October 2012 podcast transcript

This month,

• A third of cancers in the elderly are diagnosed through an emergency hospital admission.
• Report calls on dentists to help spot mouth cancer.
• Scientists uncover new breast cancer drug target
• Trial of cannabis chemical launches.
• We kick off breast cancer awareness month with an update on the latest experimental treatments.
• And finally we’re asking you to Stand Up To Cancer

Welcome to the Cancer Research UK podcast. I’m Greg Jones.

Almost a third of cancers in the over 70s are diagnosed through emergency admission to hospital, according to new research by the National Cancer Intelligence Network. That’s around 38,300 people a year in England alone.
When the researchers looked at the data for all ages, they found that almost a quarter of cancers – around 58,400 cases a year – are first diagnosed following an emergency hospital admission.

The team studied the journeys of nearly three quarters of a million cancer patients between 2006 and 2008 in England. They then worked backwards to trace the sequence of events leading up to each patient being diagnosed with cancer.

Sarah Woolnough, Cancer Research UK’s executive director of policy, explains why these figures are deeply concerning.

SARAH: These figures are really shocking and we need to urgently get behind them and understand what’s happening. It’s not good for patients to be presenting with cancer at A&E and it’s certainly not good for the NHS either. We need to understand the balance between people not recognising the early signs and symptoms of cancer and not going and visiting their GP but also we need to understand if there are delays in primary care - so GPs not spotting and recognising those symptoms and referring on in a timely manner.

Mouth cancer rates are rising in the UK. By 2030 it’s predicted there will be 9,200 cases every year compared to over 6,000 in 2009 and just 3 thousand in 1984. In light of this, leading dentists published a report last week highlighting the important role that dentists and members of the dental team can play in promoting prevention of oral cancer, detecting warning signs and referring patients appropriately.

Hazel Nunn, Cancer Research UK’s head of health information, tells us why she thinks oral cancer detection should be a top priority for all dentists.

HAZEL: There are three main reasons why early diagnosis of oral cancer should be at the top of the dentist’s agenda. First is that oral cancer is on the rise. Second is that, unfortunately, when the disease is found at a late stage the chances of survival are poor. And thirdly, dentists are in an ideal situation to be able to look in people’s mouths and to see very early stages of the disease and to refer people on quickly to the hospital.

Earlier this month, scientists at our Cambridge Research Institute showed how treatments currently being developed to target a key cancer protein, called TGF-beta, might be useful in breast cancer. They could potentially be used to treat the one in ten breast cancers that have low levels of a protein called claudin.

Earlier this year the same team published a groundbreaking study showing how breast cancer can be broken down into ten distinct types, each characterised by its own ‘genetic fingerprint’.

In this latest study they used this knowledge to explore, for the first time, how the network of genes activated by TGF-beta differs among different breast cancer types.

Dr Julie Sharp, Cancer Research UK’s senior science information manager, explains what this could mean for breast cancer patients.

JULIE: The researchers have shown that TGF-beta has a dual role in cancer: it can either prevent or switch on the disease. Now they can try and target this protein in cancer cells. There are already drugs in development that might do this and they believe that, for around 10 per cent of breast cancer patients, these treatments could offer new hope in the future.
Chemicals similar to those found in cannabis form the basis of a new drug that is being trialled in UK cancer patients for the first time by researchers in Newcastle.

The drug, called dexanabinol, is from a family of compounds called cannabinoids. It is chemically related to compounds found in cannabis plants, but is synthesised in the lab and lacks any cannabis-like psychological effects.

The trial is supported by Newcastle Experimental Cancer Medicine Centre, which Cancer Research UK helps to fund. Around 45 patients with a variety of different types of advanced cancer are expected to take part.

Professor Ruth Plummer, who’s leading the trial, tells us what makes it so exciting.

RUTH: We think it’s exciting on two fronts for us: it’s the first time a drug in this class has been taken systematically in our patients to try and work out the dose – is it safe and is it going to work? It’s exciting for us as the Newcastle ECMC because the early structural work identifying this as a potential compound was done at e-therapeutics, which is a company located in Newcastle and came out of some work at Newcastle University. So it’s very nice for us as an ECMC to be part of the team taking it forward through that network.

October marks Breast Cancer Awareness Month, so we took the opportunity to meet Professor Arnie Purushotham, one of our top breast cancer experts. Professor Purushotham heads our King’s College London Experimental Cancer Medicine Centre, where some of the newest and most exciting new breast cancer treatments are being tested. Cancer Research UK’s Ailsa Stevens reports.

AILSA: So Professor Purushotham, we know survival from breast cancer has really improved dramatically in recent decades and now eight out of ten women survive the disease compared to five out of ten in the 1970s. In your opinion, what are some of the main advances that have contributed to this?

