5 burning questions Kiwi cancer researchers could answer

The NZ Breast Cancer Foundation will receive applications next week for its new funding round, Innovation and Impact in Breast Cancer, with a particular focus on topics where Kiwi researchers might have an edge over other parts of the world.

“The list of potential research questions is huge, while budgets in New Zealand are typically small. It’s important to focus on areas where Kiwi scientists and doctors have an acknowledged strength,” said Evangelia Henderson, chief executive at the NZBCF.

Mrs Henderson cited five “burning questions” that Kiwi researchers are in a particularly strong position to answer.

1. Will there be a vaccine for common cancers like breast cancer?

Cancer vaccines fall into two camps – preventive or therapeutic. Preventive vaccines are designed to prevent cancer developing in healthy people (e.g. the HPV vaccine for cervical cancer). For many cancers, including breast cancer, it’s more likely that we’ll see a therapeutic vaccine develop first. Therapeutic vaccines harness the body’s immune system to treat cancer and prevent it spreading or recurring. New Zealand has a strong reputation in vaccine development, with tight-knit teams of virologists, immunologists and clinicians, such as at Otago University.

2. How successful are we at treating cancer and how can we do better?

We all know that New Zealand lags behind countries like Australia and the UK in access to cancer drugs. But what difference does it make? “Big Data” holds the answer – it’s “transforming the fight against cancer”, as a Forbes Magazine headline put it last year. Big data is the in-depth information held in patient registers about cancer patients, their treatments and outcomes. It will help doctors improve outcomes by showing them how other patients fared on the same treatment programme, identify inequalities of access, and understand outcomes across regional, demographic and ethnic groups. Registers enable actual healthcare practice to be assessed against recommended standard of care; and allow benchmarking against international guidelines and best practice.
New Zealand’s regional Breast Cancer Patient Registers, funded by the NZBCF, are currently being consolidated into a national register, and plans are afoot to establish registers for other tumour groups. What’s needed now is more research into the valuable data they hold.

3. Will vitamins ever play a serious role in cancer treatment?

Once perceived as being at the looney fringe of cancer research, vitamin C is increasingly acknowledged as an important topic for scientific study. Professor Margreet Vissers is currently researching the role of vitamin C in slowing the growth and spread of bowel and breast cancers, and was the 2015 recipient of the New Zealand Society for Oncology Translational Research Award in December. Vitamin D research is lagging behind vitamin C, but as a micronutrient in which many Kiwis are deficient – more than a quarter of us have less than the recommended level of vitamin D in our blood[2] – and the subject of cancer prevention studies overseas, we can expect to see increased interest vitamin D in the future.

4. How can we find out sooner whether cancer treatment is working?

Too many patients undergo unpleasant, toxic treatment for their cancer, only to find out months later that it didn’t work and the cancer has spread or become much harder to treat. New research aims to find ways of identifying faster whether or not a treatment is working via a “liquid biopsy” – measuring circulating tumour DNA (ctDNA) in the patient’s blood. Rapid identification of relapse could enable a new drug or a different dose to be tried while the cancer spread is still limited, and could also mean patients can stop ineffective treatments.

5. Will cancer that has spread ever be curable?

Cancer that has metastasised – spread beyond the initial site to another part of the body (for example, a breast cancer that has spread to bones or lung) – is considered incurable, though for some patients it may be managed for a number of years.

However, some scientists and doctors are suggesting that a cure for some metastatic cancers may be possible in the not-too-distant future. In breast cancer, there have been studies of stereotactic radiosurgery (high-energy x-rays) used with “curative intent” to treat patients with a very limited number of metastases.

Drug treatment remains the most common therapy for most metastatic cancers. Any drug-based cure is unlikely to apply to all patients – but there may be multiple cures for various small subsets of patients. Discovering who those patients are will become easier as tissue banks expand in NZ and are integrated with patient registers such as the Breast Cancer Patient Registers funded by the NZBCF. These advances, along with progress in genomic testing, will enable researchers to understand the nature of cancer right down to the individual level.

A “cure” for metastatic cancer will most likely be found in advances that allow patients to live very long and normal lives, even though there may still be disease present in their bodies, similar to the advances in treatments that have made AIDS no longer a death sentence.

“These are important questions, to which patients need answers,” said Evangelia Henderson. “We’re keen to invest in studies that tackle these and other equally serious issues.”