Research
The following research projects are taking place under the auspices of HANS
LOPAC
Laser Ablation versus Observation to Prevent Anal Cancer (LOPAC) is an upcoming study funded by the National Institute for Health Research. Homerton Healthcare NHS Foundation Trust is the study sponsor. Dr. Mayura Nathan, consultant physician and chief investigator of the study, has pioneered the use of laser to treat high-grade AIN for over two decades and leads the Homerton Hospital Anal Neoplasia Service (HANS) which receives referrals from all over the UK.
The main aim of the study is to assess whether laser treatment is effective in preventing anal cancer in HIV-positive MSM identified to have high-grade AIN disease (precancer). About 3,500 HIV-positive MSM will be recruited into the trial from four to five HIV units across London and screened for anal precancer. We estimate that between 25% and 30% of those screened will have precancerous changes. 660 participants with high-grade AIN disease (of the 3,500 enrolled participants) will be randomly assigned into two study arms: 330 patients in group 1 will be treated with laser, and patients in group 2 will have active surveillance (no treatment). All patients will be followed up every six months with a standard examination, consisting of high-resolution anoscopy (HRA), a digital rectal examination (DRE) and biopsy of persistent or new AIN 2 and/or AIN 3 or other areas suspected of cancer. Recruitment into the study will last 36 months and the total duration of the trial is 72 months. LOPAC has recently received ethical approval and is set to recruit its first patient in December 2015.
STACS
Anal cancer is 80 times more common in HIV-positive men than the general population and the benefits of anal screening are unclear.
Anal cancer screening is a method of preventing cancer by detecting and treating early stages of disease, which if left untreated, could lead to cancer in the anus. At the moment, it is unclear whether testing a sample of cells from the anus or other laboratory tests are suitable and are more accurate tool for anal cancer screening. There are many tests being studied in laboratories, but in order to see how good they are we need to be able to see how they perform in a ‘real-life‘settings.
Our aim is to compare a number of laboratory tests. These include testing of cells from the anus and possibly biopsies to see which will be most useful and accurate for anal cancer screening. We will be comparing two different anal swabs made of different materials to see how good these tests are in collecting the samples for investigation.
The purpose of this study is to find best tests to improve anal cancer screening. We also hope to identify what lifestyle and health behaviours may be associated with any anal abnormalities and cancer.
We are aiming to recruit 180 HIV positive men who have sex with men (MSM) aged ≥18 years old over the period of 18 months. Eligible patients will include all those who have been referred for anal cancer screening at Homerton Anal Neoplasia Service (HANS) in Homerton University Hospital.
FLAN
FLAN is a pilot project based at Homerton (HANS) which looks at Function before and after laser ablation of anal intraepithelial neoplasia. Tamzin Cumings is the Principal Investigator. The initial study is a pilot study. We are going to begin the recruitment soon. The study is in concert with Bart's and the London GI physiology unit.