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Early cancer detection and new treatments offer hope to millions

Professor John Robertson has dedicated his career to improving outcomes for cancer patients. Whether that’s detecting cancers early with a world-first blood test or creating new hormone treatments that give patients the best chance of beating breast cancer, his work has impacted thousands of people across the world. 

Working with colleagues in the Faculty of Medicine and Health Science he was responsible for developing the Early CDT–Lung blood test – the world’s first blood test for early detection of lung cancers, which has since gone on to be used across the globe, including within the NHS.

Professor Robertson said: “Early detection is the holy grail in cancer treatment. If we can treat cancer at the earliest possible moment we know we can help save millions of lives.”

"Early detection is the holy grail in cancer treatment. If we can treat cancer at the earliest possible moment we know we can help save millions of lives."
Professor Robertson

The blood test looks to detect autoantibodies (AAb) that are a response the body’s immune system produces to the cancer. Even at the early stages of the cancer the immune system produces significant autoantibody levels in the peripheral blood, and thereby amplifies the early cancer signal enabling the presence of a tumour to be picked up at a much earlier stage than more traditional testing methods such as CT scans.

Professor Robertson said: “The immune system responds to abnormal cancer proteins by producing antibodies, many more than the tiny amount of protein that triggered it, so rather than looking for a needle in a haystack you are looking for a haystack.” 

Studies include the Early Diagnosis of Lung Cancer Scotland (ECLS) trial run within the NHS in Scotland which reported that lung cancers in high-risk individuals (ie smokers and ex-smokers) were diagnosed, on average, 87 days earlier with a significant reduction in late stage lung cancers at diagnosis. – The ECLS study is believed to be the world’s largest randomised clinical trial for the early detection of lung cancer using such novel immune biomarkers in the blood.

"High risk patients were diagnosed, on average, 87 days earlier."
Professor Robertson

This early detection is especially crucial in lung cancer, the world’s leading cause of cancer-related deaths. If caught early enough the disease can be effectively treated with surgery, but more than 80% of patients present with an advanced form of the disease, and less than 10% survive more than ten years following diagnosis. The ECLS study has pre-planned after 5 years follow-up it will report the impact of this earlier detection on lung cancer mortality.

Professor Robertson’s work on AAbs led the university to open the UK’s first Centre for Excellence for Autoimmunity in Cancer (CEAC) in 2008, which has used the same technology seen in the EarlyCDT-Lung test to develop similar tests for other solid tumours. In 2018 an equivalent test for liver cancer EarlyCDT-Liver was launched.

The work has been commercialised with the help of university spin-out Oncimmune, formed in 2003 to drive research and development forwards with the help of investors. Professor Robertson served as Chief Scientific Officer until 2013. Whilst there he worked alongside university colleagues including Herb Sewell, Professor of Immunology, who used his expertise in the human immune response to cancer to further develop the accuracy and quality of the test.

The company floated on the London stock exchange in 2016 making an initial public offering of approximately £66,300,000. By October 2020, over 200,000 EarlyCDT lung tests had been performed on patients across 24 countries around the world, and in December 2020 the first contracts were signed to supply it to the NHS.

In April 2022, Oncimmune was awarded the Queen’s Award for Enterprise in Innovation, the highest official UK award for British business. CEO Dr Adam M Hill said: "Oncimmune has established a world-leading position in autoantibody-enabled immunodiagnostics, and we are honoured to have our truly innovative approach recognised by the prestigious Queen's Award for Enterprise 2022.”

Based on previous early research results, Professor Robertson is now working on a second generation technology to develop a similar approach for the early detection of breast cancer using an autoantibody blood test.

Professor Robertson has also been instrumental in helping develop new treatments for breast cancer – one particular endocrine treatment being the anti-oestrogen drug fulvestrant (also known as Faslodex).

