June 2012 podcast transcript
This month – a new trial looks at a cancer-fighting curry chemical, cancer deaths in middle age fall thanks to better screening and treatment, prostate cancer drug abiraterone is approved by NICE, a study reveals poor cancer survival in men with mental illness, and we bring you highlights from the world’s biggest cancer conference.
Welcome to the Cancer Research UK podcast, I’m Aaron Eccles
A new clinical trial is investigating whether a chemical found in curry can improve drug response in patients with advanced bowel cancer.
Scientists at our Experimental Cancer Medicine Centre in Leicester will investigate whether tablets containing curcumin – found in the spice turmeric – can be safely added to the standard treatment for bowel cancer that has spread.
Dr Joanna Reynolds, Cancer Research UK’s director of centres, tells us a bit more about the trial.
“So we know from tests that have been carried out in the laboratory that curcumin may have an effect in helping to make chemotherapy more effective, and what we wanted to do with this trial is test in patients with advanced bowel cancer whether it would indeed be more effective.”
The number of people in their 50s dying prematurely from cancer in the UK has fallen to its lowest recorded level, according to new statistics from Cancer Research UK.
There has been a 40 per cent drop in cancer deaths among 50-59 year-olds from more than 21,300 in 1971 to fewer than 14,000 in 2010. It’s the first time the number of deaths has fallen below 14,000 in 40 years.
For men, the cancers which have seen the biggest fall in deaths rates are stomach, testicular and lung cancers, as well as Hodgkin’s lymphoma. And for women, death rates have fallen the most for cervical, stomach and bowel cancers, and Hodgkin’s lymphoma too.
Josephine Querido, science information manager at Cancer Research UK, tells us what factors have driven the fall in death rates.
"The reduction in smoking rates has been a big help, and we’ve also got better at diagnosing cancer over the years and better at treating the disease, not just through improvements in radiotherapy but improvements in surgery and chemotherapy as well. And I’m really pleased to say that Cancer Research UK has been at the heart of progress in all these areas.”
NICE, the National Institute for Health and Clinical Excellence, has reversed its initial decision on the new prostate cancer drug abiraterone, which will now be available on the NHS in England. Wales has already approved the drug, but it’s not currently available in Scotland.
NICE had previously rejected the drug for use on the NHS in England because it felt it did not offer value for money at the price set by the manufacturer, Janssen.
This meant that the drug was only available to patients through the Cancer Drugs Fund.
But after a new price offer, and further consideration of evidence and value, the treatment will now be made routinely available for patients on the English NHS.
Emma Greenwood, policy manager at Cancer Research UK, tells us why we welcome this news.
“Cancer Research UK is absolutely delighted that abiraterone will be available on the NHS. We know that patients really value this drug – it’s been available through the cancer drugs fund in England and a number of men have made use of it through that, and we know that it’s really valuable to them.
What it does is provide an extra couple of months at the end of life which we know is really beneficial to these particular patients because they get to spend more time with their friends and family.”
Men suffering from psychiatric problems when they’re diagnosed with cancer are more likely to die from the disease, according to new research published in the British Journal of Cancer.
Researchers looked at nearly 16,500 men with cancer, of whom nearly 1,000 had been admitted to hospital with psychiatric before their cancer diagnosis. They found that those with mental health problems were more than twice as likely to die within a year of being diagnosed with cancer than those without mental illness.
The study also found that men with psychiatric illness are likely to be older when they are diagnosed with cancer – possibly indicating a delay in diagnosis.
Martin Ledwick, head information nurse at Cancer Research UK, tells us how this study can help to improve cancer survival among men with mental illness.
“One thing it doesn’t tell us is why this group of men seem to be more likely to die within a year of their diagnosis. But I think what it does tell us is that perhaps we need to be taking special care of men with mental illness in relation to cancer to make sure that we spot their symptoms early and treat them appropriately once they’ve been diagnosed with cancer.”
Each year the American Society for Clinical Oncology – or ASCO for short – holds the world’s largest cancer conference. Scientists flock from far and wide to hear about the huge progress that is being made in beating cancer all over the world.
Our science information officer Henry Scowcroft met with some of the Cancer Research UK employees who had the privilege of attending this year’s conference, which took place in Chicago.
Henry: So I’m sitting here with James Peach, director of our Stratified Medicine Programme, Nell Barrie from our Science Communications team and Debbie Rodbard, our Clinical Trials Database Manager, all of whom were at the recent ASCO cancer conference in the US. I’m interested to know what everyone’s highlights were. Debbie, how about you first?
Debbie: I was quite interested in the story that was quite big news, which was the results of the EMILIA study. That was a breast cancer trial looking at an antibody-drug conjugate. It’s interesting because it’s very new technology, it shows some benefit, and I think it’s something that – although it’s not going to change practice at this point, it’s certainly something to look out for in the not-too-distant future.
Henry: How far away from patients are we? What phase trial was it?
Debbie: Well that was a phase 3, so probably not that far in the US, obviously then it’ll have to getg through the European regulations.
Henry: Nell, how about you? What were your ASCO highlights?
