Pancreatic cancer continues to be one of the hardest cancers to treat, so as part of our Research Strategy, we’ve pledged to boost research in this area with the ultimate aim of improving patients’ survival.
Professor Nick Lemoine, Director of the Barts Cancer Institute, is a world-leading expert in pancreatic cancer and as part of our ongoing Expert Opinion series, he shares his vision for a future in which we can beat this disease.
Cancer Research UK: Why did you choose to focus on pancreatic cancer?
Nick Lemoine: It is a serious health problem across the western world and is becoming an increasing problem worldwide as we get more industrialised and people live longer.
Sadly, the 5-year survival rate hasn’t changed for the last 40 years, and that’s something that urgently needs addressing.
Cancer Research UK: What makes pancreatic cancer so difficult to treat?
Nick Lemoine: One significant problem with the pancreas is that it is deep within the body. You can’t see it, you can’t feel it and by the time symptoms or signs of the disease develop, surgery is no longer an option. And unfortunately, conventional chemotherapy drugs, which have largely been developed for other types of cancer, aren’t very effective, and neither is radiotherapy. So we need a new approach to the problem.
Cancer Research UK: What do you think the field needs in order to move forward?
Nick Lemoine: I think that there are two issues; firstly, we need to improve early diagnosis. This will increase the proportion of patients who could be cured by conventional approaches – largely surgery. And secondly, we need better treatments to offer patients at the other end of the spectrum for whom this is no longer an option.
Historically, pancreatic cancer hasn’t had a dedicated drug development programme – it has only received ‘hand-me-downs’ from other tumour types. But thankfully, this is beginning to change and it’s fantastic to know that Cancer Research UK is so committed to improving the outlook for pancreatic cancer patients.
Cancer Research UK: Could you tell us a bit about the work your lab is doing?
Nick Lemoine: My lab is interested in biomarkers for pancreatic cancer; these are molecules or genetic changes that we can measure, and that are specifically associated with pancreatic cancer. They will help us develop better ways to diagnose the disease earlier and will also provide targets for new therapies.
We study the genes and the molecules that drive the initiation and the development of cancer in the pancreas so that we can build a timeline that tells us which changes happen when. Then, we see if these changes can be detected in body fluids, particularly urine, but also potentially in blood, in order to pick up the disease at a stage when treatments have a better chance of working.
Cancer Research UK: How would you envision using this test?
Nick Lemoine: We know that pancreatic cancer becomes more common in people over the age of 60. But there are other risk factors. For instance, smokers have a moderately increased risk of pancreatic cancer. And pancreatitis is also a risk factor. This is long-standing inflammation of the pancreas which, in the UK, is largely due to excessive alcohol intake and also gallstones.
So if we can find markers that are associated with the very early stages of the disease, we might be able to use them to screen patients that we know are at an increased risk of pancreatic cancer.
Cancer Research UK: You mentioned that biomarkers for pancreatic cancer might also provide targets for therapies. How are you exploring this?
Nick Lemoine: Ours is a new approach; we’re developing gene therapy systems that are targeted against the very selective range of genetic abnormalities that affect pancreatic cancer specifically. And they’re different to those that are involved in other types of cancer. So we’re essentially turning the knowledge we’ve gained back on the problem to solve it. We’re using viruses that specifically target pancreatic cancer to deliver the gene therapy.
Cancer Research UK: Why did you decide to use viruses?
Nick Lemoine: Viruses have evolved to enter cells and deliver genes so we’re simply taking advantage of this. The viruses we’re using are found in nature but we’ve modified them so that they can only infect and multiply in cancer cells. We’re combining two viruses; they both work in different ways but cancers – particularly pancreatic cancers – can’t develop resistance against either.
We’ve found that this combination not only destroys the cancer but it also produces an enormously powerful and long lasting immunity against that cancer. So we can start thinking about treating the disease at a much earlier stage and vaccinating patients in a single shot – that’s extremely exciting!
Cancer Research UK: So what’s next?
Nick Lemoine: We recognise that one of the ways these viruses can work against cancer is by stimulating the immune system so we want to amplify that and direct it exclusively and more powerfully against the cancer. And so we’re looking at arming those viruses with particular genes that influence the way that the immune system behaves.
Once we’ve done all the testing and validation to make sure that it is safe and works the way we think it does, we plan to take it into clinical trials, hopefully over the next two or three years.
Cancer Research UK: What inspires you most about your job?
Nick Lemoine: I think that the real excitement for me is that I can bridge the divide between the lab and the clinic. So I spend half my day in the fantastic new Barts Cancer Centre overseeing the care of our patients and the other half in the laboratory developing new approaches that could change what we do in the hospital. And being able to see both sides of the spectrum is very exciting.
Interview conducted by Safia Danovi, September 2011