tag:theconversation.com,2011:/global/topics/cancer-drug-7683/articlesCancer drug – The Conversation2016-12-05T01:01:02Ztag:theconversation.com,2011:article/667742016-12-05T01:01:02Z2016-12-05T01:01:02ZCould a cannabis pill reduce chemotherapy-induced nausea and vomiting? Here’s how we find out<p>For some cancer patients undergoing chemotherapy, the thought of joining their loved ones for a meal can be, quite literally, sickening. Nausea and vomiting due to chemotherapy can cause devastating physical side effects and wreck a patient’s social and family life.</p>
<p>Patients say they find it difficult to manage the expectations of well-meaning family members and friends who want to “feed them up”, when their favourite foods become tasteless.</p>
<p>We need to do more to make chemotherapy as comfortable as possible for patients.</p>
<p>That’s why our research team at <a href="http://www.mylifehouse.org.au/">Chris O’Brien Lifehouse</a> in Sydney is about to embark on the largest and most definitive Randomised Controlled Trial ever in the world of medicinal cannabis for the prevention of chemotherapy-induced nausea and vomiting. With the help of more than 300 patients from several NSW hospitals, we hope to learn more over the next few years about how effective medicinal cannabis may or may not be for preventing chemotherapy-induced nausea and vomiting.</p>
<h2>New strategies for an old problem</h2>
<p>Cancer kills more Australians than any other disease. Almost half the 100,000 people diagnosed each year will be offered chemotherapy as an integral part of their treatment. While there have been significant advances in anti-nausea drugs over the past decade, more than one-third of patients receiving potent intravenous chemotherapy still suffer from nausea or vomiting.</p>
<p>Our team includes leading Australian researchers from Chris O'Brien Lifehouse, the University of Sydney and Royal Prince Alfred Hospital, specialising in cancer, addiction medicine and clinical toxicology.</p>
<p>We’re hoping to determine if giving patients an oral capsule of medicinal cannabis reduces nausea and vomiting during and after intravenous chemotherapy for cancer.</p>
<h2>Jury still out</h2>
<p>The jury is still out on the ability of cannabis and cannabis-derived medicines to treat a range of debilitating illnesses – and how to do it safely and effectively.</p>
<p>Despite dozens of trials internationally, the <a href="http://www.cochrane.org/CD009464/GYNAECA_cannabis-based-medicine-nausea-and-vomiting-people-treated-chemotherapy-cancer">evidence</a> is unconvincing. Some <a href="http://www.cochrane.org/CD009464/GYNAECA_cannabis-based-medicine-nausea-and-vomiting-people-treated-chemotherapy-cancer">research</a> failed to compare cannabis medicine against the best standard treatment of today. Some research had design flaws, such as failure to adequately account for the placebo effect, inappropriate dosing, small sample sizes and poor documentation of side effects and harms.</p>
<p>There remain many potentially valid reasons to use medicinal cannabis products. But we still don’t know how best to formulate and administer the drug, how well it might work, how safe it is and what the long-term side effects could be.</p>
<p>This is not to say medicinal cannabis for therapeutic use is a pipe dream – we just need to do the work first, and do it properly. And that takes time.</p>
<h2>A scientific approach</h2>
<p>However, using a scientific approach will give the best hope for patients and their families. It will give us better understanding of side effects and ideal dosages.</p>
<p>Producers of medicinal cannabis products will be encouraged to develop the most suitable formulations, delivery methods, and cannabinoid content.</p>
<p>Australian regulatory and funding authorities will have the evidence they need to decide which formulations of medicinal cannabis should be approved for which conditions, so they can be made safely available to the patients who need them.</p>
<p>Clearly, more research needs to be done. NSW is doing groundbreaking research on the use of medicinal cannabis for treatment-resistant childhood epilepsy, palliative care and chemotherapy-induced nausea and vomiting.</p>
<p>Many of my patients do not use illegal cannabis preparations because they are concerned about breaking the law. But if we were to pursue broad legalisation, as opposed to a medical pathway based on scientific evidence, we would miss the opportunity to create a safe, secure supply of cannabis medicines.</p>
<p>These medicines could be supervised by qualified practitioners to maximise the benefit to patients and manage side effects, and could potentially be subsidised under the Pharmaceutical Benefits Scheme.</p>
