The National Cancer Research Institute (NCRI) Festival brings together the brightest scientific and medical minds to advance cancer research in the UK. Edd, our Research Communications Officer, attended the Festival this year and picks some of the highlights.
Shining the spotlight on breast cancer research
A new treatment for breast cancer that has spread to the brain
Dr Thomas Bacelot, from Centre Léon Bérard, France, presented results on the effectiveness of tucatinib to treat HER2 positive breast cancer that has spread to the brain.
Tucatinib is a new treatment for secondary breast cancer that was recently provisionally turned down for routine use on the NHS .
Additional analysis of the HER2CLIMB clinical trial showed that tucatinib, in combination with trastuzumab and capecitabine, can reduce the risk of progression or death in people with secondary HER2+ breast cancer in the brain by 46%.
These results further demonstrate that tucatinib treatment combination could help people with HER2+ secondary breast cancer.
Assessing quality of life after radiotherapy
Dr Harkeran Jandu, from the University of Leicester, presented one of the analyses from the REQUITE study. This study assessed patients’ quality of life after radiotherapy.
Researchers observed that fatigue worsened after initial radiotherapy but improved after one and two years. However, pain was reported at all times after treatment. Patients also reported worse body image after radiotherapy, which improved at one year after treatment. However, sexual function was worse at both one and two years after treatment.
The next step for researchers is to understand whether genetics plays a role in side effects related to radiotherapy and what can be done to improve people’s quality of life.
Physical activity after treatment
Dr Georgios Markozannes, from Imperial College London, presented his research into physical activity programmes for women with breast cancer.
He analysed 78 trials and found strong evidence that increasing physical activity after treatment results in improved quality of life.
However, he also highlighted that currently there isn’t enough evidence to recommend what types or amounts of physical activity are best for improving quality of life after a breast cancer diagnosis.
A new kind of follow-up
Professor Valerie Jenkins, from the University of Sussex, presented early results from the PRAGMATIC study.
The study is assessing the supported self-management pathway, a new type of follow-up for people who have been treated for breast cancer. It works by allowing patients to report symptoms as and when necessary and providing a direct line to the clinic if there is a problem.
Many participants trialling this pathway felt they had to assume responsibility for follow-up and that it could help save time and money for them and the NHS. However, a few participants were concerned about the lack of face-to-face contact with a healthcare professional, their confidence in spotting a recurrence, and the ability to see a doctor.
In general, initial findings were positive but the study is continuing and will help us understand whether this approach to follow-up is helpful to people after breast cancer treatment.
Using patient avatars to inform treatment decisions
Researchers can now use samples from a person’s cancer to create a laboratory model of their disease, known as an avatar. It could reflect how the tumour responds to treatment.
So should every patient have an avatar to inform cancer treatment? Researchers and clinicians debated this topic.
Professor Thomas Helleday, from the Karolinska Institutet, Sweden, argued that currently we rely on analysing genes to inform treatment, but it isn’t always enough. Therefore, avatars could give additional information to help doctors choose the most suitable treatment.
Professor Helleday mentioned a possibility to use artificial intelligence methods to evaluate how cancer cells from a patient’s tumour respond to a variety of drugs. It won’t always accurately predict how well a treatment might work when given to a patient, but it could help some patients, especially with rare types of cancer.
Dr Kris Frese, from the Cancer Research UK Manchester Institute, highlighted that the benefit of avatars is largely unproven. Currently avatars can’t be created for every cancer patient. Evidence suggests that they work better for aggressive cancers and larger tumours. Cancers that don’t have these features wouldn’t be suitable. Research techniques need to be improved to successfully create avatars that reflect the whole tumour.
Dr Bristi Basu, from the University of Cambridge, thought that avatars are ‘a no brainer’. She explained that there will never be one method that captures all the relevant features of cancer and we need to use many different methods together to get the best picture. The concept of avatars is still early and methods are evolving and being refined. She believes that we need to be optimistic and ensure these avatars become as effective and powerful as possible for the future.
Dr Sarah Blagden, from the University of Oxford, doesn’t believe avatars are suitable for every patient, nor are they useful in their current form. We need to see the evidence before we adopt this approach in clinics. Currently, the studies that have looked at the effectiveness of these avatars are not good enough as they looked at very small groups of patients. The cost of creating these avatars is also incredibly important. It needs to be properly thought about to ensure that money and resources are being used as effectively as possible to successfully treat people.
Our take on this is that testing a range of cancer drugs on a person’s tumour in the lab before deciding the best course of treatment could be incredibly useful. But we need more research to make sure that people with breast cancer can benefit from this approach to personalised medicine.
Equality, diversity and inclusion in cancer research
There was a discussion around equality, diversity and inclusion in research, both in the scientific community and clinical trials.
To bring diversity and inclusion to research, researchers need to consider what cells they use in experiments in the lab and what groups of people take part in clinical trials are both representative of how the disease affects people of different backgrounds, age and ethnicities. If research is not equal, inclusive and diverse, the results may not be useful for everyone affected by the disease.
People who take part in research as part of their treatment are more likely to report higher levels of satisfaction with their care, but not everyone is offered the opportunity. Currently, in the best performing NHS trusts, over 50% of patients have a conversation about cancer research during their treatment. In the worst-performing trusts it’s 15% or less. While this disparity comes down to a difference in resources between NHS trusts, it highlights the need to make sure that everyone has the same opportunities to take part in research.
We look forward to seeing what exciting breakthroughs and emerging trends are highlighted at the conference next year.