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NCRI Cancer Conference 2016: Day 4 – liver cancer, obesity, immunotherapy poo predictions and more

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by Cancer Research UK | Analysis

10 November 2016

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Bacteria in the gut could help predict if immunotherapy will work.

As the world woke to a new US president-elect, the scientists, doctors and patients at this year’s NCRI Cancer Conference gathered for the final sessions of talks.

And aside from all the election news, there were also some more headlines that emerged from the conference.

A molecule found on aggressive prostate cancer cells could be used to guide treatment, according to research picked up by the Mail Online.

And blocking a molecule could bypass bowel cancer’s defences against the drug cetuximab, reported PharmaTimes.

Now on to our final roundup of highlights.

Liver cancer and obesity

Over the last couple of decades, people have become on average between 1-2 kilograms heavier, according to Professor Mathias Heikenwälder, from the German Cancer Centre.

Obesity causes liver cancer (along with 12 other types of cancer). And the disease is the second leading cause of cancer-related death worldwide.

Sadly, there are no effective treatments available. And all of this indicates that “we are dealing with an underestimated problem,” which “could become pandemic,” said Heikenwälder during an energetic talk.

The key message from the session was that the situation isn’t a simple equation of bad diet = fatty liver = liver cancer. It’s much more complex than that. For example, certain genes seem to have an influence on the risk of developing a fatty liver and liver cancer. At the moment it’s unclear the extent to which these genes raise the risk of developing the disease, and how they interact with other factors, such as bodyweight.

But Dr Quentin Anstee, from Newcasle University, put it bluntly: “However you cut it, being overweight isn’t good for your liver.”

It turns out the immune system also has a role to play in whether risk factors for liver cancer will go on to trigger the disease. That’s why researchers are looking into treatments that boost the power of the immune system, and testing if they may one day help more patients survive.

While a number of clinical trials are underway, some of which are showing suggestions of improved survival, it’s still too early to tell whether they are effective.

Surviving cancer

Thanks to research, there are an ever-increasing number of cancer survivors. But research shouldn’t stop there.

Professor Flora van Leeuwen, from the Netherland Cancer Institute, spoke about how cancer patients who have survived one type of cancer may be diagnosed with a different type later in their life.

Van Leeuwen showed data from a 30-year-long study of successfully treated Hodgkin lymphoma patients. She explained that the higher the dose of radiotherapy they received, the higher the risk the patients had of developing breast, lung, stomach, pancreatic or oesophageal as a second cancer later on in life.

Of course, the idea of a second cancer adds to the list of worries that cancer survivors face.

But science is tackling this too, with the goal of newer treatments that have fewer side effects. In fact, van Leeuwen predicts that patients treated after the year 2000 have a much lower risk of developing second cancers.

Predicting if immunotherapy will work

It wouldn’t be a cancer conference in 2016 without talking about the most talked-about breakthrough in recent years: immunotherapy.

Dr Alexandra Snyder, from Memorial Sloan Kettering Memorial Cancer Centre in the US, talked about one of the big challenges doctors still face: how to predict who is likely to benefit from these treatments.

Some of these pioneering new treatments, called checkpoint inhibitors, are producing long-lasting responses in patients with certain types of cancer, most notably melanoma. But most don’t respond in the dramatic way that has hit headlines around the world.

Snyder described some of the factors that can affect whether immunotherapies work or not – they include the number of genetic mistakes in cancer cells, the levels of a key molecule some of the drugs target – called PDL-1 – that sits on cancer cells, and the number of specialised immune cells that react to the cancer.

But none of these are hard and fast rules, and trying to piece together all this different information to give doctors a clear answer is no easy task.

“There’s a lot of biology we’re still missing,” Snyder explained. And she questioned whether or not it will be possible to distil this information down to a simple set of rules that can be used in the clinic to help patients.

Predicting if immunotherapy will work pt II (with poo)

Dr Jennifer Wargo, from the University of Texas, is confident that her team can pinpoint the differences between melanoma patient tissue samples that can accurately predict whose tumours will, and won’t, respond to immunotherapy drugs.

And in an engaging talk that closed this year’s conference she showed quite convincingly that the information may lie in an unconventional source: patient poo samples.

More specifically, her team are studying the vast ecosystem of microbes – called the microbiome – that call our guts home. And their recent research has found that there may be differences in these communities of bacteria between melanoma patients.

Research presented at last year’s conference has suggested that tweaking the families of bacteria in the guts of mice could boost the effectiveness of immunotherapy.

But Wargo’s team are one of the first to investigate this link in people.

And she hopes that the team’s microbiome analysis can be tailored for both predicting response and maybe one day even boosting the likelihood of a patient responding by changing the composition of their microbiome.

“I guarantee it’s going to be game-changing,” she said at the close of an inspiring talk.

That’s it for this year’s conference roundups. We hope you enjoyed following the latest developments in cancer research.

The Cancer Research UK news team.