Each year the National Cancer Research Institute (NCRI) conference gathers researchers, clinicians, people affected by cancer, and industry representatives to discuss recent advances in research, present new findings, and debate the best ways forward.
We’re excited to bring you the latest developments from this year’s conference on breast cancer and beyond.
How well do we know our immune system?
Immunotherapy was one of the hot topics at this year’s conference. Its promise is huge.
Treatments which retrain your immune system so it can automatically detect and destroy cancer cells is slowly becoming a reality for some types of cancer. But the question of why immunotherapy works for some, but not for others, continues to puzzle researchers and clinicians. So how can we tell in advance if a treatment will be successful?
Dr Martin Miller, from the University of Cambridge, discussed the importance of the immediate tumour surroundings – also called microenvironment – in coordinating the immune response.
Surprisingly, as observed in a patient with advanced ovarian cancer, each tumour in the body can have a different immune microenvironment, and this can affect treatment success. Now researchers need to understand whether this happens in all patients and all types of cancer, and how it could be tackled to make treatments more effective.
Another factor influencing our immune system is the bacteria living in our gut. With growing understanding of how essential these bacteria are at training our immune system and keeping it in check, researchers tend to talk about them more in the context of immunotherapies.
There is a possibility that cancer patients for whom some immunotherapies don’t work could be additionally treated with gut microbes to increase the effect of treatments. In fact, approaches like that are already in the early stages of trials in some types of cancer, including breast.
How can we exploit cancer vulnerabilities?
One of our researchers, Dr Rachael Natrajan, spoke at a session which was exploring better ways we can exploit cancer vulnerabilities.
Cancer cells – including breast cancer cells – aren’t indestructible. They accumulate many adaptations which allow them to grow fast, survive in harsh conditions, and develop resistance to certain treatments.
Studying these adaptations means researchers can understand where the weak spots of a tumour are. Researchers are taking a holistic approach to this problem – analysing a huge array of genes and proteins and trying to understand which ones are absolutely necessary for cancer to survive.
Dr Natrajan presented her work which aims to make these complex investigations easier. She has developed a 3-D model of tumour using cancer cells grown in the lab. Her model more closely resembles tumours than conventional ways of growing cancer cells do. These 3-D structures can be used in experiments to identify genes essential for breast cancer growth and progression.
We hope that by sharing these results at the conference, Dr Natrajan has inspired more scientists to try out this approach in their projects.
Triple negative breast cancer on the radar
This year, there was a session dedicated to triple negative breast cancer research. Triple negative breast cancer tends to be more aggressive and currently lacks targeted treatments, but hopefully not for much longer.
Researchers and clinicians had a clear message: if we take time to classify all triple negative breast cancers into smaller categories, it could open the doors to developing targeted treatments.
Professor Peter Schmid gave an overview of the new treatments that have been in development and trials in the last 12 months. He highlighted that PARP inhibitors – which our researchers were involved in developing – are likely to be the answer for those triple negative breast cancer patients who have inherited faults in their BRCA genes.
The ongoing PARTNER clinical study was also mentioned at this session. It is evaluating the combination of the PARP inhibitor olaparib with chemotherapy to treat early triple negative breast cancer and we eagerly await the results.
Recent clinical trials also suggested that AKT inhibitors could work well for triple negative breast cancers with high levels of a molecule called the androgen receptor. AKT inhibitors are now moving to phase III clinical trials in breast cancer.
Additionally, sacituzumab, a molecule combining a toxic drug and an antibody, was shown to have some benefit for patients with triple negative tumours in the IMMU-132 trial and will now be tested further.
Professor Schmid also highlighted that combining the immunotherapy drug atezolizumab with chemotherapy could work for treating advanced triple negative breast cancer in patients whose tumours have high levels of a molecule called PD L1. This was demonstrated in the recent IMpassion130 trial.
All these developments give hope that more targeted treatments will soon be available for patients with triple negative breast cancer. We now need to understand which approach would be the most beneficial in each case.
Dr Jean Abraham, one of the co-leaders of the Personalised Breast Programme, echoes this idea. The Personalised Breast Cancer Programme is a clinical study providing an in-depth genetic and gene activity analysis for all types of breast cancer. This information could be used to confirm that a patient is receiving the best treatment available for their type of cancer, suggest a better-suited treatment, or highlight any potential clinical trials that may be of benefit should the patient relapse in the future.
Initiatives like this, combined with a better understanding of when different treatment options work best, will lead to many more patients receiving the most effective treatment for them.
Patient voice loud and clear
Thanks to research and improvements in treatments, more and more people are living with or beyond cancer. However, cancer often leaves its mark, whether it’s the damage the disease has done or the consequences of its treatment.
Unfortunately, research hasn’t yet caught up with the needs of cancer patients to allow them not only to live, but live well.
It has prompted the NCRI to partner with the James Lind Alliance to put in place a list of the top 10 research priorities to help people affected by breast cancer live better. The process took two years and involved two UK-wide surveys, which attracted more than 3,500 responses from patients and carers, as well as health and social care professionals.
Ceinwen Giles from Shine Cancer Support spoke of her personal experience of dealing with the side effects of cancer treatments and unveiled the top priorities going forward at the meeting. These research questions included: how can treatment side effects be prevented or managed? What is the impact on mental health? Can we predict who will experience side effects?
We’re proud to say that some research projects Breast Cancer Now funds are already addressing these questions.
One of our researchers, Professor Deborah Fenlon is studying whether cognitive behavioural therapy delivered by a breast cancer nurse can help reduce the side effects of some breast cancer treatments, in particular hot flushes and night sweats.
Professor Diana Harcourt’s research will help women discuss their goals and priorities for breast reconstruction surgery with their surgeon, in the hope that they feel more satisfied with the result.
Additionally, Professor Gerry Humphris is trying to improve communication between radiographers and breast cancer patients. This will ensure that patients’ anxieties are being appropriately addressed to reduce the fear that their cancer may return.
We hope all these projects will take us a step closer to ensuring that everyone will live well with and beyond breast cancer.
Why is it so hard to change for the better?
Wouldn’t it be great if we could prevent a number of breast cancer cases diagnosed each year in the UK by simply leading healthier lifestyles? Professor Dame Theresa Marteau reminded everyone how difficult it is to change our behaviour, and why.
What’s stopping us? Mostly our environment and the way our brain works.
People tend to perceive immediate risk and the risk of something in the future differently, which is why information linking unhealthy habits to a long-term risk of developing breast cancer is not enough for people to switch to healthy lifestyles. Even if the motivation is there, our environment may be limiting healthy choices and constantly tempting us to break our vows to lead a healthy lifestyle - for example, the food we buy may come in larger portions than we need.
Professor Marteau believes that only through changing our environment can we drive positive and healthy changes in our habits. We have already seen success in reducing the number of tobacco users in the UK, but how do we extend this to other lifestyle choices?
Professor Marteau argues we first need to change our minds: we need to accept tougher measures to make the healthy the only choice possible. Maybe it wouldn’t feel too restrictive if instead of snack bars we could only buy fruit.
These are our highlights from this year’s NCRI conference. We hope to report more exciting breakthroughs and emerging trends from the NCRI conference next year, and we’re confident scientists will continue making great advances in the field of cancer sciences so we can find more effective ways to treat it.