Do we already have everything we need to stop people dying from breast cancer?
Or will it only be the treatments of tomorrow that will finally guarantee everyone survives breast cancer?
These are the questions we hoped to answer at the Breast Cancer Now debate, held at the National Cancer Research Institute (NCRI) Conference in Liverpool, on Sunday 6 November.
When it comes to research into breast cancer treatments, it’s often the new drugs that make the headlines. And it’s true that there has been a lot of excitement around new treatments like palbociclib or Kadcyla (T-DM1), and upcoming potential drugs like PIM1 inhibitors for triple-negative breast cancer or PARP inhibitors like olaparib.
But it’s not all about the brand-new – when we found that treatments could reduce risk of breast cancer spreading to the bone by 28%, or apparently obliterate tumours in just 11 days, it was existing drugs, not new ones, which were responsible.
Time is of the essence if we want to ensure that by 2050 everyone who develops breast cancer will live, and there is neither an unlimited pot of money nor an inexhaustible army of researchers to explore everything which might help achieve this. So, if we had to choose one of these routes to go down – improving and optimising existing treatments, or developing new ones – which should we choose?
Breast Cancer Now brought together two teams of experts who collectively have decades of experience in treating people with breast cancer and developing and testing drugs.
On one side, arguing in favour of being smarter with what we already have, were Professor Rob Coleman, a clinician and researcher based in Sheffield, and Professor David Dodwell, an oncologist from Leeds.
On the other team, arguing to support the search for new drugs, were Professor Paul Workman, Chief Executive of the Institute of Cancer Research (ICR), and Dr Susan Galbraith, Vice President of Oncology at the pharmaceutical company AstraZeneca.
Professor Judith Bliss, Director of the Clinical Trials & Statistics Unit at the ICR, chaired the debate to ensure a fair and honest fight – though by comparing the debate to the EU referendum and US presidential contest she ramped up the tension in the room. A pre-debate vote showed that a large chunk of the audience were undecided, so both teams knew they had a lot to play for – and hoped that everyone hadn’t had enough of experts in 2016…
Let the debate begin!
Old drugs – new isn’t always better
Prof Rob Coleman started off by reminding everyone of the task at hand – though survival from breast cancer is improving, the numbers of women dying from breast cancer every year is roughly the same as it was 40 years ago. He stated with regret that “the drug development system is broken” - the current way we develop drugs is not working for breast cancer patients as we hoped it would. Despite billions spent, there have been no new drugs approved for early breast cancer in the last ten years.
However, there is great potential in repurposing cheap existing treatments for breast cancer to benefit patients. Bisphosphonates – long-standing treatments for osteoporosis – could save more than 1,000 lives every year if given to all post-menopausal women with breast cancer. Drugs like tamoxifen that were previously used to treat breast cancer can now also prevent the disease. Rob argued that investment in trials to attempt to repurpose other treatments – aspirin or metformin, for example – could be hugely beneficial and a much better use of money.
Taking a different approach, Prof David Dodwell argued that, instead of spending money on developing new drugs, “there are plenty of things we should do to get our house in order” and improve the way we treat breast cancer right now.
One example David gave was adherence to drugs – we need to support patients to keep taking treatments like anti-hormone therapies for many years, as prescribed, and so give them the best chance of survival. There is also a wide variation across the UK in the treatments that patients receive (e.g. chemotherapy and radiotherapy), which needs to be addressed to reduce the disparity we see in survival rates across the country. David argued that though the examples he gave could prevent as many breast cancer deaths as finding a new drug, these issues are not getting the attention they truly deserve.
Hear from the chair of the debate and members of the audience
New drugs – the future is bright
Speaking in favour of continuing to develop new drugs, Prof Paul Workman invited us to “look at the bigger picture”. Though developing new treatments is difficult and expensive, drug companies are getting better and faster at finding them. He admitted we’re only scratching the surface of what we have recently found out about breast cancer, and that we need to tackle issues like tumours becoming resistant to treatments. Paul passionately argued that it’s the new drugs that will answer these questions, not the old ones designed for other purposes.
Dr Susan Galbraith dismissed Rob Coleman’s view of a broken drug development system as overly pessimistic, and aimed to defend why companies like AstraZeneca continue to invest billions of dollars into developing new cancer treatments every year. She pointed out it has historically been the new classes of treatments that have brought the biggest improvements in breast cancer survival – Herceptin being a classic example of this.
Susan reminded us that the UK continues to lag behind our European neighbours in terms of government spending on health and cancer drugs, and ultimately cancer survival. She felt the only way to rise to this challenge was by investing in new drug development, and fixing the old problem of how the NHS assesses and pays for new cancer treatments – no significant advances would be made by going back over old ground.
And the votes are in…
With the arguments over, and as many questions answered as possible, finally came the all-important audience vote. It was a close run contest; although the new drugs team got the most votes in the second round of voting, the repurposed drugs team had the greatest number of swing votes, so were crowned the overall champions.
Not just black and white
Prof Judith Bliss reminded everyone that “this is not a black and white issue”. The debate and the questions from the enthusiastic audience raised many issues and areas where we could improve. For example, we need to speed up the development of new drugs and ensure patients get access to increasingly expensive treatments. But at the same time, we can invest more into research to repurpose and optimise existing treatments, which is currently under-funded. After the debate, everyone agreed that this multi-faceted approach would be the most effective way to bring closer the day when no one dies from breast cancer.
Keep your eyes peeled over the next few days for more updates on the latest developments in breast cancer research from the NCRI Conference 2016 – or follow the updates on Twitter, using the hashtag #NCRI2016.