Personalised lung cancer treatment, skin cancer, and our new strategy
Kat: This is the Cancer Research UK podcast for May 2014. This month we hear about a groundbreaking new clinical trial for lung cancer, rising skin cancer rates, and get the low-down on our new 5-year research strategy. Plus our heroes and zeros.
Hello and welcome, I’m Dr Kat Arney. One of our top stories in the news this month was the launch of the second phase of our Stratified Medicine Programme – an ambitious plan to bring the benefits of more personalised treatments, designed to tackle the specific molecular faults in an individual’s cancer, to patients in the UK.
Following a successful first phase, which looked at whether people with a range of specific cancer types could have their tumours genetically tested and be given appropriate treatments within the NHS, we’re now moving forward with phase two. This will be a pioneering multi-arm Matrix clinical trial – the first of its kind in the UK and probably the world – testing personalised drugs for lung cancer. At the press launch of the trial, our Chief Executive Harpal Kumar explained to the media why the need for this research is so urgent.
Harpal: Lung cancer, as I think most people in this room will know, is the second most commonly diagnosed cancer in the UK for both men and women, and that means around 42,000 people are diagnosed with lung cancer every year in the UK. But it remains the biggest cancer killer, so roughly 35,000 people unfortunately die of lung cancer every year in the UK. And across the world it’s also the biggest cancer killer with an estimated 1.6 million people dying of this form of the disease every year, so it really is a major global health burden.
Survival rates from lung cancer remain stubbornly low. Five year survival rates remain one of the worst of all types of cancer, so we need to find new approaches for dealing with this disease. At Cancer Research UK, lung cancer is a major priority for us and we’re looking at a number of different approaches for addressing lung cancer, all the way through from how we can help it to be diagnosed earlier to how we might develop and optimise new treatment approaches.
What we’re talking about this morning is what we call “stratified medicine”, and the principle of stratified medicine – and you might have heard terms like personalised, individualised or precision medicine – is that we wish to, as we increasingly have the technologies that enable us to define at a much more specific basis the molecular characteristics of every patient’s tumour, to be able to use that information to guide treatment more accurately and specifically. This is something that the cancer research community and the broader medical research community has been talking about for a number of years. The question is how do you make it a reality? Do we have enough yet of the right medicines with the right diagnostics to really bring this into mainstream clinical practice?
As we thought about this a few years ago in Cancer Research UK we thought that it was important that we took a leadership role in this space, not only because cancer is at the forefront of this whole era of stratified medicine, but also because we have the opportunity in the UK to use the resources that we have – which we’ll return to later – to really start to determine how you make this a reality in mainstream clinical practice.
From July 2011 to July 2013 we ran what we called the first phase of our stratified medicine programme. We’re now moving into the second phase, which picks up both on the learnings from that first phase but also on the opportunities that we now have in front of us.
Kat: The trial will be launching later in the year for lung cancer patients in the UK, and you can find out more on our blog or by calling our Cancer Information Nurses on freephone 0808 800 4040, 9am to 5pm Monday to Friday.
We also saw a lot in the news this month about skin cancer and sun, just as the good weather turned up. New figures show that rates of malignant melanoma – the most dangerous form of skin cancer – are now five times higher than they were in the 1970s. While the good news is that more people are surviving the disease – around eight in ten - it’s still one of the most preventable cancers, as it’s strongly associated with excessive exposure to UV radiation from the sun and sunbeds. Our reporter Greg Jones spoke to our senior health information officer Yinka Ebo to find out more.
Yinka: We think the rise that we’re seeing is down to a number of reasons. One of those things is probably cheap package holidays that became popular around the 60s and the 70s, the introduction of sunbeds around that time, and this desire to have a tan. But we are also getting better at detecting and diagnosing the disease as well, which would also play a part.
Greg: What should people be looking for in terms of symptoms and signs?
Yinka: It’s a good idea to get to know your skin, know what it looks like. That way it’ll be easier for you to spot anything unusual or out of the ordinary. If you notice any changes to your skin, like a change in the size, shape or colour of a mole or freckle, or normal patch of skin, it’s a good idea to go and get it checked out by your GP. In most cases it won’t be skin cancer, but if it is, we know that spotting it and treating it at an early stage gives you a better chance of surviving the disease.
Greg: So as we move into the summer, and possibly getting some sunshine in England, what are the sorts of things that people need to be doing to take care of their skin to reduce their risk of developing skin cancer later on in life?
Yinka: The most important thing to do is to remember not to burn, and you can do that by spending some time in the shade when the sun is at its strongest – in the UK that’s normally between 11am and 3pm. Making sure you pop on a T-shirt, some sunglasses, and a wide-brimmed hat, and use some sunscreen on the bits you can’t cover with clothes. Make sure you use a sunscreen with at least SPF 15 and a high star rating to get good UVA protection.
Kat: Yinka Ebo talking to Greg Jones. One of the biggest stories of the month was the good news that more than half of all cancer patients diagnosed today will survive for at least ten years thanks to advances in research, up from around a quarter in the 1970s. We announced these figures to coincide with the launch of our new five-year research strategy, focusing on how we will take forward our work to beat cancer. To find out more I spoke to Senior Science Communications Manager Nell Barrie.
