At the beginning of November, over 2000 healthcare professionals, researchers, patients and other delegates gathered at the National Cancer Research Institute (NCRI) annual meeting in Liverpool to discuss the latest basic, clinical, and translational findings in cancer research.
Presentations at the meeting looked at tackling cancer using a variety of different approaches, from prevention to personalizing treatment and mobilizing patients’ own immune systems to fight cancer.
Prevention is better than cure?
The importance of cancer prevention was discussed extensively at NCRI 2015, and the meeting kicked off with a debate on whether we should focus more on the causes of breast cancer, or strategies to prevent the disease.
In the debate, hosted by Breast Cancer Now, experts argued for and against the motion ‘This house believes we should stop focusing on the causes of breast cancer and get on with strategies to prevent the disease.’
Exercise and diet interventions are effective; now is the time to act!
Annie Anderson and Gareth Evans argued passionately for the motion, advocating that we understand many reasons why breast cancer incidence has increased in the past few decades, so we should focus more on prevention. Evans highlighted that:
“Exercise and diet interventions are effective; now is the time to act!”
On the flip side, Douglas Easton and Tim Key contended that a lot more research into the causes of breast cancer is needed before we can prevent the disease effectively. Easton cautioned that prevention strategies based on current knowledge – including having many children and breastfeeding for a number of years – are unrealistic, and Key added that the reduction in breast cancer incidence that could be achieved through lifestyle interventions ‘just isn’t good enough’. Rounding off the debate, Easton concluded that:
“With more studies into the causes, we can make breast cancer a rare disease”
After a lively discussion involving questions for all panelists, the audience voted in favor of the motion to focus more on strategies for breast cancer prevention.
With more studies into the causes, we can make breast cancer a rare disease
Discussions on cancer prevention continued throughout the conference, with Paolo Boffetta giving an interesting talk on dietary components that have been linked to cancer, including salted fish, meat, and low intake of fruit and vegetables.
While there is strong evidence for the association between some meats and cancer, with the World Health Organization recently reporting that processed meat consumption increases the risk of developing colorectal cancer by 18%, the link with other dietary components is less clear.
Boffetta described the difficulties with classifying fruit and vegetable consumption into ‘high’ and ‘low’, and concluded that we need to focus on the association of dietary patterns – rather than individual components – with cancer risk.
Eileen Kaner discussed the importance of reducing alcohol consumption for cancer prevention, presenting the shocking statistic that nine in ten heavy drinkers in primary care do not receive appropriate advice or treatment.
Rounding off the session on lifestyle and cancer prevention, Martin Wiseman explored links between physical inactivity and cancer risk, advocating that social norms need to change in order to increase people’s level of activity and help prevent cancer.
Putting the immune system into action
2015 has seen some great breakthroughs in tackling cancer through the immune system. As described by Sergio Quezada, nivolumab and pembrolizumab have been approved this year for the treatment of non-small cell lung cancer and melanoma.
Quezada discussed the mechanisms by which these immune-modulatory antibodies – designed to activate the immune system rather than kill tumors – shift the T cell balance in favor of destroying tumor cells.
We need to fully characterize the immunological landscape of human cancers in order to inform the development of combination immunotherapy
James Larkin presented the latest phase 3 results from the CheckMate 067 trial, which showed that treatment with nivolumab, alone or combined with ipilimumab, resulted in better survival than ipilimumab alone.
These important findings indicate the huge potential of immunotherapy for extending the lives of people with cancer, but there is still a great deal of work to be done. Quezada explained that while immunotherapies targeting CTLA4 and PD-1 receptors show great promise, there are many other possible targets for immune-modulatory antibody therapy that are now being explored.
To end his discussion, Quezada recommended that we need to fully characterize the immunological landscape of human cancers in order to inform the development of combination immunotherapy.
Towards genome-driven therapies
As we understand more about the molecular alterations underlying cancer, treatment is moving from a ‘one size fits all’ approach to more individualized therapy regimens. Fabrice André discussed the need for a large database of genome-driven trials so that algorithms can be developed to interpret individual patients’ genomic data and inform treatment decisions.
Presenting the results of LaMB, the first randomized personalized therapy trial for metastatic bladder cancer, Simon Crabb explained that the trial was designed on the basis of preclinical results showing that expression of HER1 and HER2 has been linked to bladder cancer progression.
The results of the trial showed that lapatinib – a dual inhibitor of HER1 and HER2 – has no clinical benefit for metastatic bladder cancer, and the prognostic significance of HER1 and HER 2 expression is not clear. Crabb concluded that the results highlight important differences between preclinical and clinical studies, which should be taken into account in future personalized medicine trials.
Biomarkers to guide cancer management
A number of presentations at NCRI 2015 focused on using circulating DNA and RNA biomarkers to improve individualized cancer risk prediction and guide treatment decisions. Luis Diaz discussed the clinical utility of cell-free DNA (cfDNA) as a dynamic biomarker to indicate whether a tumor is responding to treatment and monitor tumor heterogeneity.
Circulating microRNAs (miRNAs) also have potential to improve cancer detection, as described by Gabriella Sozzi for lung cancer. Sozzi explained that MSC, a plasma microRNA signature classifier, has high sensitivity and specificity for lung cancer detection, and can improve lung cancer screening by reducing false-positive results.
Overall, the discussions at NCRI highlighted the many different approaches that are currently underway to understand, treat, and prevent cancer. We look forward to seeing how current research is put into practice in prevention strategies, and eagerly await the results of current studies to shed further light on how the immune system can be adapted to overcome cancer.
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