Today was the final day of the NCRI Cancer conference in Liverpool.
It’s been a fantastic meeting with many interesting talks – from discussions about personalised (and impersonalised) medicine to whiz-bang presentations on the latest imaging technologies and the fast-emerging science of the ‘microbiome’.
Here are our picks from day 4.
Improving palliative care
Dr R Sean Morrison from Mount Sinai Medical Center, New York, gave an important and thought-provoking talk on the sensitive topic of palliative medicine – care aimed at relieving and preventing symptoms without having a curative effect on disease.
People are living longer – by 2030 the number of people over 80 will have doubled in the UK. Within this ageing population comes a huge swathe of older men and women with diseases like cancer who may need palliative care.
Dr Morrison drew attention to the 6.5 million caregivers in the UK who look after relatives and friends with illness, and how palliative care should focus not just on the patient but on the people who help them cope too.
His impassioned plea was that we think more carefully about what we mean by ‘palliative care’ and that it should not be synonymous with end-of-life care. It should be part of a more holistic package of care offered early to patients and their families alongside their treatment to try to cure disease.
To underline his point, he showed how people with advanced lung cancer who were given earlier palliative care (which included help with symptoms such as sleep disturbance, pain and anxiety) had an improved quality of life, fewer depressive symptoms and received fewer burdensome treatments.
But even more important, people who received the early palliative care lived, on average, three months longer than those who did not. Dr Morrison said that cancer drugs with such life-extending effects are routinely approved, so palliative care needs to be given the focus it deserves.
Modelling cancer better
When it comes to developing more effective ways to treat cancer, it’s not always possible or ethical to carry out experiments with patients, so scientists turn to animal models. And while a lot of cancer research is done using simple organisms such as fruit flies or zebra fish, sometimes only a mouse will help yield the information we need. Yet finding ways to accurately mimic human cancers and their response to treatments in mice is a challenge.
In a fascinating session looking at the very latest developments in this field, Dr Louis Chesler’s talk stood out. He spoke about progress at The Institute of Cancer Research in developing a more accurate mouse model of neuroblastoma – a devastating but rare type of childhood cancer.
Often, children with neuroblastoma are initially treated successfully, but the cancer can come back. Thanks to this model, scientists have been able to test new approaches for treating these children, which are now being taken forward into clinical trials to help save lives in the future.
Dr Ton Schumacher from the Netherlands Cancer Institute opened a fascinating session on immunotherapy – treatments that harness the body’s own defence mechanisms to fight cancer. The buzz around immunotherapy has been building in recent years, and this was a good chance to see some of the recent research in this area.
Dr Schumacher has been studying whether the immune system can be re-programmed to recognise faulty molecules on the tumour cells based on its genetic mistakes, leaving healthy cells alone. Early results from lab models of melanoma showed that boosting the immune cells that can spot and target these tumour molecules dramatically slowed its growth.
Dr Stanley Riddell from the USA followed with a presentation on the development of genetically engineered white blood cells. The specialised cells, called T cells, can be modified to target molecules on the surface of tumours. Dr Riddell’s work has teased apart the specific types of T cells that are most effective, and clinical trials for people with lymphoma who don’t respond to chemotherapy are looking promising.
And Dr Doug Fearon from Cambridge took an in depth look at why immunotherapies have not yet benefitted patients with pancreatic cancer. He described a type of cell called a fibroblast in the tissue around the tumour that protects the tumour by barricading the white blood cells from getting in. In mice studies, blocking molecules made by the fibroblasts reversed the barrier and made immunotherapies like ipilimumab more effective.
This approach could lead to new treatments for pancreatic cancer, a disease that is notoriously difficult to treat.
Cancer cell migration is a major problem. It leads to metastasis that results in the death of many cancer patients. And yet we don’t understand very much about it. Dr Eric Sahai from our London Research Institute introduced a session to bring us all up to speed with the latest developments in this area of research.
One of the challenges in understanding cell movement is the problem of heterogenetity, which we often hear about in a genetic context from researchers like Professor Charlie Swanton. But it happens in cell migration too. Cancer cells will adapt to their environment and use a variety of methods to get from one place to another and create problems. And multiple mechanisms of getting about can all happen in the same piece of tumour at the same time.
We need to understand how cells move in the 3D environment of the tumour to truly understand this process. Professor Sahai has developed a computer model of a cancer cell that he can challenge with different environments and see how it responds. He’s created “a virtual cell that seems to be behaving in a reasonable manner”, meaning that it’s doing pretty much what real cancer cells do.
