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Working together to beat cancer in young people

by Alan Worsley | Analysis

15 July 2015

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It’s been a very busy few months for us since we launched Cancer Research UK Kids & Teensour campaign to raise money for research into cancers affecting children, teens and young adults.

And last month we brought together experts from across the children’s cancer research community for a day-long workshop to discuss the challenges we face in finding better and kinder treatments for young people with cancer.

Over the coming years we’re also doubling the amount we spend on this type of research. Our ambition is that all young people diagnosed with cancer will survive and go on to live long, fulfilling lives.

But in order for us to do this we need experts in the field to propose big new ideas as the first step to achieving this goal is identifying the biggest obstacles in our path.

We could do better

We’ve come a long way since the 1960s, when just a quarter of children survived cancer. Now more than three quarters of children are cured.

Today, there are more than 33,000 survivors of childhood cancer in the UK, and – according to a presentation given at the workshop by Dr Helen Jenkinson – a further 230,000 people have survived cancer after being diagnosed under the age of 40.

This is a fantastic achievement.

But we can’t rest on our laurels.

Recent research (Reulen et al 2010) has shown, in the decades following cancer treatment, children face a dramatically increased risk of serious health problems compared to the general population.

In a way, the problem of long-term side effects illustrates how far we’ve come in successfully treating some types of cancer in young people. But with so many surviving, it is even more incumbent on us to find kinder treatments.

And of course, not everyone survives – so as well as making life easier for survivors, we still need to improve survival for other types of cancer that haven’t seen as much success.

To work out ways to accomplish this, the research community needs to work together to tackle the problem, and identify how to break down these challenges. And, at the workshop last month, that’s exactly what happened.

The knowledge gap

The workshop gathered more than 50 researchers and clinicians to discuss topics affecting young people with cancer including clinical data, trials, radiotherapy, surgery and the long-term consequences of cancer treatment.

One of the recurring themes throughout the workshop was that the research community doesn’t collect enough data about young people treated for cancer.

This includes both long-term follow up of cancer patients, and the routine collection of detailed information on the biology of an individual patient’s tumour.

The last point is especially important, as the research communities’ understanding of cancer biology has increased in leaps and bounds in the past decade.

As Dr Antony Michalski, paediatric oncologist at Great Ormond Street Hospital, told us: “The explosion in our understanding of molecular biology has been fantastic over the last few years.

“We’ve now got the tools to really start to understand what makes the tumours tick, and how the children react to the treatment. And we have to use those tools, not just in clinical trials, but for every patient, every time.”

Ideally, this would guide the sort of treatment young cancer patients receive.

For example, if doctors knew whether a child or teenager had a particularly aggressive tumour early on, they could scale the intensity of the cancer treatment to match.

Conversely, young cancer patients with milder forms of the disease could be spared some of the side effects of treatment.

But these tactics can only be deployed to their greatest potential if the gaps in our knowledge are filled – and this means routinely analysing each patient’s cancer to look for clues for how best to treat it.

More Trial, less error

Fortunately, the number of clinical trials available for young people with cancer is rapidly increasing.

And the trials that are opening are bigger, more elaborate international trials which look to match patients to the best treatments.

At the workshop the experts discussed whether these new trials are as efficient as they could be.

Clinical trials for young people still take far too long to set up, so a quicker way of getting these trials off the ground could help get the outcomes we need sooner.

And there were also suggestions that new trials for young people with cancer should take greater advantage of new treatment types, such as immunotherapy, which have begun demonstrating some success in adults.

Other questions that were discussed included whether researchers should expand trials to include more people or whether the molecular basis of the disease should be the focus of a trial rather than a patient.

For example, pioneering clinical trials that match treatments to the specific genetic flaws causing adult cancers, such as the National Lung Matrix Trial, are marking a new era for personalised medicine. There was much discussion about the need for similar advanced in children’s cancers.

A great starting point – Now to finish

These aren’t easy barriers to overcome. But it is only by conducting more research and working together that cancer researchers will find solutions.

As Professor Pam Kearns, director of Cancer Research UK Clinical Trials Unit at the University of Birmingham told us: “The big challenge is that we can’t answer all the questions we’ve got with the resources we have at the moment. So we really need more investment, which is what Cancer Research UK Kids & Teens is all about, and then we can make a real difference for young people with cancer.”

But most importantly, the workshop seemed to foster a genuine sense of excitement. Many of the experts in the room have been adamant for some time that clinicians and researchers need to change their approach to tackling cancer in the young. And bringing these researchers together marked an important first step in determining what this approach should look like.

The next step is for the research community to work these discussions and ideas into concrete proposals, and apply for funding via Cancer Research UK, so we can help them work to overcome these challenges.

It won’t be easy guaranteeing that every young person diagnosed with cancer lives the longest, happiest life possible. But with many of the world’s leading children’s cancer researchers working together, this can happen that much sooner.