Massive gene study and cancer in the media

Cancer Research UK
We discuss a study analysing DNA from thousands of tumours, plus we look at the impact of cancer stories in the media.

Transcript

Kat: This is the Cancer Research UK podcast for October 2013. This month we’re discussing a study analysing DNA from thousands of tumours, plus we’re looking at the impact of cancer stories in the media. And we’ve got this month’s heroes and zeros.

Hello and welcome, I’m Dr Kat Arney, and with me to discuss the latest news is Anthea Martin, Science Communications Manager at Cancer Research UK.

Now the story I really wanted to talk about this month is a huge gene study from what’s called the Cancer Genome Atlas project, or TCGA, which is the letter of DNA (quite funny if you’re a nerd). Anthea, what is this study and what have they found?

Anthea: So The Cancer Genome Atlas study is a huge study as you say, Kat. It’s come from the National Institute of Health in the USA and it really aims to give us a comprehensive understanding of cancer genetics, and understand more about how cancer develops. Now they’ve been looking at a number of different kinds of cancer and reading their genetic sequence and genetic information. And what this latest study has done is pulled a lot of that information together across different types of cancer and looked at where there are similarities between different cancer types. They’ve actually pulled together the information from over 3,000 samples which covers cancers including breast, ovarian, lung, head and neck and many more.

Kat: This is a huge piece of work, isn’t it?

Anthea: It is an absolutely massive piece of work, and what’s really exciting about it is that by looking across cancer types they’ve actually found a number of distinct genetic signatures of cancer. These are shared not just within a type as we know it, say breast or lung cancer, but actually across those types. So cancers starting in different parts of the body actually have genetic similarities.

Kat: It was quite nice how they did find broad groups – you could say these cancers have a lot of individual mutations or faults in them, and these cancers generally have more messed-up chromosomes. I thought that was very interesting. But you could really pull out distinctive patterns. What were some of the most interesting things you noticed?

Anthea: I think just the fact that very, very different cancer types have similarities is just a really interesting finding in itself. So, for example, they showed that some lung cancers share their genetic characteristics with types of head and neck cancer, or bladder cancer – cancers that really are very disparate and different and caused in different ways. What it will mean in the future is that we’ll be able to look differently at cancer and potentially at how we run clinical trials and cancer treatments.

Kat: Because the important thing is when you find these genetic faults that are driving cancers, we now have more and more targeted treatments that you can give to someone that specifically target that genetic fault. So if you can say, “Oh, you have a breast cancer but it’s driven a fault in this gene, and that’s similar to that guy’s lung cancer, so both of you could have the same drug”. We’re going to have to change the way we do trials though?

Anthea: Absolutely. So at the moment a clinical trial for cancer treatment will be run in terms of where the cancer grows in the body. So for a breast cancer trial you would only include people with breast cancer. This will allow us to open up trials and open up drug treatment to many, many more patients. So you’ll have patients with lots of different types of cancer all getting the same treatment in the same trial, and it’ll mean that the drugs that we already have can be made available potentially to many, many more people.

Kat: Very exciting stuff, but of course this huge project is just one part of a much larger global effort. What’s Cancer Research UK’s role in this effort?

Anthea: Cancer Research UK is involved in the much bigger project which is known as the ICGC, or International Cancer Genome Consortium, and the American work is part of that. The ICGC is looking at fifty different types of cancer and really getting into the nuts and bolts of their genetics. Cancer Research UK funding projects in prostate cancer and oesophageal cancer, and these are being directly funded by two groups of our supporters – the Catalyst Club and the Lawrence Dallaglio Foundation. And these are really big projects in themselves, and will add to this mass of information that is being collected around the world about different cancers.

Kat: This is a huge global effort but there are some people who are saying that all these experiments are just taking snapshots of a tumour in time, looking at the DNA sequence. But what we know from work from our own scientists and others around the world is that tumours evolve, they change, they mutate. How does that fit in to this kind of work?

Anthea: That’s absolutely right – any one genetic test on a cancer does just give you a snapshot of that cancer at that particular moment. But we are doing a lot of work looking at how cancers evolve, how their genetics change as they grow and spread. And we’ve actually just started a massive new study called TracerX, which is looking at how the genetics of lung cancer evolve over time. And that will give us an extra layer of information that can be added to the information that’s coming out of projects like the ICGC project and The Cancer Genome Atlas to give us much more information to take forward into the clinic and help us define what are the best treatments for individual patients.

