Cancer Research UK chairman Prof Sir Leszek Borysiewicz on making cancer a manageable disease
The chairman of Cancer Research UK says there are good reasons to be optimistic about the future of treatments.
Prof Sir Leszek Borysiewicz, who was vice chancellor of the University of Cambridge from 2010-17, believes we are moving towards an age when many cancers will be manageable diseases.
“At the moment, one in three people in their lifetime will get cancer. By 2030, that’s going to be one in two,” he tells the Cambridge Independent. “This data is from an International Agency for Research on Cancer in Lyon.
“We can anticipate a 30 per cent increase in incidence of cancer. This is all to do with ageing populations – not to do with risk factors. Singapore is anticipating a 60 per cent increase.
“That’s the bad news. But the good news is that, of those, around 75 per cent will live for 10 years or more. I’m being careful inasmuch I’m not saying they are cured, but at the moment about two in four will live for 10 years or more with a diagnosis, so this is a considerable advance.
“The ambition is to cure cancer but if we can’t, we are moving to a position with the discoveries being made of converting cancer into a chronic disorder, much as we have done with HIV and other conditions.
“You will be able to have a good, normal quality of life under treatment. This has major implications for cancer care.”
Prof Borysiewicz will discuss some of these in his keynote speech at the Health Horizons Future Healthcare Forum, which runs from June 26-27 in Cambridge.
He highlights three major themes in oncology – the first being the importance of achieving earlier diagnosis.
“Quite rightly, Theresa May has pinpointed that. The earlier we can get it, the better the control can be of the disease,” he says.
“There is a big push to get a much earlier diagnosis in Britain. It’s the main reason our performance in terms of cancer survival statistics globally is not as good as other countries. We are just not getting the cases early enough. There is a lot of research in that area.
“There is a requirement for the NHS to adapt – how are we going to manage those people once the diagnosis is made? The challenges to the NHS are writ large.”
Ongoing improvements in treatments are, naturally, the second theme.
“Now the good news is that if you look at medicines in discovery phase, nearly a third of all those in stage two and three trials are anti-cancer agents. A huge amount is going on in the pharmaceutical sector.”
He points to our ever-improving knowledge of the mutations and genetic changes that lead to cancer, and our ability to target these drivers of disease more specifically.
“You might have a driver or mutation that is the same in the brain or colon cancer. We are starting to think differently about cancer,” he says.
The third major theme in the future of cancer care will be the importance of helping patients to enjoy the best quality of life possible, reducing the toxic effects of drugs, tiredness and other side effects.
“We will have a greater number of people living with cancer and the consequences of treatment, so we need to look at some of the longer-term issues for survivors,” he says.
But he warns that for all our progress, there remain some cancers that have proved quite intractable.
“We still have five major cancers where the outlook has not improved significantly in the last 10 or 15 years – pancreatic, lung, oesophageal, stomach and brain tumours. There is still a lot of pressure on trying to improve the statistics,” he says.
As ever, prevention is better than cure, and our knowledge of risk factors relating to cancer is building.
“Obesity is already the second largest association after smoking. The big issue is why are only 13 cancers associated with obesity?
“We have to understand those relationships better.
“That in itself could result in new treatments,” he says.
“My talk will also look at the changes we are likely to need in the NHS over the next 10 years to enable us to deliver better care faster and to make it affordable. At the present rate, we can’t afford the costs of cancer care.”
After his keynote on ‘Cancer as a manageable disease’, due at 10.15am on the second day of the conference, Prof Borysiewicz will join a discussion panel titled ‘Prevention, early detection and future therapies in oncology’ with Steve Jackson, of the Gurdon Institute, John Cassidy, of Cambridge Cancer Genomics, Cesare Spadoni, of aPODD Foundation, and Susan Critchlow, of AstraZeneca.
“I’m looking forward to the panel, which is picking out those themes and coming at them from different perspectives. What suggestions are we going to make to the NHS when they start planning for the long-term to ensure better care and accessible care?”
Early diagnosis is the focus of the work of Cambridge company Owlstone Medical, which has developed a breathalyser that detects cancer from the volatile organic compounds present in a patient’s breath.
“The Owlstone approach around breath is extremely promising,” notes Prof Borysiewicz. “People have always asked why it is that some dogs are able to detect people with cancer – these are anecdotal reports. Owlstone is trying to obtain profiles using chromatography and simple devices.
“There are a whole lot of novel approaches we are looking at.
“Can we make prostate cancer screening better than the current test, which is not very good if we’re honest?
“We are looking at new imaging technologies. All this is very good news. There are real reasons to be optimistic that we will get a series of advances in this area.