Nell: Well, we’re really starting from a position of looking at everything that we’re doing and trying to work out the places where we can invest money and make the biggest possible difference in saving lives from cancer, so that’s always our key aim. And I suppose the other key thing to say is that we fund research across the whole spectrum of what scientists are looking at in cancer, right the way from the lab to clinical trials looking at new treatments. So there’s a huge range of things that we’re going to be looking at.
Kat: Is this our first research strategy?
Nell: No – we tend to go on a five year cycle with our research strategy. So we’ve reached the end of our previous five year cycle, we’re renewing the strategy for the next five years, but it’s also longer term than that and thinking about where we want to head towards in the future.
Kat: In the new strategy, which is looking in the directions we want to go with our research, looking at where we want to be in the next five years, what to you are the key things that you’re most excited about?
Nell: I think one of the really major areas that’s coming out of it is looking at early diagnosis, because we’ve known for quite a while that making a difference there, helping more people to be diagnosed earlier, will really help save many, many thousands of lives. Because if you can spot cancer at an early stage when it’s quite treatable, when it can be removed with surgery or treated quite easily, you’re really going to help more people survive the disease. So there’s a lot of different ways that we can improve early diagnosis in the UK, right the way from better screening up to helping GPs be more aware of symptoms – all those kinds of things. So that’s a major area for us, I think.
Kat: When we launched the strategy we announced the fantastic news that around half of patients diagnosed today will survive for at least ten years. But that’s on average – it’s not across all cancer types. So is there going to be a particular distinction of certain types of cancer we’re going to be focusing on?
Nell: That’s a really good point. So that figure was really meant to show how far we’ve come, because we know that in the 70s it was only about 25 per cent that would survive for ten years, and that’s gone up massively, which is great and it really show the power of the research that we’re doing. But at the same time, we know that there are certain cancer types where survival rates are still really low and we’re looking at things like under 15 per cent for ten year survival which is terrible. Those are cancers like pancreatic, oesophageal, brain tumours and also lung cancer – which is a very common on. So we’ve identified those four areas as being really key and we need to focus more research into those cancer types and make sure we can boost those survival rates further.
Kat: When you think about cancer and cancer treatment you tend to think about things like cancer drugs, so this isn’t just about developing new treatments for cancer is it?
Nell: Absolutely. There’s a full spectrum of things we’re looking at that goes from prevention to diagnosis to developing new treatments, and the other really key thing is looking at the treatments we already have and figuring out how to make them better – reducing side effects, finding better ways to give people radiotherapy, all these kinds of things are really important. So it’s not all about drugs, there’s much wider exciting stuff we’re doing.
Kat: It’s interesting you talk about side effects, because obviously we’re seeing more and more people surviving cancer and it’s absolutely fantastic the way that survival has increased. But it means that more people are living with the long term effects of cancer and the long term side effects of treatment. What are some of the ways that we’re trying to reduce these side effects.
Nell: I think one of them would be what I was just mentioning which is looking at how we can improve the treatments we already have. Obviously we know the keys ones for pretty much any type of cancer would be chemotherapy, radiotherapy and surgery. And we can improve all of those. We can make surgery less invasive using things like keyhole techniques. We can make radiotherapy more accurate so that you’re not targeting as many areas of healthy tissue. And we can change chemotherapy – we can find new ways to combine different drugs.
The other major thing is personalising treatment, because we know that all types of cancer are different. Within different cancer types, say breast cancer, you’ve got different forms of the disease, and you need to know what’s the best treatment to give each patient. So that’s something that a lot of our researchers are focusing on at the moment.
Kat: Are there any particularly exciting areas of research that we’re going to be addressing, or addressing more that in recent years?
Nell: One really key area for us is immunotherapy, which is looking at how we can harness the power of the immune system to help tackle cancer. Because we know that the human immune system is incredibly powerful, but it doesn’t always spot cancer. That’s probably because cancer’s something that happens with your own cells, so we’ve got many, many researchers doing really exciting stuff looking at things like can you alert the immune system to the fact that cancer’s there and help it to track down the cells? Could you reprogramme immune cells, perhaps outside the body, put them back into the patient? We’ve made quite a lot of progress in this area over the past few years and we really want to ramp that up and fund more exciting science in those areas. So that should be something really exciting for the future.
Kat: With any strategy there’s obviously a long term goal, there are short term goals as well. What do you hope are going to be some of the outcomes of this?
Nell: Overall we’re looking at an ambitious aim of boosting survival rates. Ten year survival rates are 50 per cent today, we want to get that up to three quarters of people surviving cancer within the next 20 years. That’s a longer-term aim than our five-year strategy but that’s really focusing our minds and making us think that everything we’re doing should be directed towards increasing survival. And the main ways we’ll be doing that is focusing on those really hard to treat cancers, because we can’t boost overall survival rates unless we tackle the cancers that have got really poor survival at the moment.
Kat: In terms of things like the way we fund our research, the amount of money we put into research, is that going to need to change?