ARNIE: Ailsa there are many reasons why this has happened. The one thing we do know is that early diagnosis has improved survival. And the reason why women are presenting earlier is both because of increased awareness of symptoms as well as the breast screening programme, that has resulted in women being diagnosed earlier, presenting with earlier stage disease and therefore having better outcomes as a consequence. If you look at the different forms of treatment for breast cancer usually she, or he, undergoes treatment by surgery.

And the pivotal changes in the surgical management of breast cancer have been starting initially with more patients undergoing breast conserving surgery, by which I mean not having to undergo mastectomy. Which is great in terms of their quality of life and our ability to not subject them to surgery that is fairly major.

AILSA: So it’s not just that women are more likely to survive, the treatments are actually becoming kinder and better too.

ARNIE: Absolutely right. And if you extend that argument to what we do in the armpit to try and stage the disease, the surgical technique previously was that we had to remove most of the lymph glands in the armpit to get maximum information and then to plan their treatment. We now know that we don’t have to do that because the majority of women have glands that are free of disease. So a new technique called sentinel lymph node biopsy was introduced and that spared women undergoing a much more radical operation. So there are some examples in surgery of how the treatment has got better, both in terms of clearing the tumour better and trying to understand how we can preserve the breast as opposed to sacrifice the breast by mastectomy and also minimising the surgery to the armpit.
In drug treatment we have very pivotal developments that have happened over the past 50 years. Now breast cancer is a hormone driven disease largely and therefore any treatment that interferes with those pathways could have a direct impact on improving survival. And tamoxifen was the first such drug and we have experienced the benefits of tamoxifen for our patients over many years. And more recently are the group of drugs that fall under the umbrella of aromatase inhibitors. These two drugs are currently the main treatments that we use in breast cancers that are hormonally driven.

The second big area in the discovery of breast cancer and understanding how breast cancer develops is in the study of the genes that the tumour expresses. If you even just look in the last year there have been three major papers that have significantly impacted our thinking. And increasingly we are now able to classify breast cancer into very clear categories depending on their genes. That will allow us to either use existing treatments to target those genes or develop new treatments based on the genes that those tumours express.
So I guess in a nutshell we have seen a plethora of discovery that has resulted in better understanding, better development of treatments, to improve survival and to improve the quality of life.

AILSA: So you’re in charge of the Experimental Cancer Medicine Centre at King’s College London. What exactly is experimental medicine and are there any new treatments currently in the pipeline that you’re working on at the moment?

ARNIE: In a nutshell if you look at experimental cancer medicine as being laboratory to the clinic, as soon as the discoveries are made to test in patients. Or taking back those learnings to the scientists to refine those learnings or create new discoveries. That essentially is experimental cancer medicine.

There are several new drugs in the pipeline that are very promising and look very exciting. One example that is being investigated in our cancer centre is a compound called a PI3 kinase inhibitor and drugs that block that molecule result in the cell dying. Our scientists have shown that in the laboratory and have understood why that happens. And what we are doing now is we are taking that drug to patients.

So we are examining patients with breast cancer in a clinical trial and to one of the groups of patients we are adding the PI3 kinase inhibitor and we are looking at biopsy samples from the tumour to see how the tumour responds to these treatments. And the benefit of that is that we will know whether these patients are likely to respond to these treatments or are already responding. And secondly it reduces the changes of us treating patients with drugs that are not having a positive effect. And that just an example and there are many similar trials that are going on globally.

AILSA: So will this be the first time patients are given this particular class or type of drugs?

ARNIE: In this particular context it is. This drug has been used in patients with more advanced breast cancer, but in early breast cancer to my understanding this is the first time this has been applied.

AILSA: So it’s really pioneering stuff then.

ARNIE: And very exciting.

That was our reporter Ailsa Stevens talking to Professor Arnie Purushotham at King’s College London.

And now for some more good news. The rates of people dying from cancer are predicted to fall by 17 per cent in the UK by 2030, according to new statistics released last week by Cancer Research UK.

This is largely due to better survival rates, thanks to earlier diagnosis and improved treatments, but also reflects a reduction in smoking-related cancers leading to fewer deaths.

The figures show that to some extent we’re winning the fight against cancers such as ovarian, breast, bowel and prostate cancers, which are all predicted to have huge reductions in the death rate if trends continue.

But there are still some cancers for which the death rates are expected to increase, such as oral and liver cancers. This just goes to show that there is so much more to be done if we are to reach the day when no lives are lost from cancer.

Our reporter Nell Barrie met up with Cancer Research UK’s executive director of fundraising and marketing Richard Taylor to find out about the huge progress we’re making in beating cancer and why we need  the whole nation to help us Stand Up to Cancer on Friday 19 October.