“So much basic science has been done and we are now reaping the rewards of the investment in science, where Cambridge has played a huge part.”
The Cancer Research UK Cambridge Institute is one of the charity’s leading centres and has played a key role in developing our understanding of cancer.
It is now working with AstraZeneca at a Functional Genomics Centre on the Cambridge Biomedical Campus, deploying genetic screening, cancer modelling and big data processing, using CRISPR gene editing technology to create new biological models more reflective of human disease that will help advance cancer drugs. So what is the future for cancer treatments?
“We have modalities of treatment,” says Prof Borysiewicz. “Surgery is still the most successful curative treatment we have.
“Radiotherapy is now much, much better and we have the potential of proton beam therapy and new equipment is being installed.”
Enabling a dose of high energy protons to be precisely targeted at a tumour, reducing the damage to surrounding healthy tissues and vital organs, proton beam therapy was, until December, only available to NHS patients by travelling abroad.
One NHS centre in Manchester now offers it, and a second is due to open in London this summer.
“At Cancer Research UK, we are creating a programme called RadNet to get more radiotherapy research. It is something so many patients benefit from but it is not as fully investigated as it could be,” he says.
Chemotherapy will continue to be an important part of cancer therapy, he adds.
“The drugs are getting better and they are more targeted to our understanding of the changes that occur in cancer cells.
“There are now tens and hundreds of different drugs available. Now we have to deal with issues of data and how we deal with the complexity of treatment regimes that can be adapted.
“Data and personalised care are going to become really important,” he says.
“And we have the excitement of immunotherapy. But in many cancers, we still have to establish where it is best used. Should it be used early or late? Who will benefit most from it?”
Prof Borysiewicz predicts our ability to predict people’s responses to treatments will improve as our understanding of the disease at a molecular level improves.
“We will be far more targeted with personalised medicine for the individual patient,” he says.
This personalisation will begin at the screening stage.
“Knowing who may be at risk, being able to screen people better and identifying high-risk groups, who will have more screening, means cancer will be detected earlier and then much more manageable,” he says.
“It is not a diagnosis anyone would want to hear, but there are real reasons to be optimistic that care is going to improve over the next 10 years.”
Prof Borysiewicz’s own work helped to deliver one of the major success stories in cancer care of recent times: the development of a vaccine to prevent cervical cancer.
“The cervical cancer vaccine is particularly effective because we know that 99.5 per cent of cases are associated with human papilloma virus and you can make a vaccine to try to prevent that infection,” he explains.
“There are other viruses associated with cancers, more prevalent in the rest of the world than in developed countries, like hepatitis B and C.
“We still don’t know about Helicobacter pylori as an infectious agent associated with stomach cancer.”
Defining the molecular signatures of cancer could also be used to help us provide therapeutic vaccines once a tumour is detected, he adds.
And preventative vaccines may also be developed for those in high risk categories based on common ‘epitopes’ – part of an antigen to which an antibody may bind.
“These are exciting developments but they are still in fairly basic investigation,” says Prof Borysiewicz.
Immuno-oncology – using the immune system to ward off cancer – is similarly a key focus of development.
“It’s a very expensive form of treatment at the present time,” warns Prof Borysiewicz, who is also on the board of UK Research and Innovation (UKRI).“We need to define who will respond and which tumours it will work for.
“We are seeing fantastic occasional results and hearing stories of patients who have had tremendous benefits from these approaches..
“But it is unpredictable and there is a lot of work going on in different centres. There are hundreds of trials going on around the world for different immunotherapies, exploring how to combine the checkpoint inhibitors – the PD1 blockers – alongside active treatment.
“There are also CAR T-cells. People try to grow very specific T-cells that can attack cancer cells. It’s worked for particular types of lymphoma well but how far will it be adaptable?
“There is a huge amount of work to do in terms of basic and translational work, and Cancer Research UK is playing its part.”
So, too, will the proposed new Cambridge cancer hospital near Addenbrooke’s.
“A large part of that is going to be the translational research, which is a very exciting potential development.”
As we seek to drive up UK survival rates, ensuring patients have access to leading centres and avoid postcode lotteries in treatment will be critical, Prof Borysiewicz points out.
“Variation still happens in the UK,” he says. “We need to make sure that every patient gets the optimum treatment available.”
The Health Horizons Future Healthcare Forum
More than 100 speakers will grace the Health Horizons Future Healthcare Forum taking place at the Cambridge Corn Exchange on June 26-27.
Proudly supported by the Cambridge Independent, the conference brings together leaders from industry and academia to discuss the future of healthcare, from nanotechnology to novel therapeutic approaches.
Find out more and book tickets at horizons.health.