As the National Cancer Research Institute (NCRI) cancer conference closes its doors for another year, the researchers, doctors, patients and students who attended will be thinking about the exciting research reported during the last four days in Liverpool.
As ever the NCRI conference covered a wide range of topics across the breadth of cancer research, so it’s always tricky picking out key themes. Here though are three messages that I thought came across particularly strongly.
The immune response to a tumour is a key predictor of prognosis
Immunotherapy has been a hot topic in cancer research for several years now – but there has been a growing feeling that to make the most of it, we need to understand more about the interactions between cancer and the immune system.
Two major plenary lectures at the conference addressed the latest evidence on how the immune system responds to cancer – and how that could help us to predict who might respond best to immunotherapy.
One of the most exciting talks at the conference came from Dr Jerome Galon, an immunologist from INSERM, the French National Institute of Health and Medical Research.
He presented evidence that the strength of the immune response to a tumour – quantified through an immunoscore – was a strong predictor of prognosis. So strong in fact, that when its effect was accounted for, the significance of many traditional predictors of prognosis disappeared.
A second talk by Professor Ton Schumacher of the Netherlands Cancer Institute picked up the theme, suggesting that some tumour types were immunologically ‘hot’ – and consequently more likely to respond to immunotherapy.
Often the strength of the immunological response seemed to be determined by the number of different mutations in the cancer.
Researchers are now exploring various different ways to prompt a stronger immune reaction – including using immunotherapies before surgery, to expose the immune system to more cancer antigen and give it a better chance of responding.
Catch up with and watch all our news, blog posts and video content from the NCRI conference 2017 in Liverpool.
There is an evidence base now for cancer prevention – and we need to act on it
A strong theme at the conference was a push for cancer prevention to move higher up the agenda – not only to stop cancer from developing initially, but to stop it from recurring too.
Professor Jack Cuzick delivered a tour de force lecture on cancer prevention – and particularly chemoprevention – to mark his receipt of a Cancer Research UK Lifetime Achievement Award.
Professor Cuzick has been at the vanguard of UK research into cancer prevention for four decades.
He presented data from some of the big success stories of cancer prevention – from the falling rates of lung cancer in men since smoking began to decline, to the success of screening and more recently HPV vaccination in reducing deaths from cervical cancer, to the hugely successful IBIS trials which showed the potential of tamoxifen and aromatase inhibitors to prevent breast cancer.
He was particularly animated about the potential of aspirin to prevent many gastrointestinal cancers, arguing that the benefits of reduced cancer rates far outweighed the risks of ulcers and haemorrhagic strokes.
We also heard from Professor Annie Anderson of the University of Dundee, who gave some startling statistics about the impact of lifestyle on cancer incidence.
According to Professor Anderson, around 14 million people were diagnosed with cancer in 2012 – a number that is set to increase to around 22 million by the year 2030. While some of this increase is a result of an ageing population, lifestyle factors also play an important part. Tobacco use alone accounts for around 19% of all cancer cases, and there is a wealth of evidence linking cancer to obesity, alcohol use and inactivity.
Professor Anderson said this was clear evidence that we needed to place more emphasis on encouraging people to make lifestyle changes – both through legislative efforts such as ‘sugar taxes’, and through a shift in the way healthcare professionals talk to their patients about risky behaviours.
When it comes to proton therapy, economics must not be allowed to trump evidence
The hands-down winner of most entertaining talk at the conference came from Dr Anthony Zietman of Massachusetts General Hospital. Dr Zietman grew up in the UK but was returning to Liverpool for the first time in decades, and treated the audience to a fascinating story about the experience in the US with proton therapy.
Proton therapy is an extremely expensive new type of radiation treatment that uses protons, rather than the traditional X-rays, to treat cancer. Its big advantage is that protons deposit their energy in a peak at the tumour site and don’t go on to damage healthy tissue by continuing their passage through the body.
In the UK, proton therapy became famous because of the case of Ashya King, whose parents took him out of hospital and fled to Europe so he could have access to the new treatment. At the time, there were no proton therapy centres at all in the UK – whereas in the US there were more than 20.
As Dr Zietman pointed out, the two healthcare systems took starkly different approaches to proton therapy – and they could not both be right.
It turns out that the US embraced proton therapy so enthusiastically because economics was allowed to trump evidence. Most of the US proton centres are private facilities built to generate a profit by treating the large numbers of older men with prostate cancer.
The problem is that there is no good evidence that proton therapy is any better than conventional radiotherapy at treating prostate cancer – and indeed some of the cancers that were treated might only ever have needed active surveillance. The resulting backlash has seen some proton centres in the US face closure.
Dr Zietman argued that the UK had an opportunity – as it now seeks its own, cautious introduction of proton therapy – to do the clinical trials that will show who the new treatment might benefit, and when.
Proton therapy may be of limited use in prostate cancer, but it could deliver effective treatments with fewer side-effects for children with cancer – provided the evidence stacks up.
More ICR updates from NCRI 2017
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