October 2011 podcast transcript

This month: a new prostate cancer drug is licensed in the UK, red tape hinders cancer trials, HPV testing could save thousands of unnecessary cancer tests, beta-blockers could prevent cancer spread, new research on vitamin D, and we say goodbye to an amazing kid.

Welcome to the Cancer Research UK podcast. I’m Dr Kat Arney.

A new drug for advanced prostate cancer, developed with support from Cancer Research UK, has been licensed in the UK by the European Medicines Authority, although it is yet to be approved by NICE for use on the NHS.

Abiraterone, also known by the brand name Zytiga, has been shown in clinical trials to extend life by more than four months.

It works by halting the production of testosterone, not just in the testes but throughout the body. This prevents the hormone from fuelling the growth and spread of prostate cancer cells.

Cancer Research UK’s Dr Sally Burtles explains what role the charity played in discovering the new drug.

“The compound was discovered by Mike Jarman - some of his work was funded by Cancer Research UK at The Institute of Cancer Research – and he came to the Drug Development Office to say “I’ve got this exciting compound, it looks really promising in the lab and I’d like to take it into patients to see if it works where it really matter, in cancer patients.”

So the Drug Development Office undertook all the preclinical testing – everything you have to do before you can give a drug to a human being for the very first time – and then we ran three phase 1 clinical trials that demonstrated that it did what it was supposed to do in patients, and was safe, and we worked out what was the best dose to give.

After those initial studies nothing happened for a while, and then it was licensed to a pharmaceutical company called Cougar Biotechnology, who undertook further trials and demonstrated that it’s initial promise was really there, and that the drug was effective and better than some other treatments on the market. That’s what led to the approvals.

It will be appraised by NICE (the National Institute for Clinical Excellence) and they will decide whether it is value for money – as well as being effective whether the cost is worth the benefits . Hopefully they will approve it, and then it will be available to NHS patients all around the country.”

Cancer Research UK is among sixteen medical research organisations who have issued a statement about the problems caused by excessive red tape around clinical trials in Europe. It calls on the European Commission to streamline the approval process for clinical trials and to reduce variation in how European regulation of research is interpreted in different countries.

Emma Greenwood, Cancer Research UK’s policy manager, tells us what impact all this unnecessary bureaucracy is having on medical research across Europe.

“The Clinical Trials Directive was introduced in 2004 with the aim to harmonise and streamline all of the processes needed to set up and run a clinical trial across Europe, and we wanted to do more of those sorts of trials and get more people across Europe involved in research.

Unfortunately what actually happened was the Clinical Trials Directive came in and it didn’t harmonise - in fact each country interpreted it differently and chose to take on their own sets of rules and processes. So for an organisation like Cancer Research UK, we had to spend more time and essentially more money getting past all these layers of regulation, which weren’t actually doing anything to improve patient safety.

We’re really glad to see that the European Commission has listened to the concerns that the whole medical research community across Europe have raised about the trials directive, and they’ve committed to revise the current piece of legislation.

This is really good news, and organisations like ourselves can set up more trials across Europe involving more patients more quickly, meaning that patients have access to treatments they often wouldn’t get as part of their standard care, and innovative new medicines as part of clinical trials."

Testing for the human papillomavirus (HPV) as part of cervical screening could reduce the number of women needing unnecessary further tests by more than a third, according to a study published in the British Journal of Cancer.

The study analysed the effectiveness of adding HPV testing to the NHS Cervical Screening Programme for women whose smear test revealed mild or borderline abnormalities.

Most cases of cervical cancer are caused by HPV, so women who found to be free of the virus returned to routine screening. But those testing positive could be put forward for further tests to check for the presence of cancerous cells.

Jessica Harris, health information manager at Cancer Research UK, tells us more about the findings.

“This study gives us an indication of what’s going to happen when HPV testing – which is already being included in the cervical screening programme in some areas of the country - is rolled out to cover the whole country.

HPV testing is a welcome addition to the already very effective cervical screening programme. By adding HPV screening, we’ve already saved thousands of women the anxiety and the trouble of having further investigations and waiting for the results of those when they didn’t actually need them in the first place. And it also helps the screening programme itself to become more efficient and streamlined in future.”

Cancer Research UK is funding new research to investigate whether beta-blockers hold the key to preventing breast cancer spread and improving survival. Promising early results were presented at a conference hosted by the Royal Society of Medicine last month.

The study builds on earlier research showing that, out of 466 breast cancer patients – those taking beta blockers before their operation for breast cancer were less likely to die several years after their treatment.

Our reporter Laura Dibb asked chief investigator Dr Des Powe, from Nottingham University Hospitals NHS Trust, to explain more about his research.

Laura: This latest piece of research is looking at a drug that’s already on the market for heart disease – beta-blockers. Can you explain to people what a beta-blocker is?

“Beta-blockers are commonly given to patients who have heart disease. Beta-blockers bind to specific receptors – sites on cells, heart muscle and other types of muscle, and also some types of nerves – and it stops them from triggering, from firing and starting certain signalling events which lead to changes within that cell.

We’ve shown that some types of cancer cells also have these same receptors, and when you stimulate these protein receptors, it causes the cells to start moving. And this migration of cells is needed for cancer migration and metastasis formation.

Therefore if we can stop those receptors from firing in the first place, then we should be able to stop these cancer cells from migrating. So that’s the idea behind beta-blockers – they stop cells from migrating.”

Laura: What will this new piece of research be looking at?

“This new research is going to try and extend or previous study –t he initial pilot study was relatively small so we’ll be able to more confidently believe our results if we loo0k at a significantly larger number of patients. We’re going to look at more than 30,000 patients who have been diagnosed with breast cancer, and we’re going to investigate the association of beta-blockers in protecting against secondary cancer formation.”