Kat: We covered TracerX on the podcast a couple of months ago, so if you’re interested go and listen back to that interview with the lead researcher Professor Charlie Swanton.

So that’s one story – the next story I wanted to talk about was results from US researchers from the European Cancer Congress which is a conference that’s been reporting all sorts of wonderful discoveries this weekend. There have been amazing front page headlines about “cancer cures!” and all sorts of things. These were results from clinical trials looking at long-term survival from a new type of treatment called ipilimumab, also called Yervoy or “ipi”, and these are people with advanced melanoma, so survival is very poor in this group normally. The researchers have collated data from clinical trials and patients being treated with this drug, from around 5,000 patients from around the world. And what they found was really important. They found that if you make it to three years after taking this drug, you’re really likely to make it to ten years. So this is very strong long-term survival data, and it’s really exciting news.

Anthea: This isn’t a normal chemotherapy drug, is it?

Kat: No, it’s something called immunotherapy. So it’s an antibody-type drug that recognises a molecule that switches off the patient’s immune system so it can’t recognise tumour cells. Obviously, if you give the drug it knocks out the off-switch, so the patient’s immune system kicks in, starts destroying the tumour cells. And it seems to be really quite potent but unfortunately it doesn’t seem to work in everyone. And they find that around one in four patients that they looked at respond to the drug, so it’s not for everyone and we don’t know why some respond and some don’t.

Anthea: So a lot of the headlines in the past few days have been about this being a “cure” for people with this type of cancer. Is it?

Kat: I think it’s a bit soon to talk about a cure. It’s not working for everyone. We have long-term survival data that look promising, but really you start to talk about a cure when you know that it’s cured, it’s gone away and it’s not going to come back. So it’s a bit early to say that. But it’s certainly very exciting. You look at researchers in the field and they’re saying we could combine this with some of the other immunotherapies that are coming through the clinic through clinical trials now, and then you can get close to talking about good long-term survival for maybe even up to half of all patients. So it’s certainly a very positive story. Thanks very much for that Anthea, that’s Anthea Martin.

October is breast cancer awareness month, and over the past couple of weeks we’ve seen a couple of big news stories about breast cancer – one about a new way of giving the drug Herceptin, the other about a test to help doctors decide on the best treatment. Our reporter Greg Jones spoke to Cancer Information nurse Julia Frater to find out more.

Julia: Well it’s the same drug, with the same benefit and similar side effects, both given every three weeks, but the difference is in the way it’s given. Herceptin is currently given into a vein as an infusion, whereas the new jab is a subcutaneous injection. So it’s given with a very fine needle, which delivers the drug just under the skin. Subcutaneous injections aren’t new in themselves – they’re quite a common route of administering drugs – but this is a new preparation that can give this particular drug in that route.

Greg: So is it a direct injection into the actual breast itself?

Julia: No, I think it would be most likely that they would probably give it into the tummy. And from there it just has to go under the skin and it will disseminate through the body.

Greg: What’s the benefit for patients having it this way rather than the current method for delivering Herceptin?

Julia:  Well the new preparation can be given in just a few minutes – probably five minutes at the most – whereas, at the moment, Herceptin is given intravenously. So that means it’s given into a vein in an infusion and that can last anywhere from 30 minutes to an hour and a half. And, as many patients will tell you, getting access to veins can become a real problem when you’re having repeated intravenous medicines. The veins get irritated and they may collapse and women having Herceptin are likely to be having chemotherapy as well so venous access can be a real problem.

There are ways of getting round that; people can have lines inserted and these lines can be very effective. But they aren’t always trouble-free and there’s the palaver of putting them in. So, although the new jab will involve a needle – we can’t entirely abandon the needle – on the whole it will be a much more straight-forward and faster procedure.

But it won’t mean patients can just nip off immediately afterwards. They’ll have to hang around for a while to be monitored for a couple of hours probably, and a bit longer with the first injection. So it won’t be super quick but it’ll take less time than it does now and for most women it will be more comfortable, and most women would prefer it. But not everybody – there will always be somebody who would prefer to have it the other way.

Greg : The other big announcement that has been made is relating to something called Oncotype DX, which is a test that women are potentially going to be able to be given. Can you just explain a little bit about what Oncotype DX actually is?

Julia: Well it’s not going to be a test for everyone. The National Institute for Care Excellence (NICE), who have just looked at it, have said that it’s going to be used for a particular group of people who’ve had early breast cancer, breast cancer that hasn‘t affected their lymph nodes, and whose cancers are going to respond to hormone treatment but not Herceptin. What the test actually does is it looks for the genes in the cancer cell. It looks at 21 genes in the cancer cells to see how they’re behaving and then this information is used to calculate the risk of the cancer coming back.

