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NCRI Cancer Conference 2016: Day 2 – blood tests, virus treatments, preventing cancer and more

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by Cancer Research UK | Analysis

7 November 2016

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A cold Monday morning in Liverpool brought with it a raft of fresh headlines from the conference.

Substantial weight gain over many years increases the risk of obesity-related cancers in men by 50 per cent and in women by almost 20 per cent, according to research featured in the Mail Online.

And bacteria in the bowel could play a role in how effective immunotherapy treatment is in patients with melanoma, reports the BBC.

It was also an action-packed day of talks. Here are our highlights.

On the origin of lung cancer

Professor Mark Krasnow, from Stanford University in the US, is delving into the early stages of lung cancer.

His team has painstakingly mapped out how lungs develop in mice – a map that spans some 30 pages in the journal Nature. This has been crucial in finding specialised cells, called stem cells, that help the lungs develop, but also offers clues on the origins of lung cancer.

The stem cells are vital in replacing old or injured cells. But if the signals telling them to multiply go wrong the cells can start growing out of control, leading to cancer.

It’s fascinating stuff, but will it help diagnose or treat lung cancer? Krasnow believes so: “Spotting a cluster of the stem cells could be used diagnostically,” he said. And he believes the cells and their signals could also be an early ‘red flag’ pointing to the first stages of lung cancer and possible new ways to treat it.

Bad blood?

Continuing the lung cancer theme Professor Caroline Dive, from our Manchester Institute and scientific chair of this year’s conference, made some bold predictions around blood tests for cancer.

She said that in 2 years so-called ‘liquid biopsies’ will be helping to monitor patients and personalise treatment. And with a few years more work she believes that “looking for the needle in the haystack” – in this case tumour DNA or cancer cells in the bloodstream – could also help detect signs of cancer earlier.

Dive’s work focuses on lung cancer, which we’ve written about before and she explains in the video below.

And new results from her team point to a combination of two drugs that is showing early promise in the lab for small cell lung cancer. That promise is so great, said Dive, that she anticipates a clinical trial is on the horizon to test these drugs in patients.

It’s a competitive field, with bets being placed – and companies being founded – around the best thing to look for in the blood (or in some cases urine, as a talk on bladder cancer made clear). “I get lots of grief from the DNA guys,” said Dive. “That stuff is easy, this is difficult.”

But with the promise that both tumour DNA and circulating cells hold, there will most likely be room for both.

That promise was reinforced by talks from Dr Max Diehn, from Stanford University in the US, and Dr Gerhardt Attard, from the Institute of Cancer Research in London. They are working on lung cancer and prostate cancer respectively, but both believe that fishing tumour DNA out of the blood could help monitor how patients respond to treatment.

And, tantalisingly, their early work suggests the tests could pick up signs of when drugs stop working, which could help doctors switch treatment earlier than is possible right now.

It’s early days, said Diehn, and “larger studies are needed.”

“But it’s very exciting.”

Breast cancer in the developing world

Breast cancer is more common in high-income countries. But cases of the disease are increasing in low- and middle-income countries.

Why?

There are a number of reasons, said Dr Cheng-Har Yip, from Malaysia’s Breast Surgery International, but the majority are related to changes in lifestyle as countries develop. Many developing countries are witnessing expanding waistlines as they shift towards a Western diet, said Yip. And obesity increases the risk of breast cancer, as well as 12 other types of cancer.

An added issue is that poorer countries lack adequate healthcare systems and the infrastructure to keep them running. And in these countries, low awareness of cancer symptoms, coupled with the stigma attached to breast cancer, may be behind women being diagnosed late when their cancer is harder to treat.

So what can be done to close the global gap in breast cancer care, asked Yip? “What we need is empowerment, advocacy, education, support and awareness,” she said, at the close of what was a humbling talk.

A focus on preventing cancer

“Prevention has been perhaps a bit of a poor relation to treatment when it comes to cancer,” said Professor Susan Jebb, from the University of Oxford. At a conference where scientists are keen to present new science, a session focused on the research that’s needed to justify changing public policy in order to prevent cancer drew a big crowd. And it focused on three causes of cancer: smoking, alcohol and obesity.

These tweets summarise the challenges:

https://twitter.com/pressxtoskip/status/795597928840757249

It’s vital to tackle the problem on a personal level too. And Jebb highlighted how much there is to do in this area with obesity: “If you go to your doctor and you smoke you’ll be referred to stop smoking services,” she said.

“If you go to your doctors and you’re obese, it’s highly unlikely they’ll mention it.” And her recent work has shown how effective even a short conversation with a GP can be in tackling obesity.

Attacking cancer with viruses

Viruses can cause cancer. But they can also help treat the disease. Some, called ‘oncolytic viruses’, can naturally attack and kill tumour cells, while leaving normal cells unharmed.

A series of talks made it clear that using these viruses as a way to treat cancer is making exciting progress.

“I believe it’s the most beautifully engineered anticancer therapy that exists,” said Professor Kevin Harrington, from the Institute of Cancer Research in London, referring to an oncolytic virus called T-Vec. It’s now approved and licensed for the treatment of melanoma in Europe and the US.

And there are others in development.

Early clinical trials are showing how these viruses could also complement other treatments, like targeted drugs and immunotherapy, to deliver a double blow to the tumour.

Encouragingly, in the studies testing them, oncolytic viruses have caused few side effects so far. But as the University of Oxford’s Dr Kerry Fisher made clear, a major challenge still exists: working out the best way to give these viruses to patients. “We need lots of work on how to administer them – we have no real idea how to do this in the clinic,” he said.

Better pictures of cancer

Scientists and doctors are developing better imaging techniques to understand more about each patient’s cancer, and work out how best to treat them.

And Dr Christina Messiou, a consultant radiologist at the Royal Marsden Hospital, explained the latest MRI scanners that allow doctors to take pictures of a patient’s entire body, helping them make decisions about treatment in patients with myeloma – a type of cancer that starts in the bone marrow.

“Before, doctors would just image the spine for myeloma,” said Messiou. “But you’d miss about 50% of the spread of the disease if you did this.”

The technique has also been so successful in diagnosing the disease that earlier this year, NICE recommended whole body MRI for people with suspected myeloma.

This type of scan can also help doctors make treatment decisions. “If there’s one tumour, you might give the patient radiotherapy,” Messiou explained. “But the scan might show there are several tumours in the body, which would mean chemotherapy.”

Professor Alan Jackson, director of the Wolfson Molecular Imaging Centre, also showed how imaging might help work out if a patient will respond treatment.

“We found if you measure the water content of some brain tumours by imaging them, you can work out if the patient will respond to certain treatments,” he said.

Awards time

The conference is a great chance to celebrate the work being carried out by scientists up and down the country. And this year was no exception, as these tweets about the Cancer Research UK prizes summarise.

That’s it for day 2. Check back tomorrow for another day’s highlights.

The Cancer Research UK news team

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