Laura: You’re only looking at breast cancer, but could this also apply to other types of cancer?

“There’s good evidence from laboratory studies to believe that certain other types of cancer such as prostate cancer, certain types of lung cancer, and also pancreatic cancer might also express the same receptor that we found in breast cancer, so these types of cancer could potentially be treated with beta-blockers and patients benefit from this treatment.”

Fair-skinned people who burn quickly in the sun may need to take steps to ensure they get the right amount of vitamin D, according to new research.

Cancer Research UK-funded researchers at the University of Leeds measured the vitamin D levels of around 1,200 people and found that around 730 were below the optimum, with fair-skinned people tending to have significantly lower levels of the vitamin.

There’s some evidence that particularly low levels of vitamin D may be linked to a greater risk of heart disease and poorer survival from breast cancer.

Hazel Nunn, head of health information at Cancer Research UK, explains what this new research means for vitamin D intake.

“There’s already a number of people who are advised to take vitamin D supplements – they include pregnant and breastfeeding women, and in some cases people with very dark skin, and people who don’t get to expose themselves to the sun very much, so those who are hospital-bound or maybe in care homes and the like. This study suggests that there might be a new group of people for whom taking vitamin D supplements might be a good idea, and that’s pale-skinned people.

The reason why it’s difficult to interpret the data from this study is that it’s not entirely sure what optimal levels of vitamin D actually are. So for people with pale skin it’s not a clear recommendation at this stage. It may be that for some people with pale skin, taking vitamin D supplements is a good idea.

This study has also highlighted that it’s not just your skin type and exposure to the sun that affects your levels of vitamin D. Some people may be very good at making vitamin D from quite small amounts of sunlight, and other people may struggle.

So it’s not a one-size-fits-all answer, and if anyone’s worried about their vitamin D status – whether they’ve got pale skin or otherwise – they should go and talk to their GP about that.”

We were extremely saddened to hear about the death of Harry Moseley – an extraordinary and brave boy who tragically lost his fight against brain cancer at the age of just 11 earlier this month. All of us at Cancer Research UK have been touched by his story, and send our best wishes to his family.

Harry was an inspiration to children and adults alike in his quest to raise awareness of brain tumours through his campaign “Help Harry Help Others”. He single handedly raised over £100,000 for brain tumour research by fundraising and selling hand-made bracelets.

He also helped us raise hundreds of thousands of pounds by supporting our work and speaking about his illness at fundraising events. This money will help us fund vital research, including our groundbreaking work on brain tumours.

Our reporter, Ailsa Stevens, spoke to Dr Chris Jones at The Institute of Cancer Research about his research into the faulty molecules found in a type of childhood brain tumour called glioblastoma.

“Glioblastoma in adults is the most common form of brain cancer and affects around 1 in 20,000 people. Although this is significantly less common than breast or colon cancer, glioblastoma results in more years of life lost than any other tumours.

My lab is particularly interested in glioblastomas that arise in children, which are thankfully considerably rarer, occurring in approximately 1 in 250,000 patients under the age of 18. Regardless of the age of diagnosis, glioblastoma is a particularly aggressive form of cancer, with an average survival time for patients of little over a year.

It’s difficult to treat for several reasons. Firstly, surgery is difficult – it spread quickly throughout the brain, making safe removal tricky. Secondly, the tumour cells themselves appear to be very resistant to the current chemotherapies we’re using, rendering them largely ineffective.

Finally, until recently there’s been a lack of understanding of the underlying biology of the disease – particularly in children – that has hampered new treatments being developed.”

Ailsa: What progress have we made so far in understanding this type of brain cancer?

“In the past few years there have been several international collaborative groups put together with the purpose of unravelling what is driving these tumours at a molecular level. These studies have provided an unprecedented blueprint of the glioblastoma genome, allowing researchers worldwide for the first time the ability to drill down into specific alterations in key genes within the tumour cells.

This information is allowing us to understand that glioblastoma is not a single disease, but can be thought of biologically as several distinct entities, all driven by faults in different sets of genes.

Our own work has revealed, for example, that glioblastomas arising in adults and in children which look identical down the microscope are in fact rather different diseases genetically, with the likelihood that different treatment strategies will be needed to cure these patients."

Ailsa: And how might these findings help lead to new treatments for glioblastoma?

“All cells of the body relay a complex set of signals which allow them to develop and grow normally. The machinery which carries out this work is controlled by genes. In cancer, these processes are subverted in some way, resulting in the uncontrolled growth of the cells.

By cataloguing all the different genetic changes occurring in glioblastoma, we are beginning to understand how the wiring of the cells is altered, and which may be the critical weak points in a given cancer cell. We can then work to develop new targeted drugs to inhibit these cancer-specific changes.”

Ailsa: And how do you see treatment for brain tumours changing in the future?

“One really important insight that has come from the increasing detailed study of brain tumour genomes is the realisation that every individual’s tumour has a unique set of genetic alterations. The challenge for the future will be to rapidly generate a kind of tumour fingerprint for an individual patient, and to match this to a safe combination of targeted drugs.

In this way we hope to move in the glioblastoma clinic from a failed ‘one size fits all’ type of approach to a truly personalised treatment strategy, which is hitting a patient’s tumour where it hurts, underpinned by our knowledge of the molecular biology of the disease.”

To continue to support the fantastic work that Harry Moseley began please visit www.helpharryhelpothers.com

We’ll be back next month with all the latest news and features. In the meantime, you can keep up to date by checking our Science Update blog – that’s scienceblog.cancerresearchuk.org