2013 European Cancer Congress (ECC 2013)

Dr Hans Clevers talks to ecancer at ECC 2013 about comparing colon cancer cells to healthy stem cells and combining the study to discover the process where cells become cancer cells. Dr Clevers discusses how using an inducible Cre knock-in allele and the Rosa26-LacZ reporter strain, lineage tracing experiments were performed in adult mice. The Lgr5 ve crypt base columnar cells (CBC) generated all epithelial lineages throughout life, implying that it represents the stem cell of the small intestine and colon. Similar observations were made in hair follicles and stomach epithelium. In the future this discovery could lead to drug development that would target this transformation.

Patient advocate, Jana Pelouchova, talks to ecancer at the 2013 European Cancer Congress in Amsterdam about the issues facing patients in regards to communication tools and delivering vast amounts of information clearly and efficiently. Ms Pelouchova stresses the urgency for a specific and reliable source of information for each patient's specific disease.

Prof Ian Kunkler talks to ecancer at the 2013 European Cancer Conference (ECC 2013) in Amsterdam about technical and biological developments in breast radiotherapy; specifically the impact of radiotherapy on locoregional control. The Oxford overview established that postoperative radiotherapy (RT) improves loco-regional control and survival in early breast cancer both after mastectomy and breast conserving surgery (BCS). After BCS adjuvant RT roughly halves the risk of first recurrence. For patients at low risk of local recurrence, it is still uncertain whether there is a subset from whom RT may be safely omitted. Selection based on molecular subtype might provide a more reliable way of identifying benefit from RT. There is limited literature on such correlations. To date molecular classification cannot reliably differentiate those at higher or lower risk of local recurrence after RT. After mastectomy in the DBCG 82b and 82c trials (Kyndi et al, 2008) adjuvant RT significantly reduces LRR in luminal hormone receptor (HR) positive/HER2 negative tumours (3% RT , 32% RT-), HR positive, HER2 positive (3% RT , 48% RT-) and triple negative cancer (15% RT , 32% RT-). No reduction in LRR was seen from PMRT in HER negative, HER2 positive patients, perhaps reflecting the impact of Trastuzumab on local control. Analysis of TRANS SUPREMO in the BIG 2–04 MRC/EORTC SUPREMO trial should provide prospective data on molecular subtypes and risk of LRR /− RT. The role of axillary RT in patients with a positive sentinel node biopsy (SNB) remains controversial. Interpretation of the ACOSOG Z11 trial which showed no statistically significant difference in regional recurrence or DFS from axillary dissection vs no additional treatment is difficult due to the lack of adequate RT QA and failure to meet its target accrual. There is limited literature on the role of loco-regional radiotherapy in the context of neoadjuvant systemic therapy. Potentially the response to neoadjuvant chemotherapy measured at definitive surgery as residual tumour burden might individualise the need for locoregional therapy to the breast/chest wall and axilla (Smith, 2012). The role of axillary RT in this setting is under study in the recently launched NSABP-RTOG 9353 trial. The Alliance Cooperative Group trial is comparing axillary clearance and axillary RT in patients with residual nodal disease on SNB after neoadjuvant chemotherapy in T1–3, NI patients.

Prof Philippe Autier talks ecancer at the European Cancer Conference (ECC 2013) about the results extracted from data on colorectal cancer collected as part of the Survey of Health, Ageing, and Retirement in Europe (SHARE) project on exposure to screening in men and women aged 50 and over in 11 European countries between 1989 and 2010. Screening for colorectal cancer in European countries is highly effective in reducing mortality from the disease. Some of the resources currently being devoted to breast and prostate screening programmes, where the evidence of effectiveness is much less clear-cut, should be reallocated to the early detection of colorectal cancer.

Dr Kirstin De Bruijn talks to ecancer at the 2013 European Cancer Congress (ECC2013) about the link between diabetes and an increased risk of developing cancer. Researchers performed a unique meta-analysis that excludes all other causes of death and found that diabetic patients not only have an increased risk of developing breast and colon cancer but an even higher risk of dying from them. Dr De Bruijn, a PhD student in the Surgery Department at the Erasmus University Medical Center in Rotterdam (The Netherlands), and colleagues analysed results from 20 trials that had taken place between 2007 and 2012, involving more than 1.9 million patients with breast or colon cancer, with or without diabetes. They found that patients with diabetes had a 23% increased risk of developing breast cancer and a 38% increased risk of dying from the disease compared to non-diabetic patients. Diabetic patients had a 26% increased risk of developing colon cancer and a 30% increased risk of dying from it compared to non-diabetic patients.

