We asked some of our top researchers to share their personal ambitions for 2019 and the key trends that they hope to see emerge in their field.
Preventing cancer – Professor Jack Cuzick, Queen Mary University of London
Professor Jack Cuzick, from Queen Mary University of London, works in cancer prevention. He has fronted ground-breaking clinical trials showing how certain drugs can reduce some women’s risk of developing breast cancer. In 2019, he hopes to provide the maths that convinces the National Institute for Health and Care and Excellence (NICE) to recommend low-dose aspirin as a way of preventing cancer.
It’s clear that the most important thing to do to avoid cancer is to not smoke. But if you ask people what the second most important thing is, you get a variety of answers. Our calculations indicate that taking low-dose aspirin for 10 years between the ages of 50 and 70 could be among the most important things this age group can do to prevent cancer. Tackling smoking and obesity are clearly important, but we think this is as important as obesity and is much easier to make an impact on. One of my big ambitions of 2019 is to make this much more widely known.
The most important thing we’re trying to do this year is to get NICE to recommend aspirin as a means of preventing cancer. We know taking low-dose aspirin can come with side effects, like stomach bleeding, but I think the benefits outweigh the risks for almost all people. We’re hoping to get a risk analysis study done to make it clear that offering people aspirin will save the NHS money, because I think the costs of having to manage cancer far outweigh the costs of treating occasional bleeds.
One exciting area that I think we’re going to hear more about in 2019 is breast cancer prevention. Side effects of breast cancer drugs, like tamoxifen and aromatase inhibitors (such as anastrozole), have put some people off taking them to prevent cancer coming back. I think we’re going to see some trials looking at the impact of taking these drugs in lower doses. We have reason to believe low dose may be effective and may not cause most of the side effects, but I’m looking forward to seeing this explored more scientifically.
Radiotherapy – Professor Corinne Faivre-Finn, The Christie NHS Foundation Trust, Manchester
Professor Corinne Faivre-Finn is a Cancer Research UK-funded radiotherapy expert based at the Christie Hospital in Manchester. Some of the most sophisticated radiotherapy equipment in the world lives at the Christie. And in 2019, Faivre-Finn hopes to start thinking about how it can be used to help lung cancer patients.
We had a very advanced radiotherapy machine called an MR Linac installed in my hospital in 2018. It’s basically an MRI scanner and radiotherapy machine combined. At the moment there isn’t much evidence on how we can apply this technology to lung cancer, so one of my major ambitions this year is to develop a clinical trial using this machine for these patients and to secure funding to run it.
A proton beam therapy machine was also installed last year. It’s wonderful to have technology like this available for us in the UK, but we have to be very careful with it. This year I also plan on visiting centres elsewhere in the world where they have experience of treating lung cancer with proton beam therapy to learn from them. Then I can start planning potential ways in which we could test these machines to make them work best for patients.
For radiotherapy as a whole, the field is very excited about combining radiotherapy and immunotherapy. At the end of last year evidence was published to show that combining the two treatments had a very good impact on the survival of lung cancer patients. I’m sure evidence on this combination will continue to build in 2019.
Screening – Professor Jo Waller, University College London
Professor Jo Waller, based at UCL, mainly focuses on cervical screening in her research. She talked to us about the exciting prospects in 2019, including the introduction of primary HPV testing, a new national cervical screening campaign and a switch in tests for the bowel screening programme.
I am looking forward to the big improvements in the cervical screening programme in England which will come with the switch to human papillomavirus (HPV) primary testing. This change will flip the order of cervical screening tests, making the programme better at picking up and treating cell changes before they become cancer. Implementing a big change to a national screening programme is not without its challenges, but the plan is to have it rolled out across the country by the end of the year, which is really exciting.
Secondly, I’m interested in the national cervical screening campaign that will be launched in March 2019. The campaign aims to increase the number of women who attend screenings for cervical cancer, hopefully bucking the downward trend we’ve seen in uptake over recent years. It also coincides with the tenth anniversary of Jade Goody’s death from cervical cancer, which we are also hoping will be a moment where we can raise awareness about the disease again. Between the time Goody was diagnosed with cervical cancer in 2008 and her death in 2009, there were around half a million extra cervical screening attendances in England (this became known as ‘the Jade Goody effect’).
