NCRI 2014 conference summary – day 4

Here’s our final post from this year’s NCRI cancer conference in Liverpool. Once again, several sessions from the event made it into the media:

• The Times and the Daily Mail covered research about problems with lung cancer diagnosis

• The Times also wrote up exciting results of a trial of a new drug called olaparib for men with prostate cancer

• And the Daily Mail covered the session on cancer prevention and obesity we wrote about yesterday.

Resistance is futile

And so to the sessions. One of the big problems with so-called ‘targeted’ cancer treatments, tailored to attack specific molecular faults within cancer cells, is drug resistance. And understanding why and how this occurs was the focus of a whole session of talks on Wednesday morning.

One way to try to study resistance is to measure cancer’s DNA fingerprints in blood samples. As Cancer Research UK’s Dr Nitzan Rosenfeld explained, “there are a wealth of possible applications” for this technology, including tracking how cancers change over time and predicting how they may become resistant to drugs.

Another new area of research is focusing on ‘organoids’ – tiny tumour models grown from samples taken from patients. Dr Matthew Garnett explained how he and his collaborators had developed over 20 different types of bowel organoids that seem to model many aspects of the disease in humans.

They’re now working on a much larger bank of organoids that could be used more widely. “We estimate we would need well over 10,000 cell cultures to begin to capture the diversity of human cancers,” he said. It’s a challenge, but one that has real potential to help improve the effectiveness of targeted therapies.

Life at any cost?

Improvements in chemotherapy and radiotherapy now help half of all cancer patients survive for five years or more. But side-effects from these therapies are still a big problem, and often mean that despite their cancer being cured, survivors can have a lower quality of life. A series of thoughtful talks explored how this problem might be fixed, and identified new ways that cancer patients’ quality of life might be improved.

In his presentation, Dr Jervoise Andreyev from the Royal Marsden Hospital spoke about how it is “not good enough” to accept side effects as part-and-parcel of cancer treatment. Instead, more research needs to be done to understand how these side effects come about – and what can be done to stop them.

Professor Jean Klastersky from the Jules Bordet Institute in Brussels discussed how even the “cured patient has potential problems” and suggested that supportive care – which considers different aspects of a cancer patient’s well-being, from mental health to therapy-induced side-effects – should be included in all treatment programmes (something our research is confirming).

He also highlighted the need for more research into the short and long-term effects of chemotherapy and radiotherapy.

Inner space

Images from inside the body are revolutionising our understanding of cancer, giving us insights into the secret life of tumour cells. Cancer Research UK’s Professor Kevin Brindle kicked off a session on imaging with an extraordinary series of pictures taken by a variety of state-of-the-art imaging techniques, used to spy on every aspect of cancer from how cells move and grow, to how they die. A series of speakers then described how this field is rapidly advancing, combining technology with physics and chemistry, to improve our understanding of cancer.

Professor Eric Aboagye introduced us to how imaging is used to detect key molecules on the surface of cancer cells, helping to unravel the biology underpinning certain cancers.

Dr Simon Lord then described how he was using imaging techniques to investigate the anti-cancer potential of a diabetes drug in breast cancer patients, and the Institute of Cancer Research’s Dr Martin Leach gave a whistle-stop tour of the most recent imaging tools to measure tumour response to treatment.

Finally, Dr Gooitzen van Dam topped things off with glowing cancer cells; showing how his team are “making the invisible, visible” by lighting up tumours with fluorescent dyes to improve surgery.

Overall, it was clear that the world of cancer imaging is bursting with exciting advances and pioneering research, fuelling new strategies to tackle cancer and, ultimately, benefit patients.

Cancer targets

To diffuse a bomb you have to know exactly which wire to cut, and similarly to neutralise a tumour you have to pinpoint its weakness. And we heard four fascinating talks about exactly how scientists are hunting out the chinks in cancer’s armour.

The first was given by AstraZeneca’s Dr Graeme Smith, who showed how many attempts to develop new treatments fail because researchers haven’t been good enough at finding and probing these weaknesses in the lab before clinical trials. He suggested we are now moving to a new era in which we are much better at this.

Next we heard from Dr Maria Romina Girotti, who works at our Manchester Institute, who provided beautiful example of this new era. She’s identified new drug targets in drug-resistant melanoma that has spread – a disease with a very poor prognosis. Maria has studied these targets in exquisite detail in the lab through a whole barrage of tests, and is now hoping to move her ideas into a clinical trial next year.

