NCRI cancer conference day 3: radiotherapy, lifestyle… and a pill to prevent cancer?

Tuesday kicked off with continued media coverage of stories from the conference. Younger cancer patients are less likely to have access to a clinical trial reported the BBC, while the Telegraph covered research looking at how a woman’s risk of ovarian cancer is influenced by how many children she has.

There was also coverage of a story about research improving brain tumour imaging, which you can read more about here.

Radiotherapy technology… “the final frontier”

Apologising (needlessly, it turned out) for delivering a morning lecture “on physics and technology, in a German accent”, Professor Uwe Oelfke from The Institute of Cancer Research gave us a highly engaging tour of the latest developments in radiotherapy technology.

First, he looked at a developments in proton beam therapy, a topic never far from the headlines. The point of using protons, Oelfke explained, is that – unlike conventional radiotherapy, which can pass all the way through the body – protons “stop inside the patient – there’s no ‘exit beam”. On top of this, protons are heavier, “so they can do more damage to the tumour.”

The trouble is, a lot of this is still unproven – there’s more research to be done to work out exactly how to reap the benefits of this exciting new technology (you can read our in-depth article on the state-of-play re. NHS proton therapy here).

Next, we heard about another technical feat that’s still a work in progress –  a combined MRI scanner and radiotherapy machine, known as an MRI-LINAC, that should allow radiologists to ‘see’ the insides of a patient as they treat them. This should help solve the long-standing issue of the fact that the position of a tumour can shift in between having a scan and receiving treatment.

We’ve recently announced funding to support Oelfke’s team to study how best to use this technology – it’s an incredibly exciting prospect, which should lead to even more accurate radiotherapy, more cures, and fewer side-effects.

Finally, Oelfke spoke of the huge advances being made in real-time image processing, which, when ready for prime-time, will allow automated treatment of a patient’s tumour. If the radiotherapy machines are “the cannons and guns,” Oelfke said, this is the ‘targeting software’ to make precision radiotherapy a reality.

With a CGI movie of purple tumour floated behind him on the projector screen, pulsating with the patient’s heartbeat, bobbing up and down with their breath, being tracked by a fictional ‘beam’, Oelfke spoke of the problems more-accurate targeting would solve: “I don’t want to have to treat my patients based on an image someone took last week – I want to be able to treat what I can actually see in front of me,” he said.

Need to treat tumours with radiation by how they look on the day and not a week ago, Prof Uwe Oelfke #NCRI2015 pic.twitter.com/vrtyOWJbUc

— Cancer Research Wales (@cancer_wales) November 3, 2015

It was a graphic reminder of the challenges that need to be overcome in cancer radiotherapy, but also of the phenomenal technological advances rolling across our society. “Ultimately, if we get this right, we’ll see better quality treatment, better safety, and greater efficiency,” Oelfke concluded.

Tumours change through evolution

Since our researchers published a landmark study in 2012, we’ve regularly blogged on the important field of cancer evolution. So it was apt for one of the lead scientists behind that study, Dr Marco Gerlinger, to host a session on how the genetic roots and branches of tumours change as they grow.

A fascinating talk from Dr Ultan McDermott showed how tumour evolution can lead to resistance to treatments. Here he made a very important point that “simply saying resistance is happening isn’t good enough”: we need to find ways of using this information to develop the clinical trials that will actually stop resistance. And he then showed some promising results on how combining two treatments might help overcome resistance to one of those drugs.

Dr David Kent closed the session with the fascinating story of how the order in which blood cells pick up two particular genetic faults can change how resulting cancer cells behave.

If the faults appeared in one order this meant the disease developed earlier, and was potentially more aggressive, showing how important spotting these changes in tests might be in the future.

A pill to prevent cancer?

We all know the old mantra ‘prevention is better than cure’. But as with most things, it’s easier said than done, especially when it comes to a complex set of diseases like cancer. Today we heard about some of the hot topics in cancer prevention, and naturally aspirin was top of the list.  It’s a drug we’ve written about regularly and CRUK is helping fund some cutting-edge research in the field. There are still lots of questions to be answered – including how the drug actually helps prevent cancer, and how much should be given to maximise the benefits and minimise the risks. We also heard some interesting ideas about how to find people whose genes mean they could benefit the most from taking aspirin.