Additionally, there’s the switch to the Faecal Immunochemical Test (FIT) in bowel cancer screening. At the moment, the Faecal Occult Blood Test (FOBT) is used. But it’s expected that the switch should have a dramatic impact on uptake because we know that people find it easier to do the FIT as it is just one test, whereas the FOBT involves three different tests. All the evidence from the pilots suggests that it should cause a big uplift in participation. Bowel screening has historically had low levels of participation compared with breast and cervix. If we can see an improvement, it would be really welcome.
Immunotherapy – Professor Karl Peggs, University College London
Professor Karl Peggs is a clinician and researcher specialising in stem cell transplantation and immunotherapy. His research interests include engineered cell therapies and he’s particularly excited about the continuing progress of a personalised immunotherapy treatment called CAR T cell therapy in 2019.
We’ve seen some major advances in CAR T cell therapies in 2018 for certain blood cancers, and hopefully that will continue in 2019. So far, the treatment has been approved for some adults with diffuse large B cell lymphoma and some children with leukaemia, if their cancer has continued to grow or come back after standard treatments.
We’ve now got 8 centres in England that are being approved to deliver this complex treatment, 1 paediatric centre, 6 adult centres and one hospital that will treat both children and adults. These centres have begun to open and will continue to do so over the next few months. Getting this first wave of centres up and running with the treatment is essential to give us the capacity that’s required to treat patients who could benefit. And the next step in my opinion will be to expand the number of sites that offer the treatment, as it will be much better for patients if they are treated locally. We also need to do some work in 2019 to look at the best way to ensure that everyone who could benefit from the treatment is identified and referred to a specialist centre, to make sure they get the treatment at the right time.
We’re also starting to see trials opening that are testing CAR T cell therapies for patients whose disease hasn’t progressed as much. These will really help us to confirm the value of CAR T cell therapies compared to standard treatment for blood cancer. These trials have the potential to be really exciting, because if CAR T cell therapy is found to be better it could become a treatment option for a much larger group of patients. We won’t have any results in 2019, but we’ll start to see trials opening in the UK and across Europe.
Professor Karen Vousden – Cancer Research UK’s chief scientist
Professor Karen Vousden has spent the last 30 years in cancer research studying one of the most important molecules in cancer, called p53. She was director of our Beatson Institute in Glasgow from 2003 until two years ago, when she was appointed Cancer Research UK’s chief scientist. In 2019, Vousden is looking forward to understanding more about how altering diet can affect cancer treatment.
One of the areas we’re interested in is whether we can use defined diets to boost the effectiveness of treatments like chemotherapy. This approach depends on a detailed understanding of how cancer cells feed themselves. Research by us and others has shown that cancer cells are highly dependent on a supply of some amino acids, including one called serine. And we’ve found that we can slow tumour growth in mice given a diet that doesn’t contain this amino acid. Now we’re really interested in trying to move this work into people to see if the same thing applies.
Our ultimate aim is to run a clinical trial testing if a special diet that lacks serine can help patients having chemotherapy, but first we need to test the diet in healthy volunteers. This year we hope to find out if it’s possible to reduce the amount of serine circulating in the body by putting someone on a special diet, as it is in mice. We’ll also be running more experiments with mice to see if this restricted diet has any unexpected impact on the rest of the body, particularly the immune system.
Beyond my work I’m really excited about what we’ll learn about immunotherapy in 2019. The idea that we can reactivate the body’s ability to detect and kill cancer cells using these new treatments has been a game changer in recent years. But while it’s had astonishing results for some people, others don’t respond at all. So as well as looking to develop new approaches, I hope the next few years will bring a deeper understanding of why only some patients’ cancers respond to this type of treatment.
Finally, there’s a lot to look forward to at Cancer Research UK. I’m particularly excited by some of the ambitious initiatives that are being set up at the moment. We’re bringing together talented people from around the world and from lots of different areas of science to tackle some of the big questions in cancer research. And that opens up some hugely exciting possibilities.
We’ll catch up with these experts at the end of the year to reflect on the past 12 months of cancer research. We’re also looking forward to hearing about other interesting things that happened in their field in 2019, let’s hope it’s a busy year!
Gabi, Katie & Ethan