Personalised medicine has been a hot topic for several years

In our third instalment from the ASCO cancer conference, Debbie Coates writes about a major theme of modern cancer research – the concept of personalised medicine.

It’s an exciting time in the world of cancer treatment. We know more than ever before about the genetic faults driving different cancers, and we’re getting better at designing drugs that target them.

At the same time, it’s becoming clear that the more we know, the more complicated things become. As we start using genetics to classify tumours, we find that the number of cancer types is growing rapidly – for example, only last year our scientists in Cambridge showed that breast cancer is actually at least ten different diseases.

There are also huge challenges with developing drugs targeting these changes – not least designing the clinical trials to test them.

Several sessions at this year’s ASCO conference discussed the issues being thrown up by our progress into the era of personalised medicine.

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Clinical trials are vital for improving treatment for people with cancer

In our second report from this year’s ASCO conference, Trevor Bott writes about a session he attended on the need for clinical trials for older cancer patients.

People are living longer thanks to improved living standards and phenomenal medical progress in recent decades. That’s the good news.

But our aging population comes at a price: the biggest risk factor for cancer is old age, so the flipside is that the number of people developing cancer is set to soar.

Estimates vary, but an older population definitely means many more elderly men and women with cancer in future – one speaker said that by 2030 the incidence of cancer in the US will rise to 67 per cent in the over 65s compared with just 11 per cent in the under 65s.

That’s why ASCO put on a session about clinical trials for older patients. Such trials – which form the backbone of medical progress – are crucial if we’re to find the best way to treat the increasing number of older people with cancer.

Yet doctors don’t routinely ask older patients if they want to be enrolled on a clinical trial, because they are wary of the potential side effects of the drugs. They’re also concerned about how the treatment might affect other medical conditions that elderly patients may have.

In the 21st century, age is not necessarily a good indicator of fitness, and older people should not be denied the best treatment simply because of their age.

The overriding sentiment of this fascinating session was that we need to move away from an outmoded culture of broad-brush rejection of clinical trials for older patients, and to an era where we better understand the special considerations required for elderly patients on trials.

Many clinical trials exclude people over a certain age, or with concurrent medical conditions. This means that we know less about how cancers behave in older people and less about how well treatments may work. If we designed more trials specifically for older people we could look at things like:

• How cancers behave differently in the elderly;
• Designing trial end points specifically for older patients (so rather than measuring how long it takes for disease to progress for instance, use more appropriate end points such as ‘TWiST’ – Time Without Symptoms or Toxicity);
• Using functional age instead of chronological age (that is, ‘how fit’ the person is, rather than ‘how old’);
• Different ways of treating cancers, such as starting with lower doses of medication and slowly increasing;
• Enrolling older patients in smaller ‘sub-trials’ within bigger trials, so that considerations like those above could be included in the trial design.

Finally, we heard that given the chance, many elderly patients would take part in a clinical trial. In a survey, 75 per cent of patients over 70 said they would be willing to take part.

Increasingly, trials are being designed specifically for older people, such as the HCQ trial, supported by Cancer Research UK.

But the message from doctors and patients is loud and clear. We need more clinical trials designed to meet the needs of the majority of our patients – older men and women.

Trevor Bott, Clinical Trials Database Nurse

The world’s largest cancer conference, ASCO, is underway in Chicago. Among the many thousands of doctors and researchers, our nurses are at the meeting to learn about the latest research. In this first report from the conference, Caroline Geraghty writes about a session that she attended on the impact of tobacco.

Friday was World No Tobacco Day and I found myself in a packed hall listening to world experts about the devastating impact of cigarettes and the many cancers smoking causes.

Also – perhaps something we don’t focus on enough – the impact smoking has on someone who is already diagnosed with cancer.

In the UK, smoking accounts for nearly 20 per cent of all cancer cases and more than eight in ten cases of lung cancer. But there’s emerging evidence that it can also have a devastating effect on people who are already diagnosed with cancer. On the plus side, even when someone develops cancer quitting smoking can have a positive impact on their health.

Speakers discussed how smoking when diagnosed with cancer has been shown in numerous studies and research to be associated with:

• decreased survival;
• increased risk of developing a second primary cancer;
• greater side effects of treatment;
• a poor treatment response;
• higher risk of heart and lung conditions;
• and a poorer quality of life.

Doctors and nurses caring for cancer patients who are still smoking play a key role in helping that person to successfully stop.

But a worrying US study carried out by thoracic surgeons showed that a large proportion of cancer patients did not believe that smoking would affect how successful their treatment was.

The group of doctors speaking at ASCO all agreed that once diagnosed everyone with cancer and still smoking should get referred to smoking cessation clinics. In the UK these are available in hospitals and in the community. They provide expert help and advice to help people stop smoking.

So, the potential benefits of quitting are:

• a better chance of successful treatment;
• reduced side effects of cancer treatments;
• faster recovery from treatment;
• easier breathing;
• more energy;
• and a better quality of life.

Quitting smoking isn’t always easy, so we encourage people to use the resources available to them to try and stop. Your GP or cancer specialist doctor or nurse will know more about smoking cessation clinics near you.

Caroline Geraghty, Senior Cancer Information Nurse

• You can call our information nurses with any questions about cancer on freephone 0808 800 4040.