We began last week in Liverpool for the biennial meeting of the International Symposium on Pediatric Neuro-Oncology (ISPNO) and ended the week in London at the Childhood Cancer Conference 2016, organised by the Childhood Cancer and Leukaemia Group (CCLG) and Bethany’s Wish, the Wilms Tumour Charity.
ISPNO 2016: 17th International Symposium on Pediatric Neuro-Oncology
ISPNO is the major global meeting of the multi-disciplinary international community of professionals involved in the scientific research, diagnosis, treatment and rehabilitation of infants, children and young people with tumours of the central nervous system (CNS).
We were pleased to be a Silver Sponsor of the Liverpool meeting. It was a great beast of a meeting, with more than 1,100 delegates. The main meeting took place over three days, preceded by two days of pre-conference meetings. The three days themselves were packed full of content, with breakfast meetings, lunchtime symposiums and sessions running in parallel throughout the day. There were around 150 oral presentations and 600 poster presentations. All providing updates on progress in the research and treatment of childhood brain tumours.
The range of topics was diverse, with sessions devoted to all of the major brain tumour types, and from clinical, molecular and surgical viewpoints. And the conference was truly international - Europe, the US and Canada were well-represented as would be expected, but research was presented from countries including Nepal, Mexico, India, China, Poland and Taiwan.
UK Childhood Cancer Conference 2016
The Childhood Cancer Conference had a very different flavour to ISPNO. The aim of this annual conference is to provide a platform for parents and professionals to come together to find out about the latest research into childhood cancer, share experiences and collaborate.
It was a much smaller, more intimate meeting, with around 100 delegates comprised of parents, survivors, researchers, health professionals and charities.
We heard from some of the UK’s leading childhood cancer experts on developments in treatment and research, and from parents, who provided thought-provoking and moving perspectives on childhood cancer. These put a very different spin on the presentations, discussion and debate taking place at ISPNO. With so many participants presenting so much research, you would be forgiven for thinking that we are on top of this, great progress is being made and survival must be increasing, right?
What progress are we making?
Four out of five children diagnosed with cancer can now be cured. This survival rate is double what it was 50 years ago so there is much to celebrate. But survival has now plateaued. And still one child in five is dying - either because there is no effective treatment for their cancer or because their body can’t withstand the toxic treatment.
In the main, the gains in survival have been achieved not through the introduction of new drugs but rather through improvements in the way we use existing drugs. We’ve improved diagnostics and learned how to stratify children into different treatment groups so that they can be treated under the regime that has been shown to be most effective for their particular situation, using the best combinations of therapy. Improvements in surgical techniques, radiotherapy and supportive care have played an important role.
But we have reached the limits of what existing treatments can achieve. New treatments are desperately needed to save the thousands of children worldwide that are let down by current treatments.
‘Let down by science’
Oscar Knox was diagnosed with high-risk neuroblastoma when he was three years old. After a long, bravely fought battle, he died in 2014.In a poignant presentation at the Childhood Cancer Conference, Oscar’s mum, Leona, explained how she feels that Oscar was let down by science; that he didn’t die because he got neuroblastoma but because he ran out of treatment options.
This may seem harsh, given the sheer volume of research that is in progress as evidenced at ISPNO. Whilst ISPNO focused on childhood brain tumours, the Advances in Neuroblastoma Research (ANR) meeting taking place this week in Australia is on a scale not dissimilar to ISPNO, with hundreds of researchers from around the world joining together to share research findings and discuss progress in the research and treatment of neuroblastoma.
So in the face of all this research, why are children still dying of cancer? Why haven’t we found new treatments? It’s no comfort to parents to be told that research is slow, that it doesn’t happen overnight. Their children need the treatments now. Or yesterday.
In his rather sobering closing remarks at ISPNO, Professor Richard Gilbertson (Cambridge University) reminded delegates that – despite the significant developments in biological knowledge and advances in technology, little has been translated to wide scale patient benefit. He called for a paradigm shift in how prospective drugs are developed and emphasised the need to utilise new technologies to enable precision medicine and early screening.
Making a difference
Ultimately there are two measures of success in childhood cancer research and treatment: the numbers of children being cured and the quality of life enjoyed by survivors. Much attention is being devoted to the latter in light of the numbers of children now surviving cancer.
Immunotherapy and precision medicine are two areas of research that hold great promise for progress against both of these measures.
The relatively recent ability to (rapidly and affordably) map out the genetic code of any individual person and any cancer they develop holds great promise for the design of targeted treatments with the aim not only to improve cure rates but to also reduce toxicity. This type of precision medicine has proven benefit in some of the common adult cancers. Precision medicine technology is now being systematically applied in the US and Europe to children with cancer, with real success. Ad hoc efforts in the UK have also shown success and we hope that the approach will shortly be rolled out systematically so that all children diagnosed with cancer can have their tumour DNA sequenced. This is the culmination of a vast research effort, but is still only the first part of the story as its success ultimately depends on the availability of effective treatments.
Cancer immunotherapy refers to the use of treatments that harness and enhance the natural powers of the immune system to fight cancer. The last few years have seen a surge of new immune-based therapies that are changing the landscape of how children with some of the more deadly cancers are treated. Such therapies have already been used successfully in the UK in children with leukaemia and neuroblastoma. At the Childhood Cancer Conference, Professor Paul Veys from Great Ormond Street Hospital outlined a new ‘off the shelf’ approach currently being pioneered at GOSH, using engineered donated immune cells to treat relapsed leukaemia. A new trial has opened at GOSH just this month, with the first patient currently undergoing treatment. Its early days but if the treatment proves successful, it will be a turning point in the treatment of relapsed leukaemia, with implications for other childhood cancers as well.
What are the greatest barriers to progress in the successful treatment of children with cancer? Funding is obviously important but undoubtedly it is about HOW we fund as well as HOW MUCH we fund.
As funders, entrusted with publicly-donated funds, we have a responsibility to choose the research that we fund with the utmost of care. There are many criteria against which submitted research applications are scrutinised but ultimately selection is based upon the NEED for the research (is it addressing an important question that needs to be answered?), the potential IMPACT of the research (will it make a difference and how quickly?) and the quality of the SCIENCE (can they actually do what they say they are going to do and will it mean what they say it will mean?).
Richard Gilbertson is speaking at our September conference, Childhood Cancer 2016, on ‘the opportunities for precision medicine for children with brain tumours’. The conference, chaired by Dr Nick Goulden, will bring together clinicians and scientists from different disciplines within the childhood cancer field to exchange knowledge and ideas. Precision medicine is one of three themes to be featured over three days, alongside Immunotherapy and Causation.
Discussions taking place at the conference will feed into a review of our research strategy, which we hope to complete by the end of the year - to consider how best we can apply a limited amount of funds to greatest effect for the benefit of children like Oscar.
Read more: Our research | Childhood Cancer 2016
Katie Martin, Research Development Manager
21st June 2016