As we start the 10th National Cancer Research Institute (NCRI) Cancer Conference, there is a real buzz in the air. With a record number of abstracts submitted this year, there is a choice of more than 150 speakers from across the globe talking and debating a myriad of topics ranging from cancer diagnosis and therapy to survivorship and end-of-life care.
We are in for a stimulating programme, with many of our researchers presenting their work here, including Dr Gerhardt Attard and Professors Ian Collins, Johann de Bono and Kevin Harrington.
Before the main conference kicked off today, we were lucky to sit in on a fantastic debate last night – chaired by the Director of the Breakthrough Breast Cancer Centre here at the ICR, Professor Andrew Tutt – that asked ‘Genomic medicine in metastatic breast cancer: reality or hype?’
1,000 women die each month in the UK as a result of metastatic breast cancer. It’s an alarming figure, highlighting the need for better treatments that will help those diagnosed to live longer and healthier lives. With the advent of more affordable and elegant sequencing technologies, and the launch of the 100,000 genomes project, research can potentially move away from characterising the few known genetic markers associated with breast cancers and instead focus on the information found in entire genomes.
The dream of using these data to inform treatment choice is now closer to becoming a reality. Or is it?
For the debate, Professor Tutt had pulled together a panel of experts – Professor David Cameron and Dr Iain MacPherson in favour of using genomic medicine in metastatic breast cancer, and Dr David Miles and Dr Andreas Makris, who were sceptical about this approach.
To start with, Professor Tutt asked the audience, “who believes genomic medicine in metastatic breast cancer is a hype, and who believes it's a reality?” The vote was close, with around 45% of the audience believing it was hype, and the remaining 55% thinking it was a reality.
We heard a 10 minute pitch from each speaker, who threw up some really interesting points – including Dr MacPherson quoting Lord Kelvin, who said in 1997, "The radio has no future...".
On a more serious note, one of the main rationales against the genomic approach was the problem of cancer evolution and tumour heterogeneity – and the need for focusing on the driver mutations. Dr Makris stated, "You can't derail the cancer train by shooting the passenger, you have to kill the driver". Other points for the case against included the concern that we could be neglecting other promising treatment approaches in favour of this hyped up and fashionable route.
The arguments in favour included the fact that we are already focusing on HER2 copy number and ‘BRCA-ness’ with promising results. Whole genomic analyses can sometimes even show that the patient doesn't even have the disease – and Professor MacPherson also made the point that genomic sequencing will throw up rarer frequency mutations.
After we heard a very informative and at times, a very witty and amusing debate, Professor Tutt took another audience vote. It seemed that there was a bit of a swing, with a 50/50 divide in opinion.
Whatever your opinion may be, we are now at a fantastic point where we are questioning what paths to take in treating metastatic breast cancer.
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