This new-generation of anti-hormone therapy binds to and blocks oestrogen receptors which can cause tumours to grow, but it also degrades the receptor itself. Following Professor Robertson’s studies into the dosing of the drug and its impacts on patient outcomes in comparison to the drugs that came before it, fulvestrant has gone on to become the standard course of care for many post-menopausal breast cancer patients around the world.

Professor Robertson’s work on the drug is part of a 30-year partnership with AstraZeneca and has led to fulvestrant becoming the only new endocrine agent approved for breast cancer in the last 22 years.

As part of his ongoing desire to ensure all patients, regardless of their location, receive the very best cancer care he has delivered training sessions and conference sessions on fulvestrant to oncologists across the world.

Explaining the importance of this, a former President of the American Society of Clinical Oncology said: “Professor Robertson’s acknowledged leadership in the science and clinical use of fulvestrant is demonstrated by the popularity of his lectures, conference participation, and influential publications.

“All of us in medical oncology must make crucial decisions, almost daily, regarding dose and scheduling in the care of our patients. We rely on Professor Robertson’s work to inform such decisions.”

John Robertson

John Robertson, Professor of Surgery, Faculty of Medicine & Health Sciences, and Director of the Centre of Excellence for Autoimmunity in Cancer 

Further reading:

Annals of Oncology, Chapman C, Murray A, Chakrabarti J, Thorpe A, Woolston C, Sahin U, Barnes A, Robertson J. Autoantibodies in breast cancer: their use as an aid to early diagnosis.

European Respiratory Journal, Sullivan FM, Mair FS, Anderson W, Armory P, Briggs A, Chew C, Dorward A, Haughney J, Hogarth F, Kendrick D, Littleford R, McConnachie A, McCowan C, McMeekin N, Patel M, Rauchhaus P, Ritchie L, Robertson C, Robertson J, Robles-Zurita J, Sarvesvaran J, Sewell H, Sproule M, Taylor T, Tello A, Treweek S, Vedhara K, Schembri S. Earlier diagnosis of lung cancer in a randomised trial of an autoantibody blood test followed by imaging.

Lancet 2016: John F R Robertson*, Igor M Bondarenko, Ekaterina Trishkina, Mikhail Dvorkin, Lawrence Panasci, Alexey Manikhas, Yaroslav Shparyk, Servando Cardona-Huerta, Kwok-Leung Cheung, Manuel Jesus PhilcoSalas, Manuel Ruiz-Borrego, Zhimin Shao, Shinzaburo Noguchi, Jacqui Rowbottom, Mary Stuart, Lynda M Grinsted, Mehdi Fazal, Matthew J Ellis. Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): an international, randomised, double-blind, phase 3 trial

Journal of Clinical Oncology 2015: Ellis MJ, Llombart-Cussac A, Feltl D, Dewar JA, Jasiówka M, Hewson N, Rukazenkov Y, Robertson JF. Fulvestrant 500 mg Versus Anastrozole 1 mg for the First-Line Treatment of Advanced

Breast Cancer: Overall Survival Analysis from the Phase II FIRST Study.

Breast Cancer Research and Treatment 2012: Robertson JF, Lindemann JP, Llombart-Cussac A, Rolski J, Feltl D, Dewar J, Emerson L, Dean A, Ellis MJ. Fulvestrant 500 mg versus anastrozole 1 mg for the first-line treatment of advanced breast cancer: follow-up analysis from the randomized 'FIRST' study.

Robertson JF, Lindemann JP, Llombart-Cussac A, Rolski J, Feltl D, Dewar J, Emerson L, Dean A, Ellis MJ. Breast Cancer Res Treat. 2012 Nov;136(2):503-11. doi:10.1007/s10549-012-2192-4. Epub 2012 Oct 13.

Journal of Clinical Oncology 2009: Robertson JFR, Llombart-Cussac A, Rolski J, Feltl D, Dewar J, Macpherson E, Lindemann J, Ellis MJ. Activity of fulvestrant 500 mg versus anastrozole 1 mg as first-line treatment for advanced cancer: the results from the FIRST study

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