Nell: Yes. We know that thanks to the generosity of all the people who donate to the charity we’re actually looking at increasing the amount we’re going to raise over the next few years so that we can put more money into research, which is brilliant. As long as everything goes to plan, we’re hoping to increase the amount of research we’re funding by about 50 per cent, if that’s possible, so that would be an amazing achievement. What we’re hoping to do is keep going with that and make sure that we can keep funding the best research possible.
The other thing we want to do is really encourage researchers in different areas of work. We know that we need more researchers working together across different types of science, bringing in things like mathematics, physics, engineering... So we’re introducing new types of funding to encourage this sort of thing. We’ve got a multidisciplinary research grant that we’re going to introduce, also grants to encourage more really innovative research – things that could be a bit risky but really rewarding, to find new avenues for treating cancer. So we’re going to have a type of research funding stream for that. We’re also looking at things like helping researchers at certain points in their career, so we can make sure that we’re keeping the best people in the UK, funding the best researchers. So we’re trying to help researchers go towards the areas that we think are the most important.
The other really exciting one is something called the “Grand Challenge” stream of funding. So this is going to be a really different way of doing things, because essentially what we want to look at are the really big questions in cancer – things like, how can we stop cancer spreading – and to do that we think the best way is to get a group of researchers together, working in slightly different areas but on the same question, and hopefully give them a really substantial chunk of money – something like ten or twenty million – to answer these big questions. So that’ll be really exciting for the future as well.
Kat: That was Nell Barrie. One person who exemplifies the need for our work is 66-year old Tony Richards, who was diagnosed with oesophageal cancer and has taken part in clinical trials to help improve treatments and tests for patients in the future, including our sponge-on-a-string trial, which we’ve mentioned here on the podcast before. He shared his story with us, and why he feels research is so important.
Tony: I’ve had a history of indigestion and problems with reflux, and in the late 1990s I had an endoscopic examination where they identified I’d got scarring of my gullet near the entry to the stomach. In 2009 I had a recurrence of indigestion. By that time I’d been on what are called PPI’s – proton pump inhibitors – which reduce the acid in the gullet, but nevertheless the indigestion flared up and I had an endoscopic examination. I was identified as having Barrett’s [Oeosphagus]. Now it’s settled down, and eventually in 2011 I had another endoscopic examination and at that point they discovered that I’d got cancer.
It was early stage cancer that took a little while to diagnose because I had to have various examinations to identify the extent of the cancer. I was very fortunate because I was in the early stages and able to have an endoscopic operation which didn’t involve any open surgery. I was under mild sedation. The downside, of course, was that after I recovered I couldn’t take solids, so I was on baby food. My wife was very kind to me and liquidised most of the food I ate – great for the weight loss, I might add!
Anyway, I then became a participant in a number of research programmes. I had an endoscopic examination about three or four months after I had the cancer removed, just to check that things were OK, and then the following April I had a radiofrequency ablation treatment. And the purpose of the radiofrequency ablation treatment was to remove the Barrett’s Oesophagus – the Barrett’s is a condition which is precancerous cells. So having had the Barrett’s Oesophagus removed through a single application of the radiofrequency ablation, I’m now monitored on a regular basis.
Most recently I’ve taken part in some further research where I’m asked to swallow a capsule that’s attached to a piece of string – it’s called the sponge test. It’s a research project. What happens is that you take a glass of water with the capsule. It’s a bit challenging to swallow with the string and it goes down OK with the glass of water. The string is attached to a piece of cardboard so you can’t swallow the string as well. After a few minutes in the stomach, the capsule dissolves and out pops a sponge. Then the nurse withdraws the sponge through the gullet on that piece of string, and that sponge contains an analysis of all the cells in your gullet. I then have my normal endoscopic examination, and they’re comparing the results of the two analyses. I’m also having biopsies taken from my gullet, so that that tissue is being used for genetic research.
I’m very pleased to be here. I think that the reason I’m here is that I’ve had excellent treatment. I was also diagnosed quite early, which made a huge amount of different, and I’m delighted to be taking part in clinical trials.
Kat: Tony Richards there. And finally, it’s time for our heroes and zeros. Our heroes this month are everyone who’s helped to bring the advances that have led to a doubling of long-term cancer survival rates in the UK over the past decades. All the doctors, nurses, scientists, patients, policy-makers, fundraisers, volunteers, donors and supporters – you’ve all helped to make a difference. As I mentioned earlier, ten-year survival has gone from a quarter of patients surviving in the 1970s to more than half today, and we want to see it hit three quarters in the next twenty years, so we all have our work cut out.
And our zero this month is an infographic in the Metro newspaper that seemed to imply that breastfeeding causes breast cancer – something that caused consternation amongst mums (and more) on the internet. In fact, the opposite is true, and breastfeeding reduces the risk. To be fair, it’s partly our fault as Metro took their information from some slightly ambiguous wording on our website, which we’ve now updated.
That’s all for this month, we’ll see you again next month for a look at all the latest cancer news.
We’d also like to answer your questions in our podcast, so please email them to email@example.com, post on our Facebook page, or tweet us – that’s @CR_UK. And if you’re listening to this on Soundcloud, please leave us a comment with your feedback. Thanks very much and bye for now.