This information, along with the rest of the information the doctors have, will help them to decide who is most likely in this group to benefit from having chemotherapy. This is a group who are already going to benefit from having hormone therapy. Sometimes it can be harder to decide if chemotherapy is right for these patients and hopefully it will mean that people who don’t need chemotherapy are going to be identified. They can be spared the inconvenience and side effects and chemotherapy is going to be given to the people most likely to benefit from it.

But breast cancer treatment is really variable – it really varies from one person to another. It depends on factors such as their age, their health and specific features of their cancer. So doctors aren’t always going to need this test to decide who needs chemotherapy – there will be patients who they know right from the start that they’re going to be candidates for chemotherapy and they should be having it.

Kat: That was Julia Frater talking to Greg Jones. And if you have any questions about cancer or cancer treatment, just give our information nurses a ring on freephone 0808 800 4040. They’re there Monday to Friday, 9am to 5pm.

October has also been rebranded as “Stoptober”, aiming to encourage smokers to quit for the month and hopefully kick the habit altogether.  We’ve previously talked a lot on the podcast about issues around tobacco legislation, including the recent failure of the Westminster government to push through standardised packaging for cigarettes. But the fight isn’t over yet, and hopefully there’ll be some progress soon. Dr Alan Worsley spoke to our Policy Manager Kate Alley to get the lowdown.

Kate: The fight isn’t over. We have been working very hard behind the scenes and we now have an amendment on the children and families bill. This would mean that cigarettes sold in places where children go are required to be sold in standardised packaging. It’s not an ideal situation - we would like to have comprehensive legislation for standardised packaging, but it is a stepping stone to the full introduction of the law in this country.

Alan: We’re still going ahead, we’re introducing it, and we’re also now about a year on since Australia introduced plain packaging. What’s been happening down under?

Kate: Well it is a bit early to tell but we have had some early research published already over the summer. And what they have been finding is that smokers don’t like their cigarettes as much as they used to. The Department of Health actually had complaints – smokers rang up to say these cigarettes were different, they said they didn’t taste the same. And the research has actually found that smokers were saying that they were thinking about quitting more often. Because the packaging didn’t have branding anymore, it makes the health warnings stand out much more so smokers were thinking more and more that they needed to quit.

Alan: Early research but quite a profound effect. That’s fantastic but it’s not the whole story is it because there’s so much more going on?

Kate:  Absolutely, we’ve had fantastic news from Scotland. The Scottish government have announced that they will be going ahead with standardised packaging in the 2014-15 year, which is wonderful news. Scotland has always led the UK on tobacco control. They, of course, went smokefree before the rest of the UK so it’s not a surprise that they will also be leading the way on this. We’ve also had more good news from Scotland – they’ve just released their quit figures for the year and they are on track to exceed their quit targets for cessation services so that’s wonderful news.

Alan:  So Scotland is leading the way and they were one of the first countries to ban smoking in pubs, for example. Are there any other areas that are leading to people quitting smoking?

Kate:  We’ve heard that the government has announced that prisons will finally be going smokefree. This is one of the exemptions from smokefree legislation so we’re very pleased that this will be examined. What they’re going to do is a pilot programme in a couple of prisons to see how it goes down, but we’re hoping that it will be successful. One of the things we are concerned about is that prisoners who smoke are supported to quit smoking. But from what we understand, there will be procedures in place to ensure that that happens.

Alan: With all these new laws, how big a problem is this still? What is the current prevalence rate of smoking?

Kate:  We’ve just had some more good news about this. We are expecting smoking prevalence in this country to fall below 20 per cent for the first time. However, that still means a fifth of the population are smoking and that’s bad news. Smoking is one of the most lethal habits you can have. Half of all long-term smokers will die of a smoking-related illness and, at the moment, that’s around 100,000 people each year. That’s completely unacceptable and so we need to make sure more and more people are quitting smoking and that children never start smoking in the first place.

Kat: That was Alan Worsley and Kate Alley.

As we mentioned earlier while talking about the skin cancer drug in the news, over-hyped headlines may not tell the full story. Here at Cancer Research UK we spend a lot of time trying to make sure the coverage of cancer stories in the media is as accurate as possible, and to take a look behind the headlines I spoke to Olly Childs, our News and Multimedia manager.  I started by asking him how we help to get accurate cancer stories out to the public.

