The Bone Cancer Research Trust is delighted to announce our most recent grant funding awards. Thanks to your donations, this month we are delighted to be awarding two Research Explorer Grants. The first of these has been awarded to Professor Adrienne Flanagan, allowing her to carry out her research into chondrosarcoma for the next 3 years.

About the project

Chondrosarcoma is the most common form of primary bone cancer occurring in adulthood, but it is underfunded and difficult to accurately diagnose. Improvements in diagnosis are desperately required in order to advance treatment planning and in turn, improve patient outcomes.

Professor Flanagan has identified a possible biomarker which increases in levels as the tumour severity increases. In this project she hopes to expand her knowledge further and measure the levels of this biomarker in patients using a simple blood test. She plans to use the biomarker levels to predict the grade of a patient's chondrosarcoma more accurately, allowing surgeons to be correctly informed on the surgery each patient requires.

How is chondrosarcoma diagnosed and treated?

Chondrosarcoma is a type of primary bone tumour which forms in the cartilage, for which surgery is the only effective treatment. There is a spectrum of changes seen down the microscope when a chondrosarcoma is presenting, and these changes are used to inform doctors how a tumour is likely to behave. Cartilaginous tumours such as a chondrosarcoma are classified as benign, low grade or high grade, and the treatments for these classifications are different.

Benign and low grade tumours are generally ‘scraped out’, leaving the patient with few problems thereafter. Whereas high grade tumours are treated more aggressively and often require surgery that removes a section of the affected bone, which is replaced with a metal prosthesis.

The difference in treatment is because high grade tumours are more likely to recur and spread to other parts of the body. However, distinguishing between benign, low grade and high grade tumours visually, using a microscope, is not always straight forward. Therefore making a decision on the extent of the treatment that is required can be challenging, and the overall outcome for patients with chondrosarcoma has not improved for decades.

What is Professor Flanagan's project aiming to do?

Professor Flanagan has identified a promising biomarker for chondrosarcoma, in the form of a mutation to a gene known as IDH1. A biomarker is a protein or gene that offers a measurable and quantifiable way of detecting something. Mutations to the IDH1 gene are present in approximately 50% of chondrosarcomas. Her group have already seen that these mutations can be found within the tumour, and, that higher levels of mutations correlate with higher grade tumours.

The group have developed a promising new blood test which detects small fragments of DNA from the tumour, which are present in the blood: this is called circulating tumour DNA (or ctDNA). This blood test can detect IDH1 mutations in chondrosarcoma patients, and the levels detected are high before surgery and drop off after surgery.

This project will look at expanding this knowledge and determine if measuring the levels of the IDH1 biomarker in a diagnostic biopsy and in the blood tests can predict the grade of a patient’s chondrosarcoma more accurately than just looking down a microscope. The study will also look at whether we can use routine blood tests to detect the very early stages of recurrence and catch this before the chondrosarcoma begins to spread.

What does this mean for the future?

If successful, this will be the first and only biomarker for chondrosarcoma – which has been searched for by researchers worldwide! This breakthrough could offer several benefits to the clinical care of chondrosarcoma:

  • This will offer pathologists a much more accurate and reproducible way to diagnose and stage chondrosarcomas
  • This will more reliably inform surgeons and clinicians as to the type of surgery a patient requires
  • It will give a simple and fairly non-invasive way to effectively monitor patients and pick up the early stages of recurrence, hopefully before the disease spreads, allowing further surgical intervention

About Professor Flanagan

Professor Flanagan began working with the Bone Cancer Research Trust 10 years ago and has carried out some of the most successful research in the bone cancer field during her career; working with osteosarcoma, chordoma and chondrosarcoma. She is one of the leading experts in terms of both diagnosis of and research into chondrosarcoma in the world. Read more about Professor Flanagan and her relationship with The Bone Cancer Research Trust here.