Dr Ewa Paluch from University College London then talked about how cancer cells can very quickly – in seconds – switch from one way of moving to another – which she beautifully exemplified with stunning films of cell movement. This makes them very good at adapting to their environment. People in Dr Paluch’s lab are even going so far as to create lab-based obstacle courses for cancer cells, to see how they cope.
Finally, Dr Peter Friedl spoke about his work to understand how tumour cells move through real tissues. We used to think that tissues created some sort of barriers to movement. But in fact tumour cells are very good at adapting to spaces and wedging their way through. Dr Friedl described tissues as being like complex cities such as Liverpool or London. There are impenetrable areas so built up you can’t simply walk through them. But there are also tracks you can move along – like pavements and alleyways.
These tracks in tissue allow tumour cells to begin invading nearby tissue in a non-destructive way that is very hard to spot. The more we understand about this process, the more we can block it and cut off the tracks used by cancer.
Hunting cancer predisposition genes
The final talk of the conference came from Professor Nazneen Rahman, from the The Institute of Cancer Research, who gave us an engaging overview of the hunt for cancer predisposition genes. Perhaps the most famous examples – thanks to Angelina Jolie – are the BRCA genes (BRCA1 and BRCA2), linked to breast, ovarian and prostate cancer.
More than 100 of these genes have been found so far, and inheriting a faulty version of one of them significantly increases cancer risk. And tests for around half of them are already available on the NHS, helping people and their families, as well as their doctors, to make decisions about prevention, screening and cancer treatment.
Professor Rahman outlined how she and her team are searching for predisposition genes in families affected by many cases of breast and ovarian cancer, making some unusual and intriguing findings in the process. She also highlighted some of the benefits, challenges and potential pitfalls of dealing with these genes, particularly when it comes to translating genetic information into clinical decisions about cancer prevention and treatment.
Here’s to 2014
Wrapping up the whole event, our chief executive Dr Harpal Kumar, this year’s chair of the NCRI, reiterated the purpose of the conference – to bring people together across the whole cancer research community to share new ideas and push forward progress in beating the disease.
We agree with his summary that it’s been the best conference so far, with a real buzz in the air. We left feeling exhausted but also elated at the tremendous progress being made in our understanding of cancer.
We’re already looking forward to next year…
Images courtesy of National Cancer Research Institute, via Flickr.
celia November 9, 2013
Yes my husband died age 60 after being told his problems were down to early onset dementia, to late it was discovered he had a tumour on the pituitary gland. It had grown to the size of an orange before it was discovered. he died when they tried to remove it. It was benign. He would not have died if his doctor and been more aware that this sort of tumour gives very similar symptoms to dementia.
John November 6, 2013
There were I think 60 “Consumers” at the NCRI conference. That’s the name that is given to patients, carers and the bereaved who voluntarily give their time to help cancer researchers, often drawing from their own experiences. It is important to keep stories like yours in front of the professionals. The general public are often critisicised for not presenting early enough with cancer symtoms, but over and over again we hear of people being fobbed off my busy GPs. It’s not the fault of the GPs, they have to filter out the handful of cancers they may see in a year from all the hundreds of other illnesses that have similar symptoms.
@BEAUTIFULMUMSIE (@BEAUTIFULMUMSIE) November 6, 2013
How can I go about getting invited to this next year or is it for professionals only. I would really like to be able to come along and give a Mother’s account of what it was like to go through my daughter being diagnosed with cancer and being her carer and staying with her till the end. Show the carers point of view like Dr Morrison speaks of. I want to also promote that early detection is key and that doctors and professionals are trained to listen to young people. If doctors had listened to my beautiful daughter and did the tests initially instead of fobbing her off for two years telling her you are too young to have colon cancer our beautiful daughter would still be with us today. Please can someone get in touch with me. I would love to come along and be able to speak on my daughter’s behalf. I am trying to do all that I can to raise awareness about early detection in younger people who are developing cancer nowadays and that if detected early they can and should be saved. If this had been done I would not be typing this request. I would be sitting talking to my daughter, having dinner and discussing her having children. Laura died 29 days after she got married age 31. Hope to hear from someone in this connection.
Kat Arney November 12, 2013
We are very sorry to hear about your daughter, and thank you for sharing your story. While the NCRI Cancer Conference is mainly focused on presenting scientific and clinical research there are many people from patient groups and others who have a close connection to cancer, as John says. You might find it helpful to get in touch with the Independent Cancer Patients’ Voice group, who will be able to point you in the right direction: http://independentcancerpatientsvoice.org.uk/.
Science Communications Manager