December 2008 podcast transcript

00:00

Kat: In this month's podcast we find out what's it like to discover that your child has cancer, and hear about one brave little girl's story. And we discover how scientists are using new technology to see tumours deep within the body.

Coming up later, we find out how scientists are developing new ways to target cancer. But first, here's Julie Sharp with the news.

00:52

Julie: Cancer Research UK scientists have cracked the molecular code that underpins resistance to the breast cancer drug tamoxifen. Currently, the drug can only be given to women for five years, as after that time there is an increased chance that their cancer will develop resistance to it.

Dr Jason Carroll and his team at the Cancer Research UK Cambridge Research Institute have discovered that tamoxifen switches off a breast cancer gene called ErbB2. This happens indirectly, as tamoxifen activates a protein called Pax2, which acts as a 'switch' to keep ErbB2 switched off.

The researchers have shown that problems with this switch system could lead to tamoxifen resistance, which happens when ErbB2 remains switched on. The challenge now is to find ways of turning this knowledge into new treatments for tamoxifen-resistant breast cancers.

Here's Dr Carroll, explaining more about the significance of his discovery.

"We actually understand how these drugs work on a "nuts and bolts" level. We know what the proteins and the genes are now but before we were really just guessing. Now we have direct evidence - we have proof of what happens and how these drugs actually work.

It turns out that there's this new protein called Pax2 which we didn't know anything about before. It turns out that Pax2 is a critical regulator of whether these drugs work or not. So now we have better targets. We know how to make more intelligent and better deigned drugs because we know exactly what we're trying to target."

Cancer Research UK has revealed that as many as 11,000 deaths from cancer could be prevented annually if Great Britain raised its survival figures to match those of the best performing countries in Europe. This is thought to be due to poor awareness of the symptoms of cancer, late presentation to a GP and late onward referral to hospital.

The news coincides with the launch of NAEDI, the new National Awareness and Early Diagnosis Initiative, aiming to reduce the number of people needlessly dying from cancer in Britain. Harpal Kumar, Chief Executive of Cancer Research UK, is joint chair of NAEDI, which will co-ordinate activities to bring about greater awareness and earlier diagnosis of cancer.

And finally, Cancer Research UK has launched an ambitious five-year plan which will see the charity spend around £300 million a year on core areas of science to reduce cancer deaths - including greater investment in those areas where survival rates remain poor.

In the next five years, improvements in early detection and screening will be specifically targeted, enabling doctors to diagnose cancer earlier when it has a better chance of being successfully treated.

In addition, Cancer Research UK has pledged to boost research investment in surgery and radiotherapy - which along with chemotherapy are the most important approaches to cancer treatment.

Kat: And if you want find out more about these stories, or get the latest from the charity's scientists, and researchers around the world, then have a look at our News & Resources website.

04:02

Kat: Going through cancer is a difficult experience for anyone, from the oldest to the youngest. Although childhood cancer is relatively rare, 1,500 children are diagnosed with some form of cancer every year in the UK. Thanks to research, survival rates have improved dramatically, and now more than three quarters of children now survive cancer, compared with only a quarter back in the 1960s.

To celebrate the courage of children who have been diagnosed with cancer, Cancer Research UK runs the Little Star Awards, in partnership with TK Maxx. One of our Little Stars is Poppy Guilder, who was diagnosed with a brain tumour when she was just over a year old. I called up Poppy's mum, Lisa, and asked her to share her story.

"Poppy had a chest infection so I took her to our GP, who noticed that she had a squint as I walked in with her in my arms - she was fourteen months old, and a completely normal, well, healthy baby up until that point. He then referred her to an eye appointment at the local hospital. The doctor there discovered that she was actually blind in the right eye.

We were shocked by this because Poppy had just adjusted so well that there was no indication there was anything wrong with her eye at all. She only had the squint if she was tired. She was then referred to Birmingham Children's hospital where they did further tests to have a look at the optic nerve in more detail, and they then felt that there was something more serious going on. They referred Poppy for an emergency brain scan. So from the initial appointment at the local hospital to being told she need an emergency brain scan was about five days.

