AACR Meeting Highlights 'Monumental Moment' in Cancer Research

Zosia Chustecka

April 13, 2016

NEW ORLEANS — Billed as the "most important cancer research event of the year," the forthcoming American Association for Cancer Research (AACR) 2016 Annual Meeting will, as usual, showcase the latest developments in the field, but this year it also offers attendees a unique opportunity to hear first-hand about the National Cancer Moonshot Initiative.

Vice President Joe Biden will outline details of the project, and his personal commitment to "ending cancer as we know it," in a plenary session at the close of the meeting on Wednesday, April 20.

"This really is a monumental moment in the field of cancer research," said AACR Chief Executive Officer Margaret Foti, PhD. The moonshot initiative "has galvanized the cancer research and patient care community in ways that we have not seen in a long time," she said in a statement, and it is "an extraordinary honor for the AACR to welcome the Vice President."

Delivering Cures Through Science

The theme of this year's meeting is "delivering cures through cancer science," and this really highlights what "the AACR and cancer research today is all about," said Scott Armstrong, MD, PhD, director of the Memorial Sloan Kettering Leukemia Center in New York City and program chair of the 2016 annual meeting. "That is, taking fundamental science discoveries, coming up with new therapies based on those discoveries, and moving them into clinical assessment, and ultimately to make a difference for patients," he says in a blog post.

Elaborating in an interview with Medscape Medical News, Dr Armstrong said: "We are starting to see drug therapies that come out as a result of a greater understanding of cancer biology." In some cases, these new drugs have improved cancer care, and in some they have improved survival, he added.

 
This really is a monumental moment in the field of cancer research.
 

"So the idea is to highlight the fact that we expect that trend to continue, and that it really is by understanding basic and translational science behind cancer development that we can continue to develop better therapies," he said.

One area where this has already happened is genomics, and now the application of genomic testing to cancer diagnosis, and in some cases, also treatment. "The discoveries made by genomic analyses are really starting to move into the clinic," he said. In this new approach, treatment is chosen on the basis of genomic findings in the tumor, rather than by the tissue or organ that the tumor is affecting, which has been the traditional approach. Examples of this include lung cancers, where there are therapies specifically for EGFR mutations and ALK rearrangement, and in melanoma with BRAF mutations.

Further back in cancer research are developments that are continuing to push the understanding of the biology of cancer, which may in the future lead to improvements in treatment, "and I don't think that will take long," Dr Armstrong commented.

Among the hot research topics is the genome-editing tool CRISPR, which has been developed in the last 3 to 4 years and is "changing how we do cancer research," Dr Armstrong commented. This tool allows a researcher to specifically delete any region of the genome and then study how this affects biology, of for instance a cancer cell, and "it is incredibly powerful in terms of potentially finding drug targets," he said.

CRISPR has revolutionized cancer research, Dr Armstrong said, and has speeded up the process greatly. Before this, the only way to study the effects of a genome deletion was the laborious study of knockout mice, which could take months, if not years, whereas this tool allows researchers to work with human cells and get answers within weeks, and also allows them to study many deletions at the same time. "So before, you would get an answer about one mutation in 6 months (at best), whereas now you can get answers on hundreds of mutations within weeks," he said.

Another hot research topic is cancer metabolism, which Dr Armstrong describes as "a very new area in terms of how recently we've come to understand how tumors have a different type of metabolism than most other cell types. We will be focusing on how that might be used therapeutically."

Cancer Immunotherapy

Cancer immunotherapy has been hailed as a science breakthrough, and then as a clinical advance, and now drugs that block the function of the immune checkpoint programmed cell death 1 (PD-1) have "firmly planted tumor immunotherapy in the mainstream of clinical oncology."

Results with these drugs continue to grab the headlines, and last year's AACR meeting saw several landmark trials presented.

This year's meeting will hear more about the "remarkable responses seen in patients with various types of cancer through the use of different types of immunotherapy," Dr Armstrong commented. Among the clinical results to be presented are data showing efficacy for PD-1 inhibitors in several new cancer types, some of which could result in changes to current standards of care.

Also featured will be new approaches to immunotherapy, including manipulation of T-cells in novel ways to achieve anticancer activity, as well as novel small-molecule drugs that act on the immune system. A new approach here is the use of small-molecule drugs given to cancer patients to make their tumors more recognizable to the immune system, Dr Armstrong noted. Many of these novel ideas have been progressing through trials, and early clinical data on these compounds will be revealed for the first time.

Immunotherapy continues to be the hottest topic in the cancer field, at least "in terms of new approaches that are making clinical impact today," Dr Armstrong said.

But coming up not far behind is the field of epigenetics, which offers yet another approach to the treatment of cancer that homes in on tumor genetic expression, he said. Epigenetic therapies aim to disrupt proteins and modifications that determine whether a gene is turned on or off, and so is quite different from targeted agents that home in on specific genetic mutations and from conventional chemotherapy. There is already one drug available that acts through an epigenetic mechanism, azacitidine (Vidaza, Celgene) for myelodysplastic syndrome, but there are many other compounds in clinical trials.

"We are just starting to see evidence of responses in patients with these approaches," Dr Armstrong commented, mostly in hematological malignancies, although there is also some promise in solid tumors. "There's still some work to be done to understand exactly what is happening and who will benefit, but the impression is that this approach is likely to make an impact."

The concept of liquid biopsies continues to generate much excitement, with the recognition that samples of peripheral blood can give information about tumors, either in the form of tumor DNA or exomes, that can be used be for both diagnosis and treatment. "They can be used potentially for early detection of cancer, or perhaps more immediately to measure therapeutic response," Dr Armstrong commented. "If that turns out to be particularly robust and sensitive, that stands to change the way that we are able to monitor patients to check on how they are doing, how they are responding to treatment, and potentially to change their therapy," he said. "There's a lot of excitement about that, and it will be highlighted in a number of presentations at the meeting," he told Medscape Medical News.

In his blog, Dr Armstrong emphasized how wide a net is thrown by the AACR meeting. It covers the whole "breadth of research that is going on in cancer science at the moment. It really spans from metabolism to chromatin biology to immunotherapy, and there are tremendous breakthroughs going on in all of these arenas," he commented.

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