Harpal Kumar speaking at the NCRI
Welcome back to our coverage of the NCRI Cancer Conference.
Several news headlines this morning were triggered by research presented at the conference today. The BBC wrote about research on a blood test that could be used to identify patients whose skin cancer has spread. While The Telegraph reported on the survival gap between affluent and poorer cancer patients.
And Radio 4’s Today Programme used the conference as an opportunity to talk with several of our experts about the future of cancer research.
Away from the the BBC studio, we were busy attending several great talks in Liverpool that showcased the cutting-edge research going on in the UK and beyond.
The first speaker was our own Professor Charles Swanton, from the Cancer Research UK London Institute. His impressive, quick-fire presentation rattled through the latest thinking on how tumours evolve and change within the body – one of the key properties that makes the disease so difficult to treat.
Drawing on the old ideas of evolutionary biologists Richard Goldschmidt and Stephen J Gould, Professor Swanton explained that cancers are analogous to “hopeful monsters” – blindly evolving in the hope that they might become better able to survive.
We wrote about Professor Swanton’s first results on evolution in kidney cancer last year, when he discovered major genetic differences between tumours – and even regions of the same tumour – within an individual patient. Since then, he and his team have been working hard to unpick exactly what’s going on, including launching a major study looking at evolution in lung cancer called TraceRx, which we’ve previously talked about.
He showed the audience intriguing results suggesting that similar gene faults may evolve independently in different tumours within the body. This raises the possibility that we might be able to predict how a tumour will evolve and target it with drugs to proactively block these ‘escape routes’.
One particularly interesting area that Charles discussed was the effects of a process called genome doubling, where cancer cells end up with twice the number of chromosomes as they should have. This seems to allow the cells to survive, even in the presence of major genetic problems.
While many people in the field of cancer research are concerned with particular faults in specific genes, which can be targeted with drugs (such as vemurafenib, which targets a faulty version of BRAF, as discussed at the conference yesterday),Professor Swanton’s work is an important reminder that there is much larger-scale genetic chaos within tumours.
Professor Swanton is optimistic that his work will reveal ways of turning the ‘hopeful monsters’ into hopeless ones, unable to grow and thrive within the body.
The immune system and cancer – unlikely allies
Adding an international flavour to the morning’s proceedings, Professor Lisa Coussens, from Portland, USA, delivered a fascinating and detailed study of how our immune system can conspire against us by actually supporting cancer cells.
The huge auditorium was near capacity, with keen scientists taking their seats on stairs, in doorways and wherever space presented itself, before Professor Coussens expertly marshalled them to available seats. A pleasing similarity between the migration of delegates to their seats and her description of immune cells infiltrating cancer did not go unnoticed by the audience.
Professor Coussens explained that almost 60 per cent of all the cells found in some tumours are not in fact cancer cells, but perfectly healthy immune cells such as white blood cells – the very cells designed to keep us from harm.
And these white blood cells don’t just ignore the developing tumour, but “unleash pro-tumour activity”, nurturing it and providing it with all manner of useful molecules that help the tumour to grow and spread throughout the body.
She then described research showing that blocking a certain type of white blood cell (called a B cell) whilst using chemotherapy, actually stopped the growth of tumours in the lab. Her team are already about to start the clinical trials in cancer patients using this approach.
Another session looked at how we use DNA-deciphering ‘genomics’ technologies to improve cancer treatments. It largely focused on how scientists are developing increasingly sophisticated computer programmes that can match up huge amounts of information, for example comparing genetic information with patient’s drug sensitivity or resistance to treatment.
This type of approach might lead to better ways for doctors to match patients and drugs based on their individual cancer, and how to combine drugs to block the cancer from becoming resistant to treatment.
Professor Bertie Gottgens, from Cambridge, is using this computer-driven approach to untangle the networks of proteins controlling how cells in the bone marrow behave and how these networks go wrong in acute myeloid leukaemia (AML).
We still don’t know all the connections between molecules in cells – it’s like a rail map with bits missing. By looking for these missing connections, his team are finding out more about the processes that go wrong in AML and could lead to new ways to treat the disease.
Dr Kevin Brindle from our Cambridge Research Institute hosted a popular session about cancer imaging. We’ve written before about the importance of imaging in diagnosing, tracking and treating cancer, and this session was a great showcase for many new developments in the field.
Much of the research focussed on ‘multimodality imaging’, where rather than just looking at one biological facet inside the body, you measure several different things at same time – such as glucose metabolism, blood flow, pH and oxygen levels. By combining these different signals researchers can get a more complete picture of the tumour and better understand its behaviour and how to tackle it.
In a session that covered a bewildering array of cutting-edge imaging technology, some of the most exciting images on display were from Professor Vasilis Ntziachristos, from the University of Munich. He explained that despite many exciting advances, “most imaging in hospitals is still done using the human eye – we can do much better”.
He then showed how – his presentation on ‘optoacoustic’ and ‘thermoacoustic’ imaging wowed the audience, particularly videos of detailed real-time images inside the body. It will be exciting to see how such technology can be applied to cancer.
Are targeted drugs the future?
Meanwhile, other delegates were listening to a heated debate about whether or not we should be prioritising our research efforts towards developing genetically targeted treatments, or whether we should be focussing our limited resources elsewhere.
On the side of the ‘ayes’ were Professor Gerard Evan and Dr Donald Ogilvie. They pointed to the number of successes so far, including Herceptin for breast and stomach cancers. They argued that there are enough commonalities amongst the diversity within and between tumours for us to target them with precision medicines. And that the issue of resistance to targeted treatments can be overcome with combinations of treatments.
On the side of the ‘no’s Dr James Larkin and Professor Charles Swanton, arguing there are other areas of research that should be the biggest priority. They argued that targeted treatments are not cures for cancer. And that resistance to such treatments is inevitable and varied. Combination of targeted treatments will simply delay resistance to treatment.
They pointed to the perhaps greater potential of immunotherapy and targeting the processes that lead to the enormous diversity seen in cancer. Professor Swanton went so far as to say “ignoring this process is foolish”.
Amidst the friendly banter was a serious discussion of the pros and cons of the development of precision medicines targeting the mutations driving cancer. In the end the audience voted in support of the ‘no’s, targeting the drivers of cancer shouldn’t be the biggest research priority.
After all, there are other types of therapies, old and new, that are very effective at treating cancer. And we mustn’t forget that prevention is also an important research priority. But precision medicines should still play an important part in growing our armoury against cancer.
Survivors of childhood cancer
Another afternoon session looked at childhood cancer. The good news is more and more children now survive their disease. But while treatments are getting better, they can have long lasting side effects, which was the focus of several thought-provoking talks.
Dr Raoul Reulen from Birmingham talked about the large studies underway in the USA, UK and Nordic countries. The studies are showing that people who have survived childhood cancer are at higher risk from premature death later in life from new cancers and from medical conditions like heart disease. As Dr Reulen put it, “we have the obligation to learn lessons from the past”.
The next topic from Dr Hamish Wallace was fertility and how we can help cancer survivors go on to have a family. It’s a complicated topic and depends on many factors, mainly the type of treatment received. But, he said, technology to freeze ovarian tissue is improving and may provide a way to preserve fertility in women the future.
Lastly, Dr Melissa Hudson from the USA wrapped up the session by talking about the challenges of working out the individual risk of long term effects for each patient, but more crucially how we ensure that survivors receive the right level of care throughout their lives.
Watch this space
As you can see, it’s been a busy day, and we expect just as many interesting talks tomorrow.
We’ll be sure to report back again.
Images courtesy of National Cancer Research Institute, via Flickr.