Olly: We’re on the lookout for the very same stories that journalists are looking for, so we’re looking for interesting cancer research. I think the difference is that we’re not trying to sell newspapers, so what we’re actually doing is looking for those stories and trying to describe them in a non-sensationalist way.

Kat: So we don’t go for the gratuitous “This is a breakthrough cure!” headlines?

Olly: No. We’re not about every day telling people there’s a breakthrough – science isn’t really like that. Science is incremental progress towards improving cancer cure rates etc, so what we try and do is give a sense of that incremental process and champion really interesting research.

Kat: There’s two main ways that we respond to science in the media – there’s the News Feed and then there’s our Science Update Blog. What’s the difference between the two of those?

Olly: Well the News Feed is very much like the BBC website, Guardian Website, Daily Mail website – we’re looking for interesting research out there that our audience might be interested in. Our audience is basically anyone affected by cancer. So we are breaking stories as the media do, but the difference is that we’re doing it in a much more measured, caveated way. So yes, this is interesting research, but it’s research, say, in mice. The Blog allows us to go a step further in a way and respond to how the rest of the media might be making some broad assumptions that we want to address, and let people understand that the research is a lot more complex and convoluted...

Kat: ...or that the headlines are simply nonsense! It does seem that we have a good platform to go into a bit more of the scientific detail and the accuracy and the context of what’s going on that maybe the headlines don’t. And obviously it’s important that we do put accurate information out there for people – that we’re not misleading them, that we’re not over-hyping them. What do you think some of the damage that can be done by over-hyped news stories about cancer?

Olly: The fact of the matter is people reading newspapers can be people affected by cancer, and reading a sensationalist headline about “the dangers of chemotherapy” or something like that which sells newspapers can really affect cancer patients. We actually see that at Cancer Research UK in that we get people phoning our nurses helpline and worrying about these kinds of headlines. What the blog allows us to do is look at that research, step away from the short little headline that doesn’t really tell you the full story and tell a much more rounded picture of what the research is telling us and how it fits into the wider puzzle.

Kat: That’s what I really like about what we can do –we can add all that extra context that I think sometimes newspaper just jump from story to story to story with no reference to what’s gone before.

Olly: It just allows us to give a much broader context of how does this single piece of research from Lab X in the USA fit into the wider context of research across the world – what has gone before, what might this lead to? It’s not that headline-driven “This has happened, wonderful, we’re five years away from a cure!” It’s a lot more intricate than that and allows us to tell a much more accurate, real-world story about how research actually works.

Kat: And there are exciting times in our little news world, and there’s a new News App so that people can get the latest stories. Tell me about this.

Olly: Exactly. So we realised that there is an audience out there who find their news through their Smartphone apps, so as a huge cancer research charity we actually have several feeds of research. We have our blog, we have our news stories, we have our press releases, we have this podcast, we have YouTube videos, and they’re all sources of news. And we have actually developed a very nice-looking app that people can download for free onto their phone from Google Play Store or from the Apple App Store, and it brings all those stories together in a nice, easy, accessible place.

Kat: So get it on your phone and keep up to date with the latest news?

Olly: Exactly, and it’s got lots of nifty little features like you can save stories for later reading, you can share them through social media, and it’s just a really nice way to get your news, basically.

Kat: That was Olly Childs. And you can check out our news resources online at cancerresearchuk.org/news, and get the News App from the Apple App store or Google Play.

And finally, it’s time for our heroes and zeros.  Our hero this month is Dr Simon Boulton, from our London Research Institute. He’s been awarded the Paul Marks prize for cancer research by the Memorial Sloan-Kettering Cancer Center in the US, which goes to the brightest and best young researchers who’ve made important advances in understanding and tackling cancer. Simon’s work focuses on figuring out how DNA gets damaged and repaired – vital processes in the development of cancer. Not bad for someone whose first science teacher told them to give up the subject! You can find out more about Simon’s life and research on our Science Update blog.

And our zeroes are the unscrupulous people who advertise miracle cures for cancer with no evidence to support them. As part of the charity Sense About Science’s Ask For Evidence campaign, we’ve written an article about some of the miracle cures we’ve come across, and why it’s important that people ask for – and assess – the evidence behind any claims made about treatments. Sense About Science have also relaunched their helpful booklet “I’ve got nothing to lose by trying it”, which explains more about the risks of turning to unproven treatments, and how to find and assess scientific evidence. You can find out more from senseaboutscience.org

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 podcast@cancer.org.uk, 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.