Dr Felipe Ades talks to ecancer at ECC 2013 on survival after cancer diagnosis in Europe, based on goverment spending on health care. Researchers will tell the meeting that higher wealth and higher health expenditure are strongly associated both with increased cancer incidence and decreased cancer mortality. In the case of breast cancer, increased health expenditure appears to be even more strongly associated with better outcomes.

Dr Zoran Gatalica discuss identifying the molecular profile of a tumour where the primary site is unknown and how it is crucial to the choice of treatment. In up to five percent of all cancers, the site of the primary tumour is unknown and the disease is not diagnosed until it is at an advanced stage, when the cancer has metastasised (spread to other parts of the body). Until recently, the choice of treatment has been based on efforts to find biomarkers that could indicate the site of origin, but now a team of researchers has succeeded in identifying the particular molecular profiles of the metastatic tumours in a large group of patients.

Prof Cora Sternberg, scientific co-chair of the 2013 European Cancer Conference, discusses the discovery that identifying the molecular profile of a tumour where the primary site is unknown is crucial to the choice of treatment. The data was presented by Dr Zoran Gatalica as he told the congress that his team’s research has shown that the biology of the tumour is more important than its primary site.

Prof Cora Sternberg, scientific co-chair of ECC 2013, comments on the findings of Prof Jean-Charles Soria and his team on the most up-to-date data from 85 patients with non-small cell lung cancer in a large, phase I clinical trial of an experimental drug called MPDL3280A.

According to research presented by Professor Mathieu Boniol, at the 2013 European Cancer Congress (ECC 2013) men experience more harm than good from routine PSA screening. Prostate cancer screening using the prostate-specific antigen (PSA) test is widely used in France despite a lack of evidence showing that it reduces cancer deaths. Prof Boniol, Research Director at the International Prevention Research Institute (iPRI) and Professor at the Strathclyde Institute for Global Public Health at iPRI, Lyon, France, will tell the congress that the total harm men experience in terms of impotence and incontinence, and the side-effects from prostate cancer treatments, severely affects their quality of life, and should further discourage the use of PSA testing for prostate cancer screening.

Dr Michele Maio talks with ecancer at the 2013 European Cancer Congress in Amsterdam about the survival analysis of a phase III study of ipilimumab and dacarbazine in metastatic melanoma The results of this study, with 5 years of follow up, continue to demonstrate a long-term survival benefit for patients treated with ipilimumab plus DTIC compared to placebo plus DTIC. Consistent with the results of phase II studies, survival rates appear to plateau beginning at 3 years. Dr Keith Flaherty provides additional commentary on the study

Prof Cora Sternberg, scientific co-chair of the 2013 European Cancer Conference, discusses the results of a study that found the prostate-specific antigen test to be harmful. Prof Boniol, Research Director at the International Prevention Research Institute (iPRI) and Professor at the Strathclyde Institute for Global Public Health at iPRI, Lyon, France, told the congress that the total harm men experience in terms of impotence and incontinence, and the side-effects from prostate cancer treatments, severely affects their quality of life, and should further discourage the use of PSA testing for prostate cancer screening.

Prof Jonathan Ledermann the ICON6 trial at the 2013 European Cancer Conference in Amsterdam with ecancer. The trial found that on women with recurrent ovarian cancer after chemotherapy responded well to a biological therapy called cediranib. Cediranib, which is taken in pill form, is an inhibitor of a cell signalling process involved in formation of tumour blood vessels, essential for tumour growth, and it is the first oral inhibitor of its kind to show an improvement in the time before patients’ disease progresses and in overall survival. The drug is a tyrosine kinase inhibitor, a type of biological therapy that blocks vascular endothelial growth factor (VEGF) receptors, which control the development of blood vessels required for growing tumours.

Prof Jack Cuzick talks to ecancer at the 2013 European Cancer Congress in Amsterdam about the role of prostate cancer screening and why two trials, European Randomized Study of Screening for Prostate Cancer (ERSPC) and the PLCO trial, came to different conclusions about its benefits.