We then heard from Cancer Research UK’s Professor’s Martin Glennie. His approach is the equivalent of calling the professional bomb disposers, which in the human body is the immune system. He outlined how scientists are utilising our body’s natural defences to beat cancer by stimulating the immune system – an area of immense potential.

Finally we heard that great things do indeed come in small packages. The ICR’s Dr Ian Collins discussed the use of ‘small molecules’ – relatively simple chemicals – to probe a newly identified potential target and test whether it would be suitable for further drug development.

HPV in ‘head and neck’ cancer

The human papillomavirus (HPV) is most commonly thought of as a virus linked to cervical cancer. But it can also cause cancers in the mouth, nose, throat and other nearby areas – collectively known as ‘head and neck cancers’, and these were the focus of another session at the conference.

Most people with HPV-linked head and neck cancers respond well to treatment – many are cured. At the moment all patients – HPV-positive and HPV-negative – are given the same treatment, and Professor Kevin Harrington talked about clinical trials underway that are finding out if patients with HPV-linked disease could safely be given less treatment. We also heard about promising results from early stage clinical trials of immunotherapy.

Then Professor Gareth Thomas went into a bit more detail of how doctors could identify those patients with HPV-linked cancer who won’t respond to treatment. They found that patients who don’t have an immune reaction to HPV, and whose tumours contain lower white blood cell levels, are at higher risk from a poor outcome. People who smoke also tend to respond poorly to treatment, he found.

Into the final furlong

The closing plenary lecture of the conference came from Professor Elaine Mardis, co-director of the Genome Institute at Washington University in Missouri. She and her team are studying the genetic profiles of individual patients’ cancers as they evolve and change in response to treatment, particularly focusing on leukaemia and breast cancers.

She raised the fascinating possibility of personalised immunotherapy – using DNA sequencing to identify faulty molecules in a patient’s cancer cells that might be particularly visible to the immune system, allowing the creation of an individualised vaccine. It’s early days – the technique has been tested in a handful of people so far, and Mardis is still waiting for the results, but it could be a promising approach for the future.

Finally, the chair of next year’s conference, Cancer Research UK’s Professor Charlie Swanton, took to the stage. After thanking the organising team (who we agree have done a sterling job) he gave us a teaser of some of the big name speakers we can expect to hear from at the 2015 NCRI Cancer Conference.

Top of the bill is our own Nobel prize-winner Sir Tim Hunt, along with one of the “fathers of Herceptin”, Dennis Slamon.

There will also be a focus on immunotherapy, including Professor Carl June, whose work using modified HIV-like viruses to treat leukaemia made social media headlines last year.

And we’ll also hear from Nobel prize-winner Professor Harald zur Hausen, who discovered the cancer-causing human papillomavirus (HPV) and has some intriguing new ideas about how a diet rich in red meat might increase cancer risk.

Reflections

So, now the conference is over for another year, what were the ‘big themes’ at NCRI 2014?

The most obvious one was the clear excitement around the idea of tracking cancer’s development with ‘liquid’ biopsies – either using circulating tumour cells, or circulating DNA. Could we even be approaching an era where these blood tests replace conventional biopsies?

Second was the re-emergence (after several quiet years) of excitement about new drugs called PARP inhibitors – the first of which, olaparib, is set to arrive in Europe in January.

The idea that targeted drugs need to be used in combinations was another recurring theme, as was the fact that the pharmaceutical industry can be less-than-enthusiastic about running trials involving more than one company’s product – although in some cases this is starting to change.

Many talks focused on the need to improve the number of patients diagnosed at an early stage.

But despite the notable excitement at the US ASCO conference earlier this year, immunotherapy – manipulating the immune system to treat cancer – seemed to take more of a back seat here: surprisingly, none of the conference plenaries focused on this topic. That said, the immune system’s role in cancer was mentioned as part of many other talks – maybe it’s simply ‘gone mainstream’.

And last but not least, Twitter has finally arrived at the NCRI. This was the first NCRI conference where there was significant discussion and interaction online as well as in the halls… you can scroll back through all of it by visiting the #NCRI2014 hashtag.

That’s all for this year. Thanks for reading.