<p>Many of the cannabinoid products available overseas have little quality control, testing or certification.</p>
<h2>Relaxed but not “stoned”</h2>
<p>The cannabis plant varies considerably depending on its type and how it is grown. The cannabis plant contains hundreds of compounds, more than 60 of which are cannabinoids. The main cannabinoids studied in trials are delta-9-tetrahydrocannabidiol (THC), and cannabidiol (CBD).</p>
<p>THC is the type of cannabis that can make people feel “stoned”, while cannabidiol can make people feel relaxed and can hopefully relieve nausea.</p>
<p>Older cannabis medicines, such as Dronabinol and Nabilone, are made of synthetic THC. They are still sometimes used overseas as last-line options for treating nausea and vomiting caused by chemotherapy, but they’re not very effective, and can cause a lot of side effects.</p>
<p>The oral capsule for our NSW government-funded study contains equal amounts of THC and CBD. We think this will be more effective and have fewer side effects.</p>
<p>We worked with the Canadian company <a href="https://www.tilray.ca/">Tilray</a>, which developed the capsule to our specifications. It aims to minimise THC levels that have mood-altering characteristics, which means our patients are less likely to get “stoned”.</p>
<p>The trial is building on a small <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997305/">Spanish study</a> which found that a spray form of cannabis medicine containing THC and CBD in equal amounts (not routinely available in Australia) seemed to dramatically reduce nausea and vomiting in cancer patients receiving chemotherapy. The results, which found a 50% reduction in the number of patients suffering these effects, seem too good to be true, and need to be repeated in a rigorous clinical trial using a capsule that is available in Australia.</p>
<p>The NSW clinical trials exploring the use of medicinal cannabis are very significant. We don’t want to repeat past mistakes, and we want the investment in time and money to be worthwhile.</p>
<p>We can’t predict the outcome. The trials could show a benefit of medicinal cannabis, but they could also show that medicinal cannabis doesn’t work or has overwhelming side effects.</p>
<p>We are hopeful that, at the very least, NSW patients will be given a clear, scientific basis upon which to make important decisions about their treatment in the future.</p><img src="https://counter.theconversation.com/content/66774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Grimison is a medical oncologist from Chris O`Brien Lifehouse cancer hospital and The University of Sydney and is leading the research team for the NSW Government’s clinical trial into the role of cannabis-derived medicines in chemotherapy-induced nausea and vomiting. The University of Sydney and Chris O'Brien Lifehouse receives funding from NSW Health to conduct a clinical trial of cannabis for chemotherapy-induced nausea and vomiting, for whom Tilray have provided the study drug.</span></em></p>NSW is about to embark on the largest and most definitive clinical trial ever of medicinal cannabis for chemotherapy-induced nausea and vomiting.Peter Grimison, Medical oncologist from Chris O`Brien Lifehouse cancer hospital, Lead researcher NSW Government clinical trial into the role of cannabis-derived medicines in chemotherapy-induced nausea and vomiting, Clinical Associate Professor., University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/633562016-08-12T15:49:45Z2016-08-12T15:49:45ZCould friendly bacteria be used to treat cancer?<figure><img src="https://images.theconversation.com/files/133931/original/image-20160812-16372-1yn6gw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Though commonly associated with food poisoning, the strain of salmonella used is a benign variety.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/downloading_tips.mhtml?code=&id=229636501&size=huge&image_format=jpg&method=download&super_url=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTQ3MTAyODg3NSwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMjI5NjM2NTAxIiwiayI6InBob3RvLzIyOTYzNjUwMS9odWdlLmpwZyIsIm0iOiIxIiwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCIzSG5FeFlNZjhjb1NSMkt4M20yWVAvUXFOQVkiXQ%2Fshutterstock_229636501.jpg&racksite_id=ny&chosen_subscription=1&license=standard&src=lZH6XpZcJHXmzBAodf6H7g-1-12">Shutterstock/Tatiana Shepeleva</a></span></figcaption></figure><p>“The more I learn, the more I realise how much I don’t know.” Albert Einstein could have written these words about himself, a complex multicellular animal. The more we learn about ourselves and other animals, the more we appreciate that we are not simply an assemblage of the 200-odd cell types that make up the 20 or so organs and tissue types of a typical mammal.</p>
