A HIGHLY accurate urine test which can rule out bladder cancer with a negative-predictive value (NPV) of 99% using a hospital laboratory’s standard ELISA testing equipment is today being offered free to the NHS to help urologists clear the backlog of people waiting for a diagnosis and monitoring as a result of COVID-19 hospital closures.
Clinical trials involving approximately 3,000 patients have shown that ADXBLADDER, made by UK-based Arquer Diagnostics, is a simple and painless test enabling urologists to confidently exclude the presence of high-risk bladder cancer. New data being presented at the European Association of Urology congress at the end of July and recently published in the Journal of Urology reinforces the rigorous clinical trial results investigating the urinary biomarker protein MCM5 (Minichromosome Maintenance Complex Component 5), which show that ADXBLADDER can exclude the presence of bladder cancer with an NPV of 99% in newly diagnosed patients and those who require recurrence monitoring. ADXBLADDER has been shown to detect twice as many tumors as cytology in recurrence monitoring.
ADXBLADDER is a game-changing test - the first of its kind which uses patented technology to detect MCM5 in the urine, which makes it different to urine tests that have come before such as NMP22. All cancer cells – in every cancer type – are continually dividing (replicating) so contain MCM5. When a tumour is present in the bladder, these cells are shed into the urine and so the urine will contain the MCM5 biomarker. An important feature of ADXBLADDER is that the test is not influenced by infections or inflammation as bacteria do not contain MCM5 proteins and inflammatory cells cannot replicate so do not express the MCM5 protein. ADXBLADDER fits in a standard ELISA (enzyme-linked immunosorbent assay) machine widely available in NHS hospital labs.
Mr Tim Dudderidge, a Consultant Urological Surgeon at University Hospital Southampton who specializes in uro-oncology, said: “ADXBLADDER is different to previous cancer urine tests as it’s a new way of looking for cancer. The reason an MCM5 test is so powerful is that it gives us a message about uncontrolled cellular growth, which is the hallmark signature of cancer. If cancer is present, so is MCM5. Having a test like this is a great advance, allowing us to rule out cancer with very high accuracy and also helping improve how we monitor bladder cancer in patients for any recurrence.”
Recent figures from Cancer Research UK (CRUK) have shown that more than two million people in the UK were left waiting for cancer screening, tests and treatments in the first 10 weeks of lockdown alone and an estimated 290,000 people also missed out on an urgent suspected cancer referral for further tests in those 10 weeks, a time period during which 20,300 cancers would normally be caught.
Arquer is making thousands of its tests available free of charge to all NHS hospitals until the end of September to help urologists quickly assess patients with suspected bladder cancer and ease the ongoing cancer diagnosis crisis caused by COVID-19.
COVID-19 has had a devastating impact on cancer services around the country. A simple, non-invasive urine test such as ADXBLADDER can be used to swiftly identify patients at risk of bladder cancer recurrence, and who require follow-up tests, but also confidently identify those patients not at risk, who can therefore be reassured and reviewed at a later date, when the current COVID-19 risk is lower. We now have a unique opportunity to look at the cancer pathways we are currently using, which have changed completely in a very short period of time. Rather than going back to where we were pre-COVID, there is now an opportunity to change them for the better, building on and perfecting what we have been doing during lockdown.”
Mr Stuart McCracken, Clinical Lecturer and Honorary Consultant Urologist, Newcastle University and Sunderland Royal Infirmary
Bladder cancer affects more than 10,000 people a year in the UK according to CRUK and kills more than 5,400. Less than half of those diagnosed (46%) survive for 10 years or more. It is thought around 18,000* people already referred to a hospital urologist for suspected bladder cancer have not been tested because cystoscopy, ultrasound and face -to-face consultations were all cancelled and postponed as part of the NHS-wide pandemic response. Experts are now warning that urology departments could take at least a year to get through the backlog if they only use cystoscopies which could lead to those who may have the disease missing out on urgent treatment, with potentially fatal consequences.
National Institute for Health and Care Excellence (NICE) guidelines state that everyone with any suspected cancer should have their first referral appointment within two weeks but this target is thought to have slipped by at least 75% during lockdown. NICE also recommends that all patients with blood in their urine should be offered a cystoscopy, followed up by other tests such as an ultrasound if necessary. However, cystoscopy can miss up to 30% of bladder tumors and is an uncomfortable, invasive and sometimes painful procedure.
Arquer also believes the new test has the potential to save the NHS money with internal research showing that it is up to 42% cheaper than existing options which would save around £800 per patient over two years.
Mr Dudderidge added: “A 99% NPV is very high and can definitely help urologists have peace of mind that if a patient is negative for this test that they can be seen for a cystoscopy further down the line. This isn’t about replacing cystoscopy but about reducing the unnecessary ones especially now we have such a huge backlog. There is a way we can reduce the frequency of them by modifying the pathway which could halve the number of unnecessary cystoscopies a patient has to undergo by using ADXBLADDER as well. Cystoscopy is an uncomfortable, invasive, and sometimes painful test to go through. And if the test is negative patients can see that as a wasted episode. But we as doctors need to make sure that this disease hasn’t returned. ADXBLADDER has a biological USP different to any of its predecessors. This is a really unique and very sensitive way to rule out malignancy and its very high NPV is incredibly important.”
We have all heard about the devastating impact that COVID-19 has had on cancer services across the UK. Our ADXBLADDER test is quick, painless and can rule out bladder cancer with 99% accuracy because it works by detecting a cancer protein which would be shed into the urine if a tumor was present. At a time when urology services are desperately trying to work through a backlog of thousands of patients who are waiting to find out if they have bladder cancer or if their disease has returned, we are offering as many tests as the NHS needs free of charge to quickly determine which patients are clear of the disease and which need further tests. Every single person waiting for a diagnosis deserves not to have to wait any longer for peace of mind that they are cancer-free or to be able to begin vital treatment if required. Urologists should get in touch with Arquer Diagnostics as soon as possible and we can then make the tests available to their hospitals and clinics.”
Nadia Whittley, Chief Executive Officer of Arquer Diagnostics
*110,000 cystoscopies a year = 9,000 per month. Three months of lockdown with only 30% capacity = around 18,000 missed