Tuesday was a busy day at the National Cancer Research Institute (NCRI) Cancer Conference, with many interesting sessions spanning a wide breadth of cancer topics.
The session that really grabbed my attention was the second round of NCRI celebratory talks, which were a reflection back on the past and a look to the future of key areas of cancer research. I enjoyed these series of talks immensely, and came away inspired by all the incredible groundwork that has already been made in cancer research.
The lectures looked at where we are going with clinical trial design, metabolomics and localised therapies, following on from yesterday’s celebratory talks.
Clinical trials
First up was Professor Andrew Hughes from the University of Manchester, who also leads the early clinical development group at AstraZeneca. He told us that ten years ago, clinical trials were often based on biopsies, were focused on single molecular targets, and encompassed laborious data capture.
He stated that taking biopsies – particularly in patients with lung cancer – is not only painful, but can actually contribute to mortality. But now we looking to a future when we will be able to carry out ‘virtual’ biopsies – meaning looking at circulating tumour DNA from a series of blood samples, rather than putting patients through uncomfortable biopsy procedures.
Professor Hughes also told us that conducting clinical trials that only test for a single molecular target can leave patients disillusioned when they are ineligible. One way to select more patients for trials is to use a ‘bucket’ trial approach – to send a patient’s sample to a genetic technology hub, where they will be tested for biomarkers and then matched to the molecular targeted agent most appropriate to them.
Also, clinical trial data capture is still quite archaic, Professor Hughes pointed out. One of the main problems is the long delay from the point where a study nurse notes down data, to the point where an investigator views that data. By simply using an electronic tablet to capture data, in addition to other visual and audio aids – such as a picture of a rash, or patients being recorded verbally – in the future, investigators will have access to patient data more quickly.
Metabolomics
In the next talk, Professor Karen Vousden from the Cancer Research UK Beatson Institute gave us a fascinating insight into how changes in metabolic pathways can contribute to cancer. Changes can lead to many advantages for the cancer cell, promoting and supporting tumour formation.
One of the challenges facing cancer cells is fluctuation in available nutrients. They rely on the amino acids serine and glycine for cell proliferation and survival. So what if we could starve cancer cells of these crucial amino acids – would we influence tumour growth?
In a series of experiments, Professor Vousden had been able to show that removing serine and glycine from the diets of mice did indeed slow down tumour growth, increasing their survival.
Localised therapies
The final NCRI celebratory talk was from Professor Tim Maughan, from the Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology. He overviewed surgery and radiotherapy – two localised therapies commonly used in cancer.
Surgical techniques have come on in leaps and bounds over the last 30 years, Professor Maughan said, with approaches now being less invasive, more precise and better guided. Some are even being performed by robotic devices. Image-guided radiotherapy has revolutionised the field of radiotherapy – a technique trail blazed by researchers at The Institute of Cancer Research.
Professor Maughan stated the next phase of progress will be biologically driven, with variations in the tumour microenvironment – a big influencer in how well a patient will respond to radiotherapy – being defined. This biologically-based stratification of patients combined with the added anatomical precision of modern radiotherapy will carry great promise in improving outcomes in the next decade.
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