<p>A human being consists of about 10¹³ mammalian cells and, in addition, about ten times more non-human microbial cells – our <a href="http://learn.genetics.utah.edu/content/microbiome/">“microbiome”</a> – the majority of these being many different bacteria. These so-called <a href="http://www.gutmicrobiotaforhealth.com/en/glossary/commensal-bacteria/">commensal bacteria</a>, which we carry on and within us, are important for our well-being, although we’re only just starting to learn how important they are: a recent study revealed how chemical signals produced by some of our gut bacteria elicit the production of <a href="http://www.sciencedirect.com/science/article/pii/S0092867415002482">serotonin, the happiness hormone, in our cells</a>, for example. The emerging picture is that if we want to stay healthy then we need to ensure that we maintain our vast microbiome in a good state.</p>
<p>My own research on these bacteria started a few years ago with a conversation with colleague Miranda Whitten, who had recently returned from work which saw her injecting individual mosquitoes with “interfering RNA”. To learn more about the biology of complex animals such as mosquitoes, scientists use <a href="https://en.wikipedia.org/wiki/RNA_interference">interfering RNA</a> to <a href="http://www.nature.com/nrg/multimedia/rnai/animation/index.html">silence a target gene</a>. Comparing a control animal with another that has had a gene silenced can teach us things about the biological function of that gene and its product. </p>
<p>However, a small mosquito-sized animal is liable to die when it is injected, due to the trauma of being punctured by a needle. And larger insects with longer lives require repeated injections to prolong gene silencing. It was from this that Miranda and I began to explore if commensal insect bacteria could be used as a benign means of <a href="http://rspb.royalsocietypublishing.org/content/283/1825/20160042">continually delivering interfering RNA to their hosts</a>. We discovered that they could – something that will hopefully help us to better control diseases transmitted by insects like mosquitoes. </p>
<h2>Friendly bacteria</h2>
<p>As we worked on our research, I began to think about the bacteria that colonise human beings and how they could be exploited for medical treatments. A conventional medical approach is to first diagnose a disease and then treat the patient with a drug. Drugs can be delivered in various ways, but typically using oral administration by tablets, pills or a liquid. The drug is subsequently absorbed by the gut and distributed around the body, some of it arriving where it is needed to take action. Where possible the drug should have few side effects on healthy tissue. However, treatment of an aggressive disease such as cancer often requires chemotherapy drug treatment, which is highly toxic to both tumour and healthy tissue, and leads to serious consequences for the patient. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133930/original/image-20160812-16364-1x2790x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133930/original/image-20160812-16364-1x2790x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=327&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133930/original/image-20160812-16364-1x2790x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=327&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133930/original/image-20160812-16364-1x2790x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=327&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133930/original/image-20160812-16364-1x2790x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=411&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133930/original/image-20160812-16364-1x2790x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=411&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133930/original/image-20160812-16364-1x2790x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=411&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Cancer treatments, though effective, can damage other healthy tissues.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-240259327/stock-photo-green-blue-bacteria-d-rendering-background.html?src=pd-photo-433526728-1">cigdem/www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>It was this that led me to wonder whether we would be able to exploit bacteria adapted to live on or within humans to deliver medication. The concept embraces two ideas: that a given type of bacteria can potentially target a specific tissue in the body, and that these bacteria can be engineered to continuously produce the therapy once they’ve arrived at their destination and have colonised the diseased tissue. A single administration could potentially provide a continuous targeted treatment. </p>
