NCRI cancer conference day 2: big data, immunotherapy and prizes

Monday morning’s papers had lots of coverage of research presented at yesterday’s conference: data on the unacceptably high death rates of patients diagnosed as an emergency made several papers (including the front page of the Daily Telegraph).

But there was still more fascinating research presented at the conference as it got into gear for day two.

‘Big data’ to improve healthcare for all

Self-confessed “data girl” and cancer clinician Professor Amy Abernethy kicked off her talk about patient data with, unsurprisingly, a story about a patient.

Abernethy told us about Janet, a melanoma patient whose story illustrated the type of data being collected by her team at Flatiron Health, a tech company owned by Google.

It all centres on what a patient can tell their doctor – are they experiencing pain, for example.

Traditionally these kinds of patient reported data tend to only be captured during clinical trials rather than routine care. But Abernethy thinks it should be collected for all patients, and used to improve things. The hope is that by collecting lots of these datasets they will be able to track in real-time what lots of patients are experiencing during their treatment, and later on in their care.

If done properly this, she thinks, would lead to a ‘learning’ healthcare system, using everyone’s experiences to constantly improve.

For Abernethy it’s about “using the data in context,” and she warned that “hoarding data is a problem, but using and reusing it is where we’ll get the benefits.”

She compared patient and research data to “the river that powers the mill of our healthcare system”.

It’s a nice idea, and could be particularly empowering for patients and their doctors. But at the moment this is very much a US endeavour. And with a struggling NHS, we were left wondering how similar attempts would get off the ground on home soil – a frustration summed up perfectly in this tweet.

"River of data" should be driving patient care. Sadly it's more like a series of ponds and swamps supporting little paper boats #NCRI2015

— Ian Lewis (@DrIanto) November 2, 2015

Immunotherapy

“Immunotherapy”, in the words of Professor Adrian Hayday, “has made it to the big room at last.”

For the first time, many of the immunology sessions were hosted in the conference centre’s large hall – a noticeable reflection on how far this type of cancer treatment has come in recent years.

There were an incredibly diverse range of talks on immunotherapy but most boiled down to two key questions.

• What is the basic biology behind these treatments? In other words, how do they actually work?
• And what do we still need to understand about them?

Professor Ira Mellman from Genentech gave an excellent talk addressing the first question. He emphasised that looking at what’s going on in human patients in response to these treatments, and how this differs from studies in mice, is imperative if we are to figure out how they work.

Next, Dr Emanuela Romano demonstrated that the first new immunotherapy treatment, ipilimumab, actually works very differently from how we thought it did. Crucially, her work could lead to a way to work out which patients best respond to this treatment.

In answering the second question, Professor Adrian Hayday gave a fantastic talk about a type of immune cell that has been overlooked, but could prove to be an incredibly important part of future cancer treatments.

Dr Laurence Zitvogel went one further, detailing how big an influence the bacteria in our gut can have on our immune system. The bacteria in our body constantly “talk” to our immune system. And particular strains may be crucial for enabling our immune system to mount the kind of response it needs to fight cancer.

Overall, it was a fascinating series of talks emphasising how far we have to go to really understand how the immune system fights cancer. At the same time, it’s amazing how much we’ve achieved.

Watch this video for a sense of just how exciting this field has become.

https://youtu.be/Q-Mzp53Pu-k

• Watch the video on YouTube

E-cigarettes

As highlighted at an engaging session on the latest research on e-cigarettes, people still have misconceptions around these products’ safety, despite a growing body of evidence that they’re much safer than conventional tobacco products. And if we don’t do something about these misconceptions, there’s a danger people will keep smoking – and keep dying – because of them.

Crucially, evidence so far shows that e-cigarettes are not a gateway into smoking for younger people, and that e-cigarettes are becoming the method of choice for many people who want to quit smoking.

All in all, the session reiterated what we know, with some more up to date figures – smoking kills, people should be encouraged to quit, using one of several proven methods in the way that works best for them.

And while there’s mounting evidence around e-cigarettes’ potential, more research into their longer term effects is needed.

Liquid biopsies

Patient blood samples contain two things that scientists are hunting for: rogue cancer cells and chunks of tumour DNA. The promise of these so called ‘liquid biopsies’ has been growing over the last decade, and a session this afternoon asked if we were getting closer to using these in the clinic.

A few key themes emerged that tell us we are, but there’s still some way to go.

Dr Luis Diaz, from Johns Hopkins Hospital, explained that circulating tumour DNA is a “dynamic marker” that could be used to monitor the earliest stages of whether a tumour might come back after surgery. Put simply, he said this was a potential way to answer whether a patient “has been cured or not”.

University of Leicester’s Professor Jacqui Shaw agreed, showing that combining the analysis of DNA and circulating tumour cells could be used to monitor breast cancer patients after treatment. But analysing the cells is a real challenge, and her team is focusing on new technology to help their research.

Dr Nitzan Rosenfeld, from our Cambridge Research Institute, closed the session with some discussion on how, among other things, circulating DNA might be used for diagnosing cancers.

The main take-home message was ‘it’s complicated’ and he warned that “we don’t know how sensitive a test would need to be, so we don’t know if the methods we have are good enough”.

But what was clear is that among the experts in the room, we have some of the best minds trying to tackle these challenges.

Physical activity – use it or lose it

Exercise and physical activity were on the agenda again, with increasing evidence that activity can not only reduce the risk of getting cancer in the first place, but also reduce the chance of the disease coming back after treatment (for cancers such as prostate, breast and bowel), as well as helping tackle side-effects.

Dr Matthew Maddocks, from King’s College London, gave an excellent talking emphasising that physical activity can even help patients with advanced and terminal cancer – small improvements in ability can be crucial if they allow a patient to move themselves from their bed to a chair without help. But there are still a lot of questions to be answered in this highly active field.

Points win prizes

Day two came to a close with the annual Cancer Research UK prize ceremony, presented by our chief clinician Professor Nic Jones.

Among this years’ winners was a cross-disciplinary team led by Professor Alan Rickinson, who are aiming to develop a vaccine against the cancer-causing Epstein Barr virus, and Dr John Brognard, whose work is leading to a new class of experimental drugs.

This years’ lifetime achievement award went to Professor Mel Greaves, of the Institute of Cancer Research, who Jones described as “a remarkable and inspiring investigator”

Prof Greaves’ life’s work has been focused on understanding the roots of childhood leukaemia and, said Jones, is very much “a pioneer in the field. No doubt his work has inspired many other scientists, and had a huge impact in how we think about cancer.”

Delivering a subsequent talk on his life’s work, Greaves harked back to the morning’s talk on ‘big data’, he recalled how his decision to study childhood leukaemia in the 70s was driven by the fact that it was one of the few cancer types back then was that it had large, well conducted trials with lots of data available. “I defy anybody who’s a parent to look at a child having chemotherapy for leukaemia and not think ‘that could be one of mine’.”

And finally, the Lifetime Achievement in Cancer Research Prize winner: Prof Mel Greaves @ICR_London #ncri2015 pic.twitter.com/QW38oJEI2h

— Science and Innovation at Cancer Research UK (@CRUKresearch) November 2, 2015

We’ve written at length about Professor Greaves’ groundbreaking work on childhood leukemia – you can, and should, read it here.

That’s it for yesterday’s action – we’ll be back.