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Read all about it... It can be awkward when a patient asks you about a report in their favourite tabloid detailing an amazing research breakthrough or a ‘cutting-edge’ new treatment / test and you don’t know what they are talking about! So this section fills you in on the facts.


Drug giving terminal bladder cancer patients months more good quality life to be available on the NHS in Scotland – but not in England

The Mail on Sunday – 14 August 2021

The Mail on Sunday reports on the slightly uneven roll-out of avelumab for advanced bladder cancer within the UK. For those not familiar with this drug, Avelumab is a PD-L1 inhibitor, about which there was a great flurry of publications towards the end of last year, with two-year findings from the JAVELIN study being published in various journals.

PD-L1 is programmed death-ligand 1, a transmembrane protein that normally plays a role suppressing the adaptive immune system. Whilst, when it comes to urothelial cancer, we are more used to wanting to activate the immune system, the issue can be, in these advanced cases that the cancer expresses PD-L1 and gain protection for themselves.

The benefits of the avelumab monoclonal antibody were shown in the JAVELIN Bladder 100 study, a randomised, controlled, multi-centre study of 700 patients with locally advanced or metastatic urothelial cancer. Eligible patients had received first-line platinum-based chemotherapy and had no radiological evidence of progression after chemotherapy. Patients were randomised 1:1 to avelumab + best supportive care (BSC) or BSC alone.

Median overall survival was 21.4 months in the avelumab + BSC arm and 14.3 months in the BSC alone arm, a gain of 7.1 months. It is serious stuff though, with 22% of patients seeing some kind of transfusion reaction and 5% suffering serious immune related adverse events. The cost of the drug is approximated £20,000 pa.

As detailed in the headline, NICE has not assessed these results and is not recommending usage for NHS patients at the time, whilst Scotland has. The manufacturers and several bladder cancer charities are lodging a formal appeal.


Britain begins world’s largest trial of blood test for 50 types of cancer

Reuters – 13 September 2021

There was no getting away from this ‘good news’ piece back in mid-September. Regular readers of this section will not be terribly surprised that the technology is being rolled out in a larger way – the so-called ‘liquid biopsy’ has long been coming. What was a surprise, however, was that the largest trial would be in the UK. This is a brilliant testament to the scope of top tier research being carried out in the NHS and UK.

This research is being led by Cancer Research UK and the King’s College Cancer Prevention Trials unit, along with the manufacturer. One hundred and forty thousand patients aged 50-77 from eight NHS regions across the UK will be contacted by letter and invited to take a blood test which examines for circulating DNA fragments arising from 50 common malignancies. They will also be invited to repeat this test at 12 and again at 24 months. Only half of the patients will have their blood tested though, the other half will be a control group, with blood stored for potential later examination.

Clearly, it will be sometime yet (2023 possibly) before there are any results published, but possibly not so long before we begin to see patients referred for investigation of positive tests. This could potentially be an interesting can of worms to pick through at some stage but, given that I suspect I may personally now have done ‘enough’ prostate biopsies, I welcome anything that begins to move us in a direction where one day they may no longer be needed.


Doctor warns against viral Scrotox trend

The Sun – 6 September 2021

I learned something new today – some people want Botox injected into their scrotum and it’s called ‘Scrotox’. The Sun seems to be picking up on a new trend that tabloids have of taking ‘advice’ from prominent medical pundits on ‘TikTok’ and reporting on them. I asked my Foundation Year doctor what TikTok is and they told me it’s a platform for sharing small bits of news and information, so a bit like Teletext, I guess.

The story here is that people are apparently seeking injection of Botox to relax the dartos musculature in the scrotum in order to eradicate scrotal wrinkles and achieve a more youthful genital aesthetic. The problem with that though, is that relaxed dartos produces an incredibly floppy, pendulous scrotum – an appearance more commonly associated with octogenarians. The TikTok ‘celebrity’ in this case wanted to warn would-be Scrotoxers that this will result in their penis looking comparatively smaller, whilst potentially having an effect on fertility due to disordered thermoregulation of the testes. Each to their own though.

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Jordan Durrant

East Surrey Hospital, UK.

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