Professor Karen Brown then summarised her current work into resveratrol – a compound found in grapes and red wine that could one day be used in a purified form to help prevent some cancers. But as always, she was quick to point out this isn’t the same as drinking a glass of red wine – and many studies on resveratrol in the lab use much higher levels than would be safe in the bloodstream, so the results should be interpreted with caution

Professor Jack Cuzick rounded off the session with a timely reminder of how far we’ve come in breast cancer prevention. And he emphasised that prevention studies need decades of follow up, saying ‘prevention is a long game – even with 20 years of follow-up, we still don’t have all the data yet.’  It was a fascinating session on a controversial topic, that had a lot of people talking afterwards:

https://youtu.be/WfNg2HiTcdg

Lifestyle behaviour

In a packed afternoon session, we heard some excellent summaries of the most recent evidence on how alcohol, diet and physical activity affect our risk of cancer. Given that many of the audience had been to the conference drinks reception the night before, the sobering statistics on alcohol consumption were especially interesting.

One thing that jumped out was research showing the public will accept a 1 in 1000 chance of dying as a result of ‘voluntary’ risky behaviour like drinking alcohol. But to meet that risk level, we’d need to be drinking just 3g of alcohol per day – and the average level across the EU is 30g.

Getting from 30 to 3 is a big goal but one that, along with helping people change their habits, we can also tackle with evidence-based policies. Research shows that increasing taxes on alcohol and introducing minimum pricing are, for governments, both effective and cost-effective – speaker Professor Eileen Kaner made the point that there’s a lot more we could be doing in the UK on this front.

The other speakers covered the growing evidence on diet, activity and cancer risk – we know that things like eating too much processed meat definitely increase the risk of cancer, but there’s still a lot of work to do to understand the chemicals and biological processes involved.

Dr Paolo Boffetta then challenged researchers to stop focusing only on specific components of our diets, and to study wider ‘dietary patterns’ instead to build a more accurate picture of how our food affects our risk.

And Professor Martin Wiseman from World Cancer Research Fund finished the session on an optimistic note by emphasising that, while it’s a big task, we can change cancer risk for whole populations. He said we need to accept that society has changed – for example we’re all less active than in previous generations. If we can change the way the whole of society behaves then we can tackle the lifestyles that increase cancer risk.

Turning lab research into new treatments

Next, we had what was one of the most eagerly anticipated sessions of the whole conference – the story of how the Nobel Prize-winning breakthrough in understanding how cells divide (made, in part, in Cancer Research UK’s laboratories) has been successfully translated into a brand new treatment for breast cancer.

First, we heard from one of the architects of the original discovery, Professor Sir Tim Hunt. Despite occupying “the more basic end of the research spectrum,” Hunt recalled how the fact that several members of his family had been affected by cancer had spurred him on in his scientific career.

He then told the story of how his painstaking research, in collaboration with Professor Sir Paul Nurse, led to the discovery of a number of proteins – known as cyclin-dependent kinases (CDKs) – made by our cells that control how they grow and divide (covered in more detail in this post). It was a charming, humble, inspiring look back over a stellar career in basic laboratory discovery.

Brilliant and funny talk from Tim Hunt, but fails to address elephant in the room…. How long has he worn that jumper for? #NCRI2015

— Richard Berks (@DrRichardBerks) November 3, 2015

But to improve things for patients, basic research needs translating into cancer care. And next we heard exactly how this could be done. Professor Dennis Slamon, who’d flown in overnight from LA despite illness, was a member of the team who developed breast cancer drug trastuzumab (Herceptin), which has transformed the outlook for thousands of women with the disease. And today he described his recent work in developing another new cancer drug, which targets the very CDK proteins that Hunt, Nurse and co. had discovered decades previously.

The drug, known as palbociclib, was identified among thousands of candidate drugs languishing on the shelves of a pharmaceutical company, and Slamon told us how his team dusted it off, and proved it could help treat of advanced, ER-positive breast cancer. Trials suggest it could double the time it took for the disease to return when compared with standard therapies.

It’s now working it’s way through the regulatory system, and we hope it’s made available to women in the UK before too long. And, excitingly, even more potent CDK-targeting drugs are now in the pipeline.

It’s the final day of the NCRI conference today – we’ll be back then to bring you a round-up of the final sessions shortly.