Nell: I totally agree. I think the EMILIA trial was a really interesting one because it was looking at how you can target chemotherapy directly to cancer cells, so that’s something that people have been trying to do for a long time. It looked like this technique was working really well and also resulted in fewer side effects, as far as they could tell at this point, which some of the scientists were saying was really exciting because it was a better treatment than what we’ve currently got for women with HER-2 [positive] breast cancer that’s spread, and it’s also kinder to them too. So that was a really nice results I thought, but as Debbie was saying, we’ve got to wait and see.
Debbie: I think the other thing to point out is that at this point they’ve got progression-free survival data...
Henry: Can you just explain what that means?
Debbie: So they’ve got data that can see that there’s a longer period before the breast cancer gets worse, but they haven’t yet got data for overall survival. There are trends pointing towards that, but that would presumably need more trials or longer-term follow-up.
Henry: Proving that this saves lives rather than just time to the disease getting worse?
Nell: Yes. They seemed quite confident that they would show benefits, but obviously we haven’t got them yet so we’ll have to wait and see.
Henry: And James, how about you? You were over there with the Stratified Medicine team.
James: It was a great conference for me. In particular I judge the conference on how many people are in one of the sessions, and you couldn’t move in the melanoma sessions, which shows that this is a really exciting area of cancer research and cancer care at the moment – particularly with the discovery that BRAF is a mutation that’s present in about 40% of skin cancers, and we can target it with a drug which dramatically changes response rate in the short term.
And there’s a lot more research going on at the moment to find out whether other drugs can do this with less toxicity, or indeed we can work out how to overcome the resistance that seems to come forward around these drugs. So melanoma, for me, was very exciting.
As well there was a lot of stuff going on in lung, and even though I’m more of a personalised medicine person, it’s nice to see immunotherapy really starting to work. There’s a drug from Bristol Myers Squibb which is starting to have some early tests, but there’s really a chance that this area of cancer research, which has been promising a lot for a very long time, might start to make a big benefit for patients.
Henry: And you actually presented at the conference as well. How was that? Did you have a big audience?
James: Yes, we had a poster talking about the Stratified Medicine Programme, and we had a surprisingly high audience this year as opposed to last year. This year we had our clinical lead Emily Shaw presenting and there were maybe about 30 or 40 people came up and talked to her. Sadly when I was doing it last year only four people came along. So that shows either that Emily’s very good at presenting, or that we’ve actually got something more to share.
This time we were sharing the results of the programme so far – how many patients had volunteered to take part in it, and also the interesting scientific outcomes of what sort of mutation rates we’re seeing. So are we seeing mutation rates similar to other programmes, or for example do you have mutation rates different in the English population against, say, the Japanese population, which we think we do.
Henry: That’s really interesting. So any other things that struck you about the conference? Was it mainly focused on drugs and chemotherapy or were there other aspects of care?
Debbie: A lot of the focus was on drugs because there are so many agents at the moment that are being developed, and lots and lots of results or earlier phase trials. So a huge variety, but also that prompts lots of discussion about the importance of finding predictive biomarkers, looking at finding subsets of patients who are likely to benefit. So there’s always quite a lot of discussion about those sorts of aspects as well.
Nell: There was quite a lot about helping people who are developing new drugs to come up with ways to find biomarkers so you could see how important everyone was feeling that process is now, I think.
Henry: What was the overall sense? Was it an optimistic conference? How did it all fit together? Did everyone leave thinking ‘we’re making really big strides’? Where did it all fit together?
Nell: It felt pretty optimistic to me, especially James was talking about melanoma and there was a real buzz around that I thought. There were lots of clinicians there who seemed really excited that they were coming to conferences and actually hearing about treatments that were benefiting patients because that hasn’t happened for decades really. So that was really nice to see.
James: There were some slightly sobering news from a session I went to around the international nature of cancer and how the US clinicians are helping out internationally. The thing that struck me most was to discover from Peter Boyle that there are 30 countries in the world today that do not even have one radiotherapy machine. We at CRUK are campaigning to get radiotherapy up to an acceptable level in this country and we have a lot of radiotherapy machines. So it really puts the whole thing into perspective to pick up that sort of thing.
There were also some very good sessions around the cost of cancer – both in the US, where costs have really been increasing unsustainably, and around the world. There was a Canadian presenter who showed that in the last 30 or 40 years while survival rates have doubled, the average costs of cancer drugs has gone up by 340 times.
This is the sort of thing which is not what the conference is deeply about – the conference is about finding new cures – but I think it’s important to see the perspective around it and think what can we do to make sure that in future patients will be able to not only access but also afford the care that we’re giving them.
Nell: There were a couple of little points around that when you were hearing about all these exciting new drugs and you’re thinking “hey, this is great!” and there was just a question at the end going “we don’t know how much this is going to cost yet”. So it’s always in the back of people’s minds I think.
Debbie: I went to a session about treating metastatic breast cancer – again, a huge range of agents likely to be coming along in the near future if not already, and I think all three (definitely two) of the presenters – they were European rather than American on this occasion – did finish their presentations asking the question about how we’re going to pay for these drugs? Who’s going to pay for these drugs?
Henry: ...which is very much a question on everyone’s lips at the moment, for a variety of reasons. Nell, Debbie, James, thank you very much.
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