NELL: Richard, we’ve seen that cancer death rates are set to drop in the future. Can you tell me a bit about how research has contributed to this really great news?

RICHARD: Absolutely. The results we’ve seen in previous years have been completely and utterly down to the progress we’ve made in research. Research is by far our greatest weapon in tackling cancer. At its heart, if it were not for research we wouldn’t be advancing our knowledge in how to prevent people from getting cancer. We wouldn’t be able to develop new diagnostics and ways to diagnose cancer at its very earliest stages. And of course without research we just wouldn’t be able to develop new treatments for cancer patients. And if I just think about in the last year or two here at Cancer Research UK we’ve been behind the development of a couple of treatments which are going to radically transform the lives of many cancer patients. One is a drug called abiraterone which can be used for men in the advanced stages of prostate cancer. Whereby abiraterone has not just extended the life but has improved the quality of life for these people who would otherwise have given up hope for any help with their cancer. And another more recent advance is a drug called vemurafenib, which is a treatment for patients with advanced stages of melanoma cancer. And again this is a drug which seems to be revolutionalising treatment for these patients who might otherwise have given up hope. So two very tangible examples of where by research has lead to new treatments giving patients hope that they otherwise would never have had. So we’re very excited about that and we can only imagine that more developments like that, better ways to diagnose cancer earlier through things like biomarkers or things like screening programmes will contribute to these falling death rates. And we expect to see in the next 18-20 years death rates that should drop by nearly 20 per cent by the year 2030. And it’s absolutely research that is behind that progress, so very very exciting.

NELL: So can you tell me a little bit more about Stand Up To Cancer. What’s the campaign and how did it start?

RICHARD: Stand Up To Cancer is a campaign that started in the US. There are some incredibly interesting if not powerful women who work in Hollywood. They formed a charity called EIF, the Entertainment Industry Foundation. And between them they created a programme which became a telethon. They’ve done three of them now. The first year it just went across the three major networks. This last year it went across 23 networks. This single programme, an hour long of music, entertainment, case studies, promoting the work of cancer scientists and asking the public to send in donations. And it went out across all states in America at the same time across 23 channels and it was incredibly powerful and raised an incredible $350 million just over the three shows they’ve done. We spoke to these guys and said to them why not think about bringing Stand Up to Caner over to the UK. So we’ve been doing that with them, working with them for the last year or so. And we’re bringing Stand Up To Cancer to Channel 4 in October and it’s going to be slightly different in that it’ll only go out on Channel 4, not across all networks. And it won’t just be an hour in length, it’ll be at least four and a half hours in a single night of TV. But preceding that there’ll be a whole week of promotion around Stand Up To Cancer, be it case studies of cancer patients who’ve done incredible things like joined a cancer choir or a special edition of Embarrassing Bodies. Then on the night there’s going to be lots of entertainment, music, live chat, and we hope it will raise millions of pounds for our lifesaving work.

NELL: So how exactly will this fundraising help to accelerate research. Where’s the money going to go?

RICHARD: Well one thing we’re very clear on is that it’s going to go into an area called translational research. So that’s when we’ve done research in the lab and we want to make sure those learnings from the lab are translated into treatments for patients. So every penny from Stand Up To Cancer is going into the development of new treatments for patients. And that will probably be by funding clinical trials right across the UK and in a whole series of hospitals and universities. So Stand Up To Cancer is all about finding the new treatments of tomorrow.

NELL: What’s the best way for people to get involved with the campaign and make a difference and help Stand Up To Cancer?

RICHARD: Well there are many ways to get involved with Stand Up To Cancer, the first is to make sure you’ve got it in your diaries so watch the programme on 19th October on Channel 4 and indeed all the programming beforehand. And in readiness for that perhaps you could go out and buy some merchandise, Stand Up To Cancer merchandise, which will be on sale mainly in Tesco but also wrist bands from TKMaxx. But also you can donate money to Cancer Research UK via Stand Up To Cancer.  On the night you could do something daft and get yourselves sponsored. You can talk to your families and friends to promote this amazing event that’s coming soon. There are hundreds of ways of getting involved with Stand Up To Cancer, please be a part of it because we believe it will make a difference to thousands of people everywhere across the UK, who are worried about cancer.

That was our reporter Nell Barrie speaking to Richard Taylor, Cancer Research UK’s executive director of fundraising and marketing.

That’s about all we have time for now, but a quick good luck message to all those taking part in Stoptober –a challenge to stop smoking for 28 days through October. You can find out more online at stoptober.org.uk

We’ll be back again in November, which is lung cancer awareness month. In the meantime, you can keep in touch with us on facebook and twitter, and why not check out our science update blog at scienceblog.cancerresearchuk.org, where you’ll find all the latest news and views.