Crossing Disciplines to Explore Questions about Cancer
“A lot of the easy stuff [in cancer research] has been done,” Dr. Elizabeth Blackburn said over the weekend at the annual meeting of the American Association for Cancer Research (AACR), currently under way in Orlando, FL. The “face of cancer research” is much more interdisciplinary today than in the past, and this is how new frontiers will be explored, she added.
Dr. Blackburn, who is president of AACR and a Nobel laureate for her pioneering research on telomeres, noted that life sciences, physical sciences, and engineering are converging: “Over and over, we are seeing what we thought were separate disciplines come together.”
She was speaking to reporters about new research exploring possible connections between telomere shortening, chronic psychological stress, and the risk of certain cancers. While the research is preliminary, the study is an example of how investigators in disciplines that may not have worked together in the past are combining efforts.
There have been many such examples at the AACR annual meeting, where the theme is “Innovation and Collaboration: The Path to Progress.”
“The concept of team science is important,” said Dr. José Baselga of the Massachusetts General Hospital Cancer Center. Not only are basic scientists and clinicians collaborating more, but investigators from different institutions, who may have been competitors in the past, are now sharing data from the beginning of a project, he added.
The meeting’s plenary session featured several talks about translating basic research into new tools for detecting, treating, and preventing cancer. NCI Director Dr. Harold Varmus also discussed what he called “imperatives” in times of uncertain budgets. These included the reorganization of the NCI Clinical Trials Cooperative Groups, a new center for cancer genomics (to oversee the diverse efforts in the field), a new center for global health, and cancer prevention.
“Good science begins with good questions,” said Dr. Varmus during a brief discussion about NCI’s Provocative Questions Project. The project Web site is dedicated to collecting important but non-obvious questions that will stimulate the cancer research community to think in creative ways about the problem of cancer. Dr. Varmus invited the audience to join the online discussion.
Last week, the Annual Report to the Nation on the Status of Cancer was released. The authors reported continued decreases in both new cancer diagnoses (incidence) and cancer deaths. Of note, lung cancer death rates in women declined for the first time in decades.
In a talk at the plenary session, Dr. Paul Bunn, Jr., executive director of the International Association for the Study of Lung Cancer, welcomed this news. But he noted that half of lung cancer cases develop in former smokers, so new tools are needed to reduce the risk of lung cancer in people who have quit smoking.
—Dr. Harold Varmus
Dr. Bunn presented results from a clinical trial testing whether a drug called iloprost can help repair damaged lung tissue in former smokers. The researchers used abnormal cell changes, known as endobronchial dysplasia, to assess the drug’s effect. They concluded that measuring a chemopreventive agent’s effect on endobronchial dysplasia could help predict whether the agent is effective.
“A team science approach will be critical” for identifying potential chemoprevention agents and markers to assess their effectiveness, noted Dr. Waun Ki Hong of the University of Texas M. D. Anderson Cancer Center during a talk about personalized approaches to lung cancer prevention at the plenary session.
New technologies are driving changes in how clinical trials are designed, noted Dr. John Heymach, also of M. D. Anderson. “In the past, when an interesting idea emerged [over the course of a study], you would then go back and look at the tumors to try to understand the result,” he said. The goal now is to capture as much information as possible prospectively, he added.
Dr. Heymach predicted that, in a few years, tumors will routinely be analyzed using whole-genome sequencing. As a step in that direction, researchers at the AACR annual meeting reported preliminary results from the sequencing of tumors from 50 women with estrogen receptor-positive breast cancer, demonstrating the heterogeneity of the disease.
The hope, said lead investigator Dr. Matthew Ellis of the Washington University School of Medicine, is to eventually perform whole genome sequencing early in the treatment of the disease rather than retrospectively, so that doctors may select therapies based on the genetic alterations in a patient’s tumor.
When people think about the fight against cancer, they often think about the treatment of cancer, noted Dr. Blackburn. “But more and more we have to think about prevention.” Prevention can mean preventing the very earliest stages of the disease that unfold over years and preventing recurrences in survivors of the disease, she added.
The idea is “to intercept the biology of cancer as it unfolds on its deadly trajectory,” Dr. Blackburn continued. “So we really have to understand the biology behind it.”