Stepping Up Cancer Treatment Targeting

Hardly a day goes by now without some further refinement of cancer therapy-not necessarily the sort of development that wins popular applause as a breakthrough, but certainly a steady chipping away at the multiple challenges that cancer presents, by deploying the widening range of tools and techniques that science and technology increasingly offer.

Take, for instance, the possibility of reducing the use of chemotherapy among breast cancer patients, reported in the New England Journal of Medicine in late August. The MINDACT clinical trial has demonstrated that nearly half of early stage breast cancer patients can avoid unnecessary exposure to the rigors of adjuvant chemotherapy without any greater risk of recurrence if a more sophisticated test is used alongside standard clinical-pathological methods.

A 70-gene test, known as Mammaprint, makes possible more refined evaluations of likely outcomes, the study claims. The results of the Phase III trial in 112 hospitals across nine European countries should help oncologists decide which patients will be able to safely avoid chemotherapy, it says. MINDACT, which stands for “Microarray In Node negative and 1 to 3 positive lymph node Disease may Avoid ChemoTherapy,” has shown that use of this test can spare many patients "a treatment that may cause toxicities, and will offer no to very little benefit."

The ability to focus treatment more accurately is in line with developments in other forms of therapy and approaches to prevention. Cancer Research UK has just launched a novel clinical trial for pancreatic cancer in which selected patients will receive AstraZeneca's Lynparza to reduce tumor size, as well as radiation and chemotherapy. A major Lancet survey recently remarked on how radiotherapy beams can be shaped and modulated to conform to the exact shape of tumours, maximizing radiation dose deposition in the cancer while sparing normal tissues from high doses. New UK figures-based on high-quality data-reveal with unprecedented clarity links between chemotherapy and deaths among breast and lung cancer patients.

These, and a thousand other advances, offer new hope, but present new challenges, not only for scientists and technologists, but for those who must translate potential into patient benefit-regulators, industry and the organizations that pay for healthcare. Established patterns are not necessarily able to cope with the new choices and complexities and decision-making that progress presents, and the search intensifies for new ways of working together across a broader front to meet the new demands.

The MINDACT trial itself is an interesting example of international and multi-disciplinary cooperation. It was sponsored by academic organizations, part-funded by the European Union, and backed by disease-specific charities and campaigning organizations, as well as commercial partners.

As the Breast International Group, one of the principal groups involved, said on releasing the results, "Global collaboration is crucial to make significant advances in breast cancer research, reduce unnecessary duplication of effort, share data, contribute to the faster development of better treatments, and increase the likelihood of cures for patients." According to the principal investigators, MINDACT was the first trial to evaluate a genomic-based biomarker in the clinical setting, and has made a substantial contribution to showing the role that genomics can play in helping treat breast cancer. Dr. Emiel Rutgers of the Netherlands Cancer Institute in Amsterdam said it is "a great example of public-private partnership with the involvement of academic research groups, industry, patient organizations and European funding."  

Against this background of increasingly common searches for solutions, the autumn that will shortly be upon us already offers a series of meetings in Europe that may help deliver some sharper thinking on how to forge closer links to approach cancer prevention, diagnosis and treatment. The first week of September will see a joint meeting in Brussels of the European Organization for Research and Treatment of Cancer, the US National Cancer Institute, the EMA, and the American Association for Cancer Research, explicitly responding to the perceived need for multi-stakeholder collaborations. And policy-makers, healthcare professionals, and researchers will join with child cancer patients, parents and survivors in the European Parliament the same week to explore multi-stakeholder proposals to improve EU regulations that can drive innovation in pediatric therapies. And these are just a taste of what is to come as the autumn evolves.