Our final round-up from the National Cancer Research Institute (NCRI) Cancer Conference in Liverpool, where we share our highlights from the final two days.
Stopping cancer evading the immune system
Our body’s immune system, as well as fighting off illnesses and infections, can sometimes help seek and destroy cancer cells. However, many cancers have the ability to shield themselves from the immune system by producing a protein called PD-L1. This molecule interacts with one called PD-1 on immune cells, fooling the immune system into thinking the cancer isn’t a threat.
Tuesday started with a talk from Dr Lieping Chen, from Yale University USA, who talked about his 20-year journey that led to drugs that block either PD-L1 or PD-1, to stop tumours tricking the immune system. One of these drugs, pembrolizumab (Keytruda), has already shown some promising results in treating advanced skin cancer and lung cancer, and early clinical trials for metastatic triple negative breast cancer are underway. Breast Cancer Now is also funding research to understand how breast tumours evade the immune system.
Dr Lieping Chen. Photo by Dr Richard Berks.
On Wednesday Dr Alexandra Snyder from the Memorial Sloan Kettering Cancer Center in the USA outlined her recent successes and frustrations in trying to find ways to predict which patients are likely to benefit from anti-PD-L1 and anti-PD-1 drugs. She's found some promising candidates, including the number of genetic mutations in a person's tumour, but feels that a combination of complex factors will reveal the full picture.
Slowing down cancer evolution
Prof Paul Workman from the ICR, London explained that understanding how cancers evolve and change over time is critical to ensuring tumours cannot resist the next generation of cancer medicines. He explained that one of the drivers of cancer evolution is a group of proteins called the ‘APOBEC3’ family - these are normally involved in DNA repair, but when they are particularly active they can cause many mutations in the DNA, helping tumours become resistant to treatments.
Dr Nnenna Kanu from the UCL Cancer Institute presented her work on how APOBEC3 proteins end up being overproduced in breast cancer. She has found that they are particularly active in HER2-positive breast cancer, and in cells grown in the lab these APOBEC3 molecules can be activated in response to certain chemotherapy drugs. The knowledge gained from this research could eventually help stop breast tumours becoming resistant to treatments.
Reminding cancer how to die
When we think about cancer, we think of cells growing and dividing out of control. Interestingly, it’s not simply that cancer cells have ‘super-powers’ enabling them to do this, in fact they have lost a power that’s vital for our cells to function normally: the ability to die. We heard from Dr Pascal Meier from our Breast Cancer Now Toby Robins Research Centre, whose team specialises in studying the complex processes of cell death, how breast cancer cells evade it, and how we can push cancer cells back towards the cliff edge of death.
Professor Meier explained that the issue of whether a cell lives or dies doesn’t just rely on its own internal ‘death machinery’, but also on the signals it receives from its environment. And the way surrounding cells respond to dying cancer cells are cause for concern: Dr Meier’s findings suggest that they might be helping tumours to re-grow and become resistant to the effects of treatments like chemotherapy. He ended the session by posing the surprising question - should we really be trying to kill cancer cells?
Professor Pascal Meier. Photo by Simon Callaghan
Tackling the fear of cancer recurrence
In a session about patient-centred care, Dr Gozde Ozakinci from the University of St Andrews focussed on patients who struggle to cope with the fear of their cancer returning. She explained that being afraid of cancer recurrence is a completely natural response experienced by the majority of patients. But she is concerned that some patients find it much harder to cope with this fear than others, and they aren't getting the support they need. This level of fear can become problematic and have a huge impact on people's daily lives, as well as their long-term outlook on life.
Dr Ozakinci described a number of initiatives which have been designed to support these patients to cope with their feelings, and results should show in the next few years whether they are helpful. But she also pointed out that these initiatives are resource-intensive, requiring patients to attend extra appointments with trained therapists, so implementing them in the NHS could be difficult. This is why Breast Cancer Now is funding research to understand whether a series of phone calls could be effective instead of face-to-face appointments, saving resources and working around patients' busy lives.
Managing symptoms in palliative care
Continuing onto palliative research, Prof David Currow highlighted the gaps in our ability to control symptoms like pain and delirium in patients with advanced cancers. Worryingly, despite evidence being published in recent years showing that commonly-used treatments like anti-psychotics can actually worsen delirium in some cancer patients, Prof Currow reported that some doctors are reluctant to stop using these 'old-favourites'. He encouraged everyone in the room to take an honest, un-biased look at the evidence, and to work together to find effective new ways to treat these debilitating symptoms.
Practise changing data from David Currow at #NCRI2016 questioning our assumptions and harms in palliative care. Really powerful.— Katie Spencer (@katiespencer72) November 8, 2016
In a separate, moving, talk, Prof Currow also offered hope through recent successful attempts to manage some of the symptoms of cachexia - the incapacitating loss of weight and muscle mass that some patients with incurable cancer experience. some patients with incurable cancers.
Protecting hearts and saving lives
It’s well known, but perhaps not often talked about, that certain cancer treatments come with a risk of health complications in later life, such as heart disease. On Wednesday, Dr David Hodgson from the University of Toronto outlined the heart risks associated with radiotherapy and anthracycline chemotherapy, and the importance of finding ways to screen for patients who are more likely to develop these complications. He explained new imaging techniques are emerging to identify these patients, and that certain drugs including ACE-inhibitors could be used to help protect patients’ hearts. But in the end he concluded that lowering patient’s other risk factors for heart disease, for example body mass index, would make the biggest difference
Mind the age gap in breast cancer surgery
About one third of all breast cancer cases occur in women older than 70, who may also be dealing with other health issues which might affect their chances of having surgery or developing complications afterwards. An ongoing study called ‘Bridging the Age Gap’ hopes to shed more light on their experience of breast surgery.
Dr Osama Zaman from University of Sheffield Medical School presented some early results from the study, finding that though women with dementia are just as fit for breast surgery as women without, they were two-thirds (66%) less likely to have surgery for their breast cancer - which could affect their survival and quality of life. This study adds to the growing picture of how older breast cancer patients do not necessarily receive the same standards of treatment as younger women.
That’s it for the round-ups from the NCRI conference 2016. Don’t forget you can catch-up on the talks from earlier in the week in our first highlights blog and our report from the ‘new tricks from old drugs’ debate.