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'Exciting' bladder cancer drug trial

Bladder cancer

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A drug which makes a wide range of cancers more vulnerable to the body's immune system is "exciting" and may mark a new era, say doctors.

It strips cancer cells of the "camouflage" they use to evade attack by the immune system.

In the most detailed study, published in Nature, some patients completely recovered from terminal bladder cancer.

Cancer Research UK said the field of immunotherapy was delivering "a lot of very exciting results".

The immune system is in delicate balance with some chemicals in the body encouraging a strong vigorous response, while others try to dampen it down.

Tumours can hijack this system to hide from the immune system.

One trick which tumours use is a protein called PD-L1 which is normally used to prevent autoimmune diseases.

Bladder

An international team of scientists has been trialling a drug to block PD-L1, produced by the company Roche, on 68 people with advanced bladder cancer.

All the patients had tried chemotherapy and had been given six-to-eight months to live.

More than half the patients, whose tumours were using PD-L1 to hide from the immune system, showed signs of recovery.

In two patients there were no signs of cancer after the treatment.

One in ten patients responded to the experimental therapy even if PD-L1 was not present in the tumour.

Dr Tom Powles, an oncologist at the Barts Cancer Institute and part of the research team, said "There have been no new drugs for bladder cancer for 30 years.

"The tumours have developed a camouflage layer, PD-L1, and by removing the camouflage the tumour becomes identifiable.

"A subgroup of patients seems to do exceptionally well."

Dr Powles is funded by the NHS and receives no money from Roche.

The drug has been given "breakthrough therapy" status in the US and could be used widely by patients there at the end of 2015, if a larger trial shows the same results.

Much larger randomised clinical trials would be needed in order for the experimental therapy to be used in Europe.

More cancers

Dr Roy Herbst, who led the research at the Yale Cancer Centre, told the BBC: "This is a new paradigm in cancer.

"Immunotherapy for cancer has opened up an entirely new modality for treatment of the disease alongside chemotherapy, radiotherapy and surgery.

"Now we have immunotherapy and it is here to stay and the challenge for clinicians is seeing how it fits alongside those others."

His study was focused on the environment around a tumour and immune cells there, in order to help predict which patients would respond to therapy.

A similar set of trials to boost the immune attack revealed at the American Society of Clinical Oncology conference in Chicago in June, showed similar therapies could improve survival in advanced skin cancer.

In a trial of 411 patients evaluating a drug, pembrolizumab - 69% of patients survived at least a year.

Those results were described as having the "potential to be a paradigm shift for cancer therapy".

A separate study of 175 patients, led by Yale University in the US, showed responses to the drug in patients with non-small cell lung cancer, melanoma, renal cell carcinoma and other cancers.

Prof Peter Johnson, the chief clinician at Cancer Research UK, said: "We're seeing a lot of very exciting results from these new treatments using the immune system.

"This study in bladder cancer is further proof of the power of this approach, and it's really good to find a new treatment for a type of cancer that we've been struggling to make progress with for many years."

GPs 'failing' to find liver disease

Man drinking

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Early detection of liver disease by GPs in the UK is "virtually non-existent", leading medical experts warn.

A group of doctors and researchers have criticised a reliance on "outdated" blood tests for diagnosis - saying these sometimes give false reassurance.

Their report in The Lancet says the UK has one of the worst death rates from liver disease in Europe.

GPs' leaders agree that family doctors need better access to diagnostic tools.

Liver disease cases are often related to alcohol consumption or obesity. The illness can also be caused by the hepatitis B and C viruses.

The report says liver disease is already the UK's third most common cause of premature death, with the number of fatal cases rising.

Start Quote

Deaths will continue to rise until there are radical improvements in services”

End Quote Prof Roger Williams

Most lives lost are among people of working age.

Find cases early

The report quotes NHS figures that say 600,000 people in England and Wales have some form of liver disease. About 10% of them have cirrhosis.

Liver disease was behind 57,682 hospital admissions and 10,948 deaths in 2012.

The report says picking up cases earlier leads to better outcomes for patients.

Prof Roger Williams, who led the research and is the director of the Institute of Hepatology in London, said: "The rising rates of mortality from liver disease over the past three decades are a terrible reflection on the UK.

"Deaths will continue to rise until there are radical improvements in treatment services.

"Hospital care for patients with advanced liver disease has been shown to be less than good in more than half of cases.

"And early detection of liver disease by GPs and primary care services is virtually non-existent.

"GPs know very little about it and don't particularly want to get involved.

"The ordinary test for liver function often shows as normal - even when someone has cirrhosis."

The report says GPs rely on blood tests that show inflammation to the liver, which can fluctuate, rather than having access to scanners, which give a more consistent picture of scarring.

Start Quote

With the resources available to us, it is difficult for GPs to identify liver disease in its early stages”

End Quote Dr Imran Rafi Royal College of GPs
'Outdated' technology

Another member of the team, Dr Nick Sheron, who runs the liver unit at Southampton General Hospital, said: "GPs don't have access to the right technology.

"They are using blood tests which simply don't work. It's 19th Century technology for a 21st Century problem."

The experts also want politicians to set a minimum price for a unit of alcohol and to tax sugary drinks.

Their report also calls for drugs and vaccination against hepatitis viruses to be made available on the NHS.

Cocktails
'Reduce drinking'

Prof Sir Ian Gilmore, who co-founded the Alcohol Health Alliance UK, said: "Getting people to reduce their drinking works and is really cost-effective.

"But our politicians will not take this seriously.

"Alcohol dependency is treated as a lifestyle choice - like a designer brand of jeans - rather than as a disease."

Public Health England welcomed the report and said it would work with the doctors.