It was absolutely devastating. I was worrying about Poppy having to wear glasses, or having a patch on her eye one minute, and the next minute we're being told that they thought she had a brain tumour. She had a brain scan the next day, and they told us we'd have to wait two or three days for the results.

But the tumour was so big that they told us there and then what they'd found. It was like our world had ended. I couldn't see that she could ever survive with anything that big in her head, facing surgery. It was like the world had stopped at that point.

Poppy had brain surgery within a few days of that initial diagnosis, which was an eight hour operation. They gave her a fifty-fifty chance of survival, but she recovered really well and was home within five days. They removed sixty per cent of the tumour, and found it to be low-grade, which was really good news, and it hadn't spread anywhere else.

However, they did a scan seven weeks later and the whole tumour had grown back. So they operated again, this time expecting Poppy to be very, very ill, as it was only nine weeks between the two surgeries, but she was actually sitting up in bed eating toast an hour after a six-hour brain surgery!

Then a couple of weeks later - she was 17 months old at this point - she started chemotherapy. She had chemotherapy three weeks on and three weeks off until she was almost three. Then we had about a year and a half of Poppy being stable, and then a cyst that was inside the tumour decided to start growing in 2007, so she had surgery to drain that.

She coped and was home the next day after the operation. Then this year the tumour started to grow again, so she had three months of chemotherapy at the start of this year, which she coped with really well. She just had Tuesday afternoons off school, even though she was having it every week.

She's absolutely fantastic. She's nearly six now, and we didn't think she'd even live to see her second birthday, let alone be here. She's in the top group in her class, she does ballet at the weekends, she goes swimming. They said she's never walk or talk, and would have learning difficulties, but she seems to want to prove everybody wrong with whatever they've thrown at her.

The day your child's diagnosed with cancer, your life's never ever going to be the same again. Initially we thought our lives had ended. Obviously it hasn't, but it's just a different ‘normal' now - this is our normal, it's not the same as everybody else's life. We just live day by day - instead of making great big plans like everybody else can, we just live day by day and are really grateful for every day that we've got.

Poppy was originally supposed to go on a chemotherapy protocol when she started her chemotherapy at 18 months old. But in the two week gap between her planned chemotherapy and the treatment starting, her consultant went to a huge meeting which was all to do with research, and there was an option for Poppy to try a different protocol that hadn't been used for her tumour before, at Birmingham Children's Hospital.

So she went ahead and had that treatment, and we think that's one of the biggest reasons that she survived, is because she had that treatment. Without research, Poppy wouldn't have had that option, to have that treatment. The research is absolutely vital - we wouldn't have Poppy without it."

Kat: Our Little Star Awards celebrate the courage of children with cancer. If you'd like to nominate a Little Star that you know, please visit our website to find out more. The nominations close in February.

10:03

Kat: We've all seen it - the media reporting the latest 'cure for cancer' - which gives the impression that one drug will treat everything. But after decades of research, it's clear that cancer is much more complicated and there are no easy answers.

Here at Cancer Research UK, we're supporting scientists who are trying to work out how we can target cancers more effectively and monitor their progress. One such researcher is Professor Richard Begent at University College London.

He and his team are first working out how cancers differ, then using antibodies to carry drugs to where they're needed, and finally using imaging techniques to look at the results. Our roving reporter Anna Lacey went to meet him.

Targeted treatment package

"We're working on developing new treatments for cancer which carry a treatment selectively to the cancer cells anywhere in the body. To do that, we need to design new treatments which discriminate between cancer cells and normal cells in the body.

We also need to consider the way that each individual person reacts to their cancer, because that affects how the cancer - and the patient themselves - respond to the treatment.

It seems that everybody's cancer is pretty well unique, and for most common cancer they change during their course in one individual, so it's a moving target in many ways."

