Professor Fitzgerald’s ‘pill on a string’ enters third clinical trial

The ‘pill on a string’ developed by Trinity Fellow, Professor Rebecca Fitzgerald, to detect early signs of oesophageal cancer will be tested in a major clinical trial of 9,000 patients across the UK.

This is the third trial for the Cytosponge and associated laboratory tests, which Professor Fitzgerald, who is Professor of Cancer Prevention at the Medical Research Council Cancer Unit at the University of Cambridge, has spent more than 20 years thinking about and developing.

Oesophageal cancer is notoriously difficult to diagnose sufficiently early to treat effectively because the symptoms – ranging from heartburn and indigestion to feeling full and something ‘sticking’ when eating – are common.

Speaking to Eddie Mair on BBC Radio 4’s PM programme, Professor Fitzgerald said the experience of BBC journalist Steve Hewlett, who recently died of oesophageal cancer, was sadly common.

That is whole nub of the problem really. Heartburn and indigestion is so common and the GP has to make a really difficult decision about which patients to refer for an endoscopy – you couldn’t possibly refer everybody with a bit of indigestion – so a lot of people with these symptoms just don’t get investigated.

Her innovation – a tiny sponge in a capsule the size of a multi vitamin – may change all that. Instead of requiring a referral for an endoscopy in hospital, a patient in their GP surgery will swallow a capsule, which is attached to a string. The pill quickly dissolves and a sponge pops out.

Professor Fitzgerald said:

The nurse can retrieve the sponge in a few seconds and as it comes out it collects a very good cell sample – from the top of the stomach and all the way along the oesophagus. The whole thing takes five minutes – very simple and straightforward.

Simple and straightforward it may be for patients, but the science behind the test is sophisticated and has taken years to refine to make it as accurate as possible. Professor Fitzgerald said:

We test the cells for a specific protein that tells us whether there are signs of early cancer – we are trying to detect a pre-cancerous condition, called Barrett’s oesophagus. There are second tier tests we can do to be even more specific – to look for mutations in DNA, for example.

This third clinical trial will see half the patients treated according to current practice and the other half offered the Cytosponge. The aim is to gain feedback from patients who undergo the test, ensure it is cost effective and that it could be rolled out to the NHS.

Professor Fitzgerald said:

I see patients in my practice like Steve Hewlett and it is pretty grim. However good our medicines are, and they are getting an awful lot better, when patents present at an advanced stage it is very difficult to cure this disease.

What I would like to see is the Cytosponge, or if not that, something else, to be successful, to turn things around for patients so we can improve early diagnosis of cancer of the oesophagus.

Listen to Professor Fitzgerald on BBC Radio 4’s PM (starts at 47 min).