Prof Jack Cuzick talks to ecancer at ECC 2013 about a discussion on a paper authored by Dr Autier on the prevention of cancer using vitamin D. The study found that the considerable discrepancy between observational studies and randomised trials strongly indicate that vitamin D status is essentially a consequence rather than a cause of ill health. Inflammatory processes would be the cause of declines in 25(OH)D concentrations. This would explain why decreased 25(OH)D levels are associated with so many conditions, including poor survival (for any condition), cancer aggressiveness and colorectal cancer occurrence.

Dr Karim Fizazi talks to ecancer at the 2013 European Cancer Congress in Amsterdam about the use of immunothereapy in both melanoma and castration resistant prostate cancer. In recent clinical trials, it has been shown that use of ipilimumab in both melanoma and castration resistant prostate cancer increases, if only marginally, overall survival. In a phase III trial, patients with advanced disease performed worse than those who had not yet recived chemotherapy, allowing for the concusion that immunotherapy is a better approach in early disease. Dr Fizazi also discusses a phase I study with androgen blockade agent, ODM201.

Dr Yvonne Wengstrom talks to ecancer at ECC 2013 about the need for finding new ways to support the growing number of cancer survivors. Dr Wengstrom discusses how recent advances have come through the medium of mobile phone and tablet applications because of their simplicity and user friendly designs.

Prof Ian Judson talks to ecancer at the 2013 European Cancer Congress in Amsterdam about centralised care of sarcomas. Establishment of a standard of care began with an agreement on the standard practice and then moved into the clinic. Prof Judson explains the further benefits of organising care, which could result in more research, clinical trials and an increase in overall survival of patients.

Prof Dirk Schadendorf talks to ecancer at ECC 2013 about a meta-analysis of a collection of trials investigating ipilimumab. By pooling all of the 1,800 patients analysed for long term survival, in addition to more than 2,000 patients in early access programmes, researchers were better able to understand the overall durability of the drug in melanoma.

Dr Caroline Drukker talks to ecancer at the 2013 European Cancer Congress in Amsterdam about the RASTER study and the 70-gene-signature testing. The test and study looked at the 70 genes associated with breast cancer and metastasis. The aim of the study was to observe the feasibility of conducting this test in a large; community-based hospital while preventing distant recurrence of breast cancer.

Dr Piotr Rutkowski talks to ecancer at the 2013 European Cancer Congress about the FLIMS workshop, Methods in Clinical Cancer Research, which aims to discsuss the need for more clincal trials and how to properly structure them.

Prof Jean-Charles Soria talks with ecancer at ECC 2013 about the most up-to-date data from 85 patients with non-small cell lung cancer in a large, phase I clinical trial of an experimental drug called MPDL3280A. New results from a trial of an antibody that helps the immune system to recognise and attack cancer cells have shown particularly encouraging responses in patients who are smokers or former smokers.

Dr Keith Flaherty talks with ecancer at the 2013 European Cancer Congress in Amsterdam about a study that compared the progression free survival and overall survival in melanoma clinical trials with trametinib, ipilimumab and vemurafenib. The relationship between PFS and OS was established by looking at the hazard ratio reported in each of the studies and a series of sensativity analysis.

Dr Marlies Reimers talks with ecancer at the 2013 European Cancer Confernece in Amsterdam about how aspirin improves survival in patients diagnosed with colon cancer. Although previous research has shown that taking low dose aspirin after being diagnosed with colon cancer improves patient outcome, the reasons why this happens remain unknown. The new research has shown that aspirin improves outcome in patients whose tumour cells express a specific protein on their surface; the protein is known as Human Leukocyte Antigen class I (HLA class I), a cell-surface protein produced by a collection of genes involved in the functioning of the immune system. The results mean that HLA class I could be used in the future to predict whether or not a patient would benefit from aspirin.

Prof Richard Sullivan talks to ecancer at the 2013 European Cancer Congress in Amsterdam about the launch of the Institute of Cancer Policy. The ICP is a new initiative addressing cancer policy and global public health. The institute will bring together specialists from inside and outside the field of oncology to look at the problems of health economics and the state of cancer research and drug development.