Its lead for liver disease, Prof Julia Verne, said: "These cases involve a marginalised group of people who are often hard to reach."

She added: "10% of people who die from liver disease have had no admissions to hospital in the last year of their life - showing they have not been picked up at all."

Dr Imran Rafi, chairman of the Royal College of GPs' Clinical Innovation and Research Centre, said: "It is clear that more needs to be done to identify this condition as early as possible in adults - and to tackle the negative effects that alcohol consumption and obesity can have across society.

"With the resources available to us, it is difficult for GPs to identify liver disease in its early stages.

"So it is welcome that the report recognises the need for GPs and practice teams to have better access to diagnostic and screening tools.

"Our influence is limited. It is politicians who need to act now and introduce measures to really make a difference."

Many elderly 'struggle' at home

An elderly woman's hand on  a stick

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Thousands of older people in England are struggling in their own home with little or no help, research suggests.

The analysis by the Independent Age charity and Strategic Society Centre think tank indicates more than two million have difficulty with washing, dressing, cooking or eating.

And of the 560,000 of these with severe needs, 160,000 receive inadequate help while another 70,000 have none at all.

Some 850,000 older people have help paid for by themselves or the council.

But over the years state-funded services have been increasingly rationed.

Meanwhile, 30,000 older people care for others in situations considered a risk to their health and wellbeing - alone and for at least 20 hours a week.

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Older people and care in numbers
  • There are 8.6 million people in England aged 65 or above
  • Of these, about four million are living at home with limited day-to-day activities, although some of these have needs classed as low-level
  • Of these, more than two million have difficulty with one or more daily tasks, such as washing, dressing, cooking or eating
  • Of these, about one in four - 560,000 - have needs classed as severe
  • Of these, 160,000 say the help they receive is inadequate and another 70,000 receive no help, paid or unpaid
  • 850,000 older people receive paid help funded by themselves or their local authority
  • Another 1.5 million rely on unpaid care from friends and family
  • 30,000 older people care for others in situations considered a risk to their health and wellbeing

Source: Independent Age and Strategic Society Centre based on 2011 to 2013 data

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The two groups looked at:

  • census data
  • government figures
  • the English Longitudinal Study on Ageing
Hands of an elderly person

They said the research "highlights alarming gaps" in the system and raised questions that needed addressing ahead of April 2016, when care costs will be capped at £72,000 over a person's lifetime.

Independent Age policy director Simon Bottery said it "defies belief" how those who did not receive the right care were getting by.

Without better support, there would be a knock-on effect on the NHS with more older people seeing their health suffer, he added.

Fifth of millennium babies 'obese'

Obese child

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One in five children born at the start of the millennium was obese by the age of 11, according to a major study.

The Millennium Cohort Study, which follows 13,000 children born in the UK, showed a sudden surge in obesity between the ages of seven and 11.

Experts said the figures were worrying and some called for mandatory weight monitoring of children.

In Wales and Northern Ireland, 40% were obese or overweight. The figures were 35% in England and 33% in Scotland.

The Institute of Education in London analysed data on the children's height and weight at ages three, five, seven and 11.

The proportion who were obese was roughly constant, between 12% and 13%, until age seven. But shot up to 20% at 11.

There was a similar pattern in the proportion classed as either overweight or obese, which went from 25% at age seven to 35% at age 11.

'Family obesity'

Lead researcher Dr Roxanne Connelly told the BBC: "To be honest, unfortunately I wasn't surprised.

"Generally healthy weight children were becomingly increasingly overweight or obese so parents should be vigilant of even healthy weight children.

"But this is a whole family problem, parents who are overweight are handing it down to their children in a vicious circle."

Children with obese mums were the most likely to be obese or overweight.

"If we could help mothers with weight loss, then they could pass that on to their children," Dr Connelly said.

Child taking sweeties

The National Obesity Forum called for children to have their weight checked more regularly to tackle the obesity epidemic.

Spokesman Tam Fry told the BBC: "Up to now we have known only that the rate of excess weight has doubled between primary school entry and exit but not when.

"It should be now be mandatory that every child's weight and body mass index be monitored at seven to identify and intervene with children piling on excess pounds before it continues to escalate."

Unhappy

The study also showed the impact of obesity on wellbeing.

More than 10% of obese children had low self-esteem, compared with 7% of healthy-weight children.

And only 34% of obese children were happy with their looks, compared with 43% of healthy-weight children.

Dr Ann Hoskins, the director of the healthy people division at Public Health England, said: "It is deeply concerning that there is a virtual doubling of obesity rates from Reception to the end of primary school and that it is particularly worse for children from low-income households.

"Parents and carers can help their children maintain a healthy weight by following a balanced diet, ensuring portion sizes are not too large and avoiding sugary drinks and sugary or fatty snacks.

"Children also need a minimum of 60 minutes of moderate to vigorous exercise each day, which can be achieved in one session or through shorter bursts of 10 minute activity."

U.S. approves GSK's purchase of Novartis vaccine business - companies

WASHINGTON (Reuters) - GlaxoSmithKline won U.S. antitrust approval to buy Novartis AG's vaccine business, with the exception of influenza vaccines, the two companies said on Wednesday.

The deal is part of a three-way transaction unveiled in April, which includes Britain's GSK buying the vaccines business of Novartis, the Swiss company purchasing GSK's cancer drugs, and the two groups tying up in consumer healthcare.

The U.S. Federal Trade Commission had previously announced on Wednesday that it approved the consumer health care joint venture on the condition that Novartis sell its Habitrol nicotine patch.

Novartis and Glaxo, which has Nicoderm CQ, are two of only three companies that sell nicotine patches to U.S. retailers, the FTC said.

(Reporting by Diane Bartz; Editing by Diane Craft)

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