Turning the tide against cancer

 

In July 2014 the European Translational Research Network in Ovarian Cancer (EUTROC), held its annual conference in London. High on its agenda was cancer's resistance to established drugs.

Cancer is a complex disease. It arises from random "errors" in our genes, which regulate the growth of cells that make-up our bodies. Error-laden cells either die or survive, and multiply as a result of complex changes that scientists don't fully understood.
 
Translational medicine
Translational medicine is a rapidly growing discipline in biomedical research, which benefits from a recent technological revolution that allows scientists to monitor the behaviour of everyone of our 25,000 genes, identify almost every protein in an individual cell, and work to improve cancer therapies.
 
Ovarian cancer is the forth most common form of cancer in women, after breast, lung and bowel cancer. Each year, in the UK some 7,000 people are diagnosed with ovarian cancer, in the US it's 240,000. Most women are diagnosed once the cancer has spread beyond the ovaries, which makes treatment challenging, and mortality rates high. Only 10% of women diagnosed with ovarian cancer at the latest stage survive more that five years. 
 
 
Molecular profiling
EUTROC employs a multi-disciplinary, collaborative, "bench-to-bedside" approach in order to expeditiously discover new therapies, which tailor medical treatment to the specific characteristics of specific cancers: personalised medicine.
 
Cancers are like people: not all are alike, and when examined at a molecular level they show that their genetic makeup is very different. Clinicians use molecular profiling to examine the genetic characteristics of a person's cancer as well as any unique biomarkers, which enables them to identify and create targeted therapies designed to work better for a specific cancer profile.
 
Combatting cancer resistance
Personalising treatment to target errors in specific cancers at the point of diagnosis fails to address the fact that cancers mutate in response to treatment. Even drugs that are initially effective may become ineffective as the cancer returns and re-establishes its ability to grow and spread. Cancer often behaves like a taxi navigating a way round a localised traffic jam

 

An approach to combat this is to treat a cancer with one target drug, and if the cancer returns with newly developed resistance, identify how that resistance occurred and target that with another drug, and so on, until the cancer and its resistances are beaten.  This is similar to accepting that a local traffic jam may be bypassed, and finding and blocking all the ways around the jam.
 
Another approach is to target and block something critical for the survival of a specific cancer. This is similar to blocking a strategic point that controls all the traffic coming in and leaving a city. For example, taxi drivers clogging up Trafalgar Square and bringing London to a standstill. But scientists are a long way from achieving this because researchers don't know whether such targets in relations to cancers exists, and even if they did, they don't know whether they can be blocked effectively. And, even if such targets were discovered and were blocked, scientists still don't know what would be the side effects of doing so. 
 
Takeaways
For personalised medicine to be successful, clinicians and scientists need to track the evolutionary trajectories of cancers in patients through sequential episodes of treatment and relapse. Besides being a major clinical and scientific challenge, this is also a significant informational and communication challenge, which networks such as EUTROC are addressing.

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