Cancer is caused by changes or mutations in our genes. And because the changes differ from person to person, then so does the cancer. But researchers have now got a much better understanding of what the mutated genes are doing in different individuals - which is helping Richard and his team to design treatments that target cancer more effectively.

"Here we work particularly on antibodies, which are molecules made in nature, mostly to recognise infections and eradicate them from our bodies. We develop antibodies which react with part of a cancer cells, and we use the antibody to deliver a therapy to the cancer cell which will kill it. The antibody sticks to the cancer, and it has a "package" stuck on the back that helps in treating the cancer.

We've particularly been working with two types of treatment. One uses a radioactive isotope, which can destroy cancer cells. Another approach we have is to deliver a thing called an enzyme to the cancer. That doesn't do anything by itself, but we subsequently give a harmless prodrug which is converted into an active drug within the cancer by the enzyme, so it gives a bigger dose to the cancer, and a lower dose to the rest of the body."

By using antibodies to carry drugs directly to cancer cells, it gives a big dose of treatment right where it's needed, and can reduce the number of side effects. In early stage clinical trials these therapies have shown promise in bowel cancer and Hodgkin's disease, but they still need many more years of testing. The question now is: 'what's the best way to check how well these treatments are doing?' Well another area of Richard's work - cancer imaging - is trying to find an answer.

"Because cancer tend to change during their lifetime, it's very useful to be able to tell how they are responding to treatment, because that often changes. Now Cancer Research UK, the Engineering and Physical Sciences Research Council, the MRC and the Department of Health have given us a most important grant to work with Kings College developing a whole range of new imaging techniques.

So we can see in patients how a cancer works, study how drugs affect that cancer, and to make sure it's working in those patients. So much better tailored, personalised medicine should be the result of that."

14:04

Kat: As you heard in that previous interview, developing imaging techniques to see cancers within the body is an important part of drug development.

At the Cancer Research UK Cambridge Research Institute, Professor Kevin Brindle is using the latest technology to develop new ways to investigate how well new cancer drugs are working. Anthea Martin spoke to him to find out more.

"My premier area of interest is in using magnetic resonance imaging (MRI), and we're using that in oncology to detect early treatment response in tumours. So the idea is that traditionally the way that treatment response has been detected in the clinic is to look for evidence that a tumour is shrinking after you've treated it.

The problem with that approach is that it can take many weeks or months before you see evidence of tumour shrinkage. And with some new therapies it may not shrink at all , and therefore you wouldn't know that the patient was responding to treatment if you only looked at tumour size.

What we've been doing is developing methods that tell us about tumour function, the biological function of the tumour cells. In this way we can get an earlier indication of whether the patient's responding to treatment.

You can diagnose tumours using MRI, but our focus has been on treating patients when you already know they have tumours, so we're using it in a slightly different way. It's extending the capability of the technique.

The way it's been used so far is really to look at tissue structure and just measure the size of the tumour. But we know that we can do much more than that. MRI is a very flexible technique, and can be used to give us a lot more information. And as our understanding of the biology of cancer grows, we can exploit that to develop new and more sensitive imaging which methods which tell us earlier on whether the tumour is responding to treatment or not.

What we hope is that by targeting therapies more effectively, we can pick those patients that are responding well early on, and obviously they can continue with that treatment. But if they're not responding, you can save a lot of time and money and improve the welfare of the patient by saying "this treatment's not working, let's try a different one." Whereas at the moment you may not know for weeks or months, and valuable time is lost in that period."

16:37

We've reached the end once more so we hope you've enjoyed this month's podcast. You can keep up to date with all the latest progress in research from our Science Update blog. And please let us know what you think of this podcast by leaving feedback on the blog, or emailing your comments to podcast@cancer.org.uk.

We'll be back next month with all the latest news from Cancer Research UK, and a roundup of this year's achievements, so until then, goodbye!

• Credits:
• Presented and produced by Kat Arney
• News by Kat Arney and Julie Sharp
• Targeted treatment package by Anna Lacey
• Original music written and performed by Kat Arney and Henry Scowcroft
• With special thanks to all the participants