group of 10 patients with growing sporadic VS listed who are due to undergo surgery will also be enrolled. This group of patients will not receive anakinra but will undergo the same tests detailed above, with MRI imaging and blood collection at day 0 and day 14, and analysis of resected tumour tissue.
Basic science research
SNOMan Lab
The Surgical Neuro-Oncology Manchester lab investigates the biology of and treatments for brain and skull base tumours.
- Twitter: @SNOMAN_Lab
Investigators
Catherine McBain
Petra Hamerlik