Having just returned from the 10th National Cancer Research Institute (NCRI) Conference – the UK’s biggest cancer meeting – BMC Medicine takes a look at some key themes and new research presented at the meeting.
NCRI 2014 brought together clinicians, scientists, patients, funders and many other groups in Liverpool to showcase and discuss the latest findings in cancer research.
Cancer risk and prevention
One of the key themes of the meeting was cancer prevention. As highlighted by Peter Sasieni, smoking is the number one cause of cancer, and removing tobacco would substantially reduce the number of people developing cancer. However, Tim Lobstein from the World Obesity Federation explained that after smoking, being overweight is the second most important preventable risk factor for cancer.
“Diet is the new tobacco” – Tim Lobstein, World Obesity Federation
Lobstein emphasized that a coordinated effort to improve diet and reduce obesity is required alongside smoking cessation efforts, in order to reduce the incidence of preventable cancer.
Focusing on pharmacological cancer prevention, Jack Cuzick explained that prophylactic aromatase inhibitors have shown promising results in clinical trials for the prevention of breast cancer in women at high risk of developing the disease. Cuzick described results from the IBIS-II prevention trial, which revealed that anastrozole is more effective than tamoxifen in preventing the return of breast cancer in postmenopausal women. Increasing evidence also points towards taking regular aspirin as an effective way to prevent cancer; Peter Rothwell from Oxford University outlined the research, discussing how the risk:benefit ratio of taking daily aspirin should be carefully considered.
In addition to these modifiable cancer risk factors, genes play a key role in determining an individual’s chance of developing cancer. Sir Mike Stratton, whose early work identified the BRCA2 breast cancer susceptibility gene, explained that the next 5 years should see some infrequently mutated cancer genes unveiled, to provide further insights into genetic cancer susceptibility. Of course, genetic and environmental risk factors do not operate independently; in a commentary published in BMC Medicine’s Spotlight on breast cancer article collection, Olivia Fletcher and Frank Dudbridge discuss gene-environment interactions that could modify breast cancer risk, and explain that a number of these putative interactions require further validation in large cohort studies.
Caring for cancer patients: therapeutic strategies and palliative care
Many therapeutic strategies – from neoadjuvant chemotherapy to treatments targeting specific tumor proteins – were explored at NCRI. In the clinical trials showcase, Corinne Faivre-Finn presented findings from the REST phase III clinical trial showing that thoracic radiotherapy improves survival in patients with small-cell lung cancer. Helena Earl presented evidence for the benefits of the angiogenesis inhibitor bevacizumab combined with neoadjuvant chemotherapy for patients with breast cancer. Earl explained that when investigating therapies in the neoadjuvant setting – i.e. treatment that is given before surgery – pathologic complete response can be used as a measure of therapy efficacy in the absence of overall survival information.
While many clinical trials such as these show very promising results in terms of improving longevity in patients with cancer, extending life may not be the main priority for all patients. As outlined by Roger Wilson, founder of Sarcoma UK and patient representative, palliative care may be preferable to intense therapy for some people with more advanced cancer, and clinical decisions should be made with and by patients. Irene Higginson discussed the integration of oncology and palliative care, giving the example of how breathlessness support can be integrated into cancer care. In a randomized controlled trial published in BMC Medicine, Morag Farquhar and colleagues show that the Breathlessness Intervention Service (BIS) is effective for relieving dyspnea in advanced cancer patients, and in an accompanying guest blog, Sara Booth describes the development of this intervention and how it can help patients cope with breathlessness.
Looking to the future: genomics
Focusing on individualized patient care, a number of speakers explored the concept of genomic medicine to help guide treatment decisions. Lewis Cantley opened the meeting with a plenary session on targeting phosphoinositide 3-kinase (PI3k) in many cancer types, highlighting how PI3k-targeted agents typically used in B cell cancers, such as idelalisib, are now undergoing trials for other cancer types with PI3k alterations. Ramasamy Govindan discussed recent progress in lung cancer genomic profiling and described that some genetic alterations can be targeted therapeutically, for example crizotinib therapy can be given to lung cancer patients with ALK rearrangements.
Looking to the future of genomic cancer medicine, a debate on genomic medicine in metastatic breast cancer: hype or reality? was held at the conference. Arguing that it is a realistic prospect, David Cameron and Iain Macpherson emphasized that genomic medicine is already here and cannot be ignored, explaining the results of the SAFIR-01 trial, where Fabrice André and colleagues carried out the first study of its kind to test genomically-driven treatment in metastatic breast cancer. Macpherson argued that:
“tumor heterogeneity is a fact; a patient-centric approach is required to deal with it”
David Miles and Andreas Makris argued against the case that genomic medicine is already here; Miles explained that mutations identified within a tumor may not be driving cancer progression, and cancers can adapt quickly to targeted therapy, stating that:
“one dumb tumor is smarter than 10 oncologists”
Kimberly Blackwell and Mark Robson debate the use of tumor mutation profiling and next-generation sequencing in a forum debate article in BMC Medicine. While Blackwell supports Cameron and Macpherson’s view that genomic medicine is ready for the clinic, Robson argues that genomically-directed therapies are not yet appropriate for routine use.
These debates highlight that while genomic medicine holds a great deal of promise in breast cancer and other cancer types, it is still a very controversial topic. We look forward to the results of further genomic-driven clinical trials to further elucidate whether genome-directed therapies represent a viable future in cancer medicine. As concluded by Sir Stratton, the next 20 years should address whether genomic sequencing and molecular-guided therapy will become the new standard of care.
Both the genomic medicine forum debate and Fletcher and Dudbridge’s commentary on gene-environment interactions, together with articles from Fabric André and Sunil Verma, can be freely accessed as part of our Spotlight on breast cancer article collection. This article is now open for research submissions, and if you have any studies you would like us to consider for inclusion in the collection, please email firstname.lastname@example.org