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I recently attended a conference called The Challenges Preventing Cancer Cure, which brought together leading cancer researchers from universities and industry, policy experts, and private investors at the Francis Crick Institute in London.
The British Association for Cancer Research (BACR) event was organised by researchers including Professor Julian Downward, who holds scientific posts at both the Crick and here at The Institute of Cancer Research, in association with the Royal Society of Medicine.
Here are nine big challenges that some of the experts, including several researchers from the ICR, said need to be addressed in the journey towards cancer cure.
1. Analyse cancer in the fourth dimension
We need to be better at looking at cancer in the fourth dimension: time. Standard biopsies taken by clinicians only give a snapshot of how cancer is progressing, so we need better tests that can monitor it more often, in more detail. The ICR is a pioneer in developing these ‘liquid biopsy’ tests.
2. Account for cancer’s complexity in trial design
Cancer is a highly complex disease and can be very different from person to person. We still need to get better at trialing new treatments in the patients most likely to benefit from them. Once a drug fails in a major trial, it may never have chance to demonstrate benefit in a more carefully selected group. Olaparib, an ICR success story, famously failed to show clear benefit in initial trials in a broad group of women with ovarian cancer, before proving effective in BRCA-mutant cases.
3. Accept that attempting ‘cure’ may not be best for everyone
For some patients, particularly the elderly and frail or with some cancer types, it may be best to manage disease long term rather than try to totally clear it. In his lecture at the Crick, Professor Johann de Bono compared this idea to playing snooker: for some patients, it may be enough to pot most of the balls, but leave some on the table. Chronic lymphoid leukaemia is treated as a chronic disease, but for other cancer types the idea of treating but not curing can be controversial.
4. Deliver longer-term benefits for drugs
There was a passionate debate among scientists about the urgent need to fix the broken system of drug discovery and development. At the moment, companies can command extremely high prices for cancer drugs despite benefits often being brief. Of the 72 cancer drugs approved by the FDA from 2002-14, the average extra survival benefit was 2.1 months.
5. Encourage more innovation
Some academic scientists at the summit were highly critical of the trend for pharmaceutical companies to copy each other in developing similar sorts of drug. For example, PD-L1 inhibitors have represented a step-change in cancer treatment in past few years, but it doesn’t make sense to have so many reaching the market at the same time, they said: too much focus on these immunotherapies is sucking air out of drug discovery and development.
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6. Develop better models of disease
The gathered scientists were challenged to develop improved models that better predict the effectiveness of cancer drugs, and drugs for other diseases. If the rate of failure for drugs in clinical trials is still high and, despite screening many tens of millions of compounds, we cannot find new drugs, does this mean there are no new drugs to be found? Or could there be something wrong with our methods?
7. Look for folk knowledge
There could be hidden ‘folk’ knowledge in research organisations that represents untapped potential for new treatments. Long-serving, junior researchers or support staff in large institutions may sometimes harbour beliefs about what sorts of drugs could work in some patients, based largely on anecdotal evidence and gut feeling but underpinned by years of experience. Are some of these hunches worth acting on and exploring properly?
8. Look at ‘full’ survival
Current drug approval systems generally look at the difference one drug or combination makes on survival. But can we develop new systems that look at the total survival added by all treatments, giving more incentive to develop new sequential treatments and combinations that work better than what we currently have?
9. Find advocates for ‘less glamourous’ disciplines
Towards the end of the meeting, the researchers at the Crick debated the importance of patient advocates in raising money and generating public support for the development of new treatments. People’s stories can be very powerful. But are there more advocates for new drugs than surgery or radiotherapy – which do after all currently cure more people? How do we energise those cured by radiotherapy to tell their stories?
The tenth challenge
After a conversation about this blog post with another senior scientist here at the ICR I’m adding a tenth challenge here, which is arguably the greatest challenge of all: early diagnosis. Researchers at the Crick event also discussed the challenges of early diagnosis and the difficulty in treating cancer types that are often not detected until it’s too late. New screening methods and tests that pick up cancer earlier, allowing patients to be treated before their cancer grows and spreads, are urgently needed – and scientists at the ICR are pioneering new approaches that could dramatically improve the early detection of some cancer types, including for example through genetic screening.
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Curing cancer represents an enormous challenge. It was a pleasure to see the determination and depth of feeling held by some of the leading figures in UK cancer research to find new treatments that will cure cancer, or help people with cancer manage their disease and stay alive for longer.
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