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Pancreatic cancer cells (credit: LRI EM Unit)

Pancreatic cancer can be very hard to treat (picture credit: LRI EM Unit)

Tackling pancreatic, oesophageal and lung cancer is one of the biggest challenges facing cancer researchers today. Together more than 55,000 people are diagnosed with these cancers every year in the UK, yet survival rates have changed little over the last few decades.

An inspiring session at the NCRI Cancer Conference last week showed just how passionate researchers and doctors are about making a difference for people with these diseases.

The session was chaired by Professor Herbie Newell of the Northern Institute for Cancer Research in Newcastle.

He explained that the increases in numbers of people surviving cancer in the UK are ‘a good news story but also a bad news story’. Good, because overall average survival has doubled when we look across all cancers as a whole, but bad because of the lack of improvement in these particularly hard-to-treat cancers.

Against this background, the three speakers in the session were keen to show the immense effort that’s being made to improve treatment for oesophageal, pancreatic and lung cancer – or ‘the bad boys and girls of the class’ as Professor Newell described them. Personalising treatment was a key theme running through all the talks.

Oesophageal cancer – moving towards personalised treatment

Professor David Cunningham of the Royal Marsden Hospital was first to speak, covering the encouraging progress that’s being made in treating oesophageal cancer – cancer of the foodpipe or gullet. This cancer is often diagnosed after it has already spread, meaning surgery’s not suitable for most patients. Other treatment options include chemotherapy and radiotherapy.

The precise treatment a patient receives depends on exactly where the tumour is located in the oesophagus, and on features of the cancer cells that can be seen under a microscope.

But changes are afoot. Professor Cunningham described how trastuzamab (Herceptin) – better known as a breast cancer treatment – has been licensed to treat oesophageal cancer patients with specific genetic faults in their cancer cells.

Several other ‘targeted’ experimental drugs are also being tested, and researchers are finding new ways to select treatments based on genetic and molecular changes in patients’ cancer cells. For example, drugs such as cetuximab and panitumumab target specific molecules that are found on some cancer cells, and could be effective for a proportion of people with oesophageal cancer.

The future of treatment for this disease will focus on this personalised approach. The hope is that this will help more patients to live longer, and avoid giving people drugs that may not be effective for their particular type of cancer.

Pancreatic cancer – understanding the barriers to treatment

Next to take the stage was Professor David Tuveson of Cancer Research UK’s Cambridge Research Institute. His fascinating talk explained how his team is tackling the challenge of treating pancreatic cancer.

Professor Tuveson and his team have developed a new mouse ‘model’ of pancreatic cancer, which is a much more accurate representation of how the disease develops in humans than has previously been available. Their results using this model to test drugs for the disease have been striking.

The team discovered that it’s suprisingly difficult to get drugs into pancreatic tumours. The tumours don’t have many blood vessels, and are mainly made up of structural tissue called stroma. This makes it tough for drug molecules to get deep inside and target cancer cells.

The team is now testing ways to fix this problem– for example using drugs that increase the number of blood vessels in the tumours. This technique has given promising results in the lab, and the team is now running a small trial to see if it could work in patients. As Professor Tuveson said, ‘this is an important concept and we should move forward with it hard.’

He ended his talk by making the point that it’s crucial to improve patients’ quality of life so that they are able to take part in clinical trials that will help to develop better treatments. Better pain medication is one key way to help. According to Professor Tuveson, ‘we need to change our approach to patients so that we can make progress.’

Personalising lung cancer treatment

Last but not least was Dr Scott Gettinger from Yale University USA. His talk echoed the other speakers in highlighting the personalised approach to treatment, this time focusing on lung cancer. He also mentioned a trial in the US that is raising hopes that screening people with a high risk of the disease could help to save lives.

Dr Gettinger showed how trials are testing ways to group – or ‘stratify’ lung cancer patients based on the characteristics of their cancer. This approach has yielded good results in some forms of the disease already. For example, some patients with non-small cell lung cancer have changes in their cells that can be targeted by drugs known as EGFR inhibitors – this is looking like a promising new way to treat these people.

Professor Newell rounded off an encouraging session by pointing out of the window of the lecture room. ‘It looks like the sun is coming out over the Mersey – and I think our speakers have shown that light is being shone on these cancers too.’

Nell Barrie

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