Image: The ICR's Dr Valeria Cazzaniga in the lab
With the turn of a new decade many people are looking at the best things that came out of the last 10 years, from films, music and gadgets to the most innovative medical advances. But amongst all the retrospection, others are choosing to look ahead.
Recently, I attended the launch of a new report published by University College London (UCL) aiming to set the agenda for cancer research and care in the 2020s. The report argues that over the next few years, our ability to better control cancer will not be the result of one or two major breakthroughs, but the accumulation of incremental advances in many different areas.
One reference I loved from the report was how the worldwide pursuit of better cancer treatments is arguably the biggest scientific project in history, dwarfing even the US moon landings of the 70s, and it’s true – I can't fit all of the really exciting things coming for cancer over the next 10 years into one blog post!
Instead, I’ve picked three topics mentioned in the report that have the potential to be instrumental for better cancer control in the next decade, and what the ICR is already doing to help.
Can we crack cancer evolution?
Alongside its report, UCL surveyed more than 2,000 people about their attitudes towards cancer research and treatment in 2019. Perhaps not surprisingly, given that one in two of us will be diagnosed with the disease in our lifetime, half of the British population believe that tackling cancer is their biggest public health priority.
But, will there ever be a cure for cancer? This question gets asked of our researchers often, and was addressed in a recent blog post by our CEO, Professor Paul Workman. Cancer is a disease made up of more than 200 main types, and a plethora of other molecular subtypes, so it’s unlikely we will ever have a single cure.
During the report launch, Professor Charles Swanton of the UCL Cancer Institute spoke of the success of the past 20 years in understanding more about the complexity, diversity and instability of cancers and how they evolve to develop drug resistance.
Cancer evolution is the cause of a vast majority of cancer deaths, and at The Institute of Cancer Research, it will be a central area of focus over the next decade.
While we share the goal of patients and the public in wanting cancer to be completely cured, focusing exclusively on curing cancer can risk overlooking some of the amazing progress that has already been made in the field – with statistics showing that the average length of survival from cancer approximately doubled over a 10-year period as new targeted drugs, combination treatments and immunotherapies begin to improve long-term control.
As we begin the new decade, the ICR is launching the world’s first ‘Darwinian’ drug discovery programme, within our new Centre for Cancer Drug Discovery, aimed at achieving further dramatic improvements in the proportion of patients whose disease can be controlled long term, as well as increasing the chances that patients will be cured.
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At the ICR, our scientists are changing the way we think about cancer. We are combining advanced DNA sequencing and image analysis with evolutionary theory, mathematical modelling and artificial intelligence to understand and predict how cancers mutate and adapt to resist treatment.
The aim is to stay one step ahead of cancer, by creating new treatment strategies that anticipate, prevent and overcome evolution and drug resistance.
Gearing up for genomic medicine
Advances in the technology to read people’s DNA have made it possible to sequence a patient’s whole genome – or that of their tumour – quickly and cheaply. That can allow researchers to predict how cancer will respond to treatment and to select the drug that is most appropriate for a patient and their tumour.
It is also increasingly possible to assess a person’s risk of cancer by looking at their genetic information. These scientific advances are matched by a public appetite for genetics, which has seen enthusiastic participation in pilot studies and – rather more controversially – increased interest in direct-to-consumer genetic tests.
The Government have responded to increased knowledge of and interest in genetics with the imminent rollout of the NHS Genomic Medicine Service, which will embed genetic testing into primary care for the first time in the UK. The service will allow healthcare professionals to personalise treatments and interventions more than ever before.
The data gathered from this extensive testing will also be available for research – once it has been anonymised – so scientists can better understand cancer and its evolution. It’s safe to say the Genomic Medicine Service is promising big things, and the NHS aims to embed genetic testing into routine healthcare by 2025 – so watch this space!
One innovative way researchers at the ICR are using genetics to tailor cancer treatment is by looking at circulating tumour DNA – DNA that has ‘shed’ from tumours and circulates in the blood stream of a patient.
Circulating tumour DNA can be identified through a blood test, which is less painful than standard tissue biopsies and can often be a quicker and easier way to investigate tumour development in a patient and monitor treatment success. Results have been extremely promising.
One example is the plasmaMATCH clinical trial – early results of which were released in December. In that study, ICR researchers looked at whether a blood test could detect traces of genetic faults that are known to drive breast cancer.
The study was so successful, scientists believe it is reliable enough to be routinely used by doctors in the clinic – once it has passed regulatory approval.
Spotlight on screening
As we learn more about cancer’s genetics and evolution, we start to understand the reasons for something that has been known for a long time – that the more a cancer has progressed, the harder it is to treat. And that in turn is placing an increased emphasis on research to understand how cancer can be detected earlier or even prevented in the first place.
One way cancer can be detected earlier is by setting up dedicated screening programmes – such as those that exist for breast cancer, bowel cancer and cervical cancer. The report from UCL called for enhanced screening programmes to improve early detection of lung cancer, but screening also has the potential to benefit many more cancer types in the future.
While screening programmes are estimated to save 10,000 lives a year in the UK through prevention and early diagnosis, there is also evidence that they are not reaching their full potential.
People live busy lives, and uptake of screening appointments is not as high as the Government would like. To address this, ministers asked Professor Sir Mike Richards, a former national cancer director, to review adult screening programmes in England.
One of the review’s key recommendations called for a new organisation to be set up that is able to manage all cancer screening under one roof. This could avoid unnecessary delays where multiple organisations are managing different aspects of the screening pathway, and might ensure accountability when things don’t run smoothly.
Sir Mike also highlighted the value of targeted screening in his review. Targeted cancer screening programmes aim to identify people in the population who may have a higher risk of developing certain cancers based on factors such as genetics, lifestyle and environment. This information allows healthcare professionals to tailor screening programmes for smaller groups of people.
One example of this is with PSA testing in men which, while not proven useful in the general population, has been shown to be more effective in a smaller population of men – those with a fault in their BRCA2 gene.
This research, from the IMPACT study, was conducted by researchers at the ICR. Regular screening using this test in men who have this particular gene fault could help identify those at risk of prostate cancer far sooner than current methods of diagnosis.
Targeted screening based on factors such as an individual’s genetic profile will not only save the NHS money, but will avoid subjecting large numbers of people to unnecessary medical appointments.
It’s an exciting time to work in the field of cancer research and treatment, and it seems pretty clear that the next 10 years are going to bring some revolutionary advances.
This blog post has highlighted just three areas where there are being dramatic advances – I haven’t, for example, touched upon the great strides being made in areas such as precision radiotherapy, advanced imaging or AI.
Check back here in 2030, when I’ll be doing a round-up of the best advances in cancer research from the last decade…
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