News Headline: Discovering the Best Way to Tackle Cancer
Outlet Full Name: The Herald
Author: Stephen Ackland
WE have tended to identify cancers as being of the breast, of the lung, of the bowel and so on, categorising them according to the tissue’s origin. However, a modern and developing paradigm is that cancer is better characterised by abnormalities in the cell rather than where the cell came from.
There are similarities between bowel, breast and lung cancer, particularly in response to therapy, so the next important scientific step is to understand the molecular aberrations in, dare I say, all cancers.
The Cancer Genome Atlas is a global initiative funded by governments to define the genetic abnormalities in each of the major cancers by defining the genome of 5000 to 8000 people with cancer.
In NSW we have two contributions – pancreatic cancer and melanoma – from which a spectrum of genetic abnormalities will be compiled.
It introduces the concept of targeted therapies. For every protein or enzyme in the body, drugs are being developed to inhibit them. So if molecular pathology identifies a gene or protein that is abnormal or elevated in a particular cancer, clinicians may be able to match the profile with an off-the-shelf inhibitor to administer to the patient.
For example, in 20per cent of breast cancers, the gene HER2 is over-expressed with more HER2 protein present than normal, and Herceptin is an antibody that inhibits its function. Clinical trials showed the drug slowed tumour growth, often made it shrink or in some cancers, disappear.
In early breast cancer, where microscopic traces of cancer remain after surgery, and where HER2 is over-expressed, we’ve shown that Herceptin can reduce the recurrence rate by 50per cent. That’s a bigger gain than we’ve ever seen with chemotherapy or radiation in early breast cancer.
We’ve now identified that HER2 is over-expressed in a small proportion of stomach and other cancers, and Herceptin is now being studied in clinical trials in those cases.
Translating these breakthroughs requires clear communication along the path between basic scientists, clinical scientists and those involved in healthcare delivery. Also, the transfer of research ideas and results from T1 (laboratory) to T2 (clinical trials) to T3 (practice based) must go two ways – either forward to provide a patient service or backwards to the lab to better understand the basic biology.
Current grant funding is skewed towards the delivery (T3) end. Blue-sky biological research may be a long way from a health outcome, yet it can ultimately lead to a cure. Without new developments from the lab, our capacity to improve cancer outcomes will be limited. Clinicians need to understand where basic scientists are coming from and what findings are in the pipeline to help them deliver their service. Basic scientists need to understand why T3 research is important – some of them regard T3 as being quality assurance, which shouldn’t qualify for research funding.
From tomorrow, we are staging a three-day international Translational Cancer Research Conference in Newcastle, which I’m hoping will achieve a greater awareness of what translational research means, and a greater understanding of the terminology that people from different disciplines use.
The issue of implementing and disseminating cancer research results is a challenge – health administrators need to create systems capable of rapidly incorporating new evidence-based management strategies into their systems. Currently, we don’t have a health system that’s geared to deal with new molecular diagnostic information and its patient management implications.
For example, regarding molecular profiling in lung cancer, there are at least two genes we recognise as important and which have specific inhibitor drugs that are superior to chemo. But most lung cancer patients are still having a fine needle biopsy; enough to establish whether the tissue is cancerous but insufficient for researchers to analyse relevant molecules.
The health service has to be prepared to do bigger biopsies. We need support in the operating theatre and pathology on standby to deal with the tissue appropriately and link with the molecular genetics department. It means systems and cultures will have to change right around the country.
Finally, there needs to be a way to evaluate an outcome – a clinical cancer registry that tells us what treatments patients have had, how well it worked, how long they live, and whether they’re cured or five-year survivors. Hunter New England Health is working towards this.
The goal is to be able to choose therapies that affect the disease more and the patient less. Precision medicine, with the best treatment for individual patients, based on precise analysis of each cancer.
Professor Stephen Ackland is director of HMRI’s Cancer Research Program. Cancer research in the Hunter is conducted under the Hunter Cancer Research Alliance.