<p>Given the debilitating side-effects of the current treatments available, we have begun to explore whether this idea could be possible for cancer therapy.</p>
<h2>Targeting tumours</h2>
<p>Tumours result from an accumulation of genetic changes in our cells and as they progress, they become more aggressive. This can be attributed to the activity of oncogenes – genes which, under certain circumstances, drive the rapid multiplication of cancer cells at the expense of healthy cells. Because of this, pharmaceutical companies have invested large research budgets into how to use interfering RNA to silence these oncogenes. But, as was the case in insects, a major hurdle is delivering this therapy, which has impeded much progress in using this method as a cancer therapy. </p>
<p>We have been using a harmless strain of salmonella bacteria in our research, which other researchers have shown <a href="http://www.sciencedirect.com/science/article/pii/S0958166911000619">preferentially colonise solid tumours</a>. Much as we did previously in our work with commensal bacteria in insects, we have engineered this salmonella to continuously produce interfering RNA to silence four different oncogenes in advanced prostate cancer cells. This research is at an early stage, but initial results suggest that the interfering RNA can silence these genes. </p>
<p>We are currently testing this new therapy, not only for prostate cancer but other solid tumours too, before any human trials can even be envisaged. If successful it could be a new way to treat a variety of medical conditions, as other bacteria which target other specific tissues can be developed to deliver different therapeutic payloads to alleviate a range of diseases.</p><img src="https://counter.theconversation.com/content/63356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Dyson receives funding from CRUK, Welsh Government and BBSRC.</span></em></p>What started with a study of diseases transmitted by mosquitos, could end with a new way of treating cancer.Paul Dyson, Professor of microbial genetics, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/496072015-11-02T14:13:42Z2015-11-02T14:13:42ZComplex sugar molecules may be the key to safer chemo<figure><img src="https://images.theconversation.com/files/100148/original/image-20151029-15365-1nqod8t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>The ability to aim chemotherapy drugs at cancer cells - and just cancer cells - has been <a href="http://www.cancerprogress.net/timeline/targeted-drugs">a goal</a> for medical researchers for a long time. So is the recent discovery of a <a href="http://bit.ly/1WjKcrv">malaria protein</a> that appears to target the tumour and not the patient’s normal cells a significant step forward in the arms race against cancer? </p>
<p>Certainly the idea of targeting cancer cells with proteins that carry a toxic drug payload is not new. In fact, several of these <a href="http://www.cancer.gov/about-cancer/treatment/drugs/fda-brentuximabvedotin">“protein-drug complexes”</a> have been approved by the US Food and Drug Administration since 2011. Perhaps the most important difference between this latest discovery and the available protein-drug complexes is the target: a complex sugar molecule that is mainly found on cancer cells or the placenta of pregnant women and is largely absent in other normal human cells. </p>
<h2>Helpful malaria parasite</h2>
<p>The origin of the protein that binds to these sugars, in this case from the malaria parasite, may make <a href="http://www.dailymail.co.uk/health/article-3270894/Cancer-breakthrough-MALARIA-protein-destroy-nine-10-cancers.html">big headlines</a> but its source is largely irrelevant. It is the ability of a protein to distinguish between cancer cells and normal cells that will largely determine its fate as a drug delivery mechanism. </p>
<p>The ultimate goal of cancer drug discovery has always been linked to the ability to discriminate between normal and cancerous tissue. The ability of a drug to kill cancer cells and not normal cells would minimise the toxic side effects associated with traditional chemotherapy and allow higher doses to be used to speed up the destruction of the tumour. </p>
<p>Proteins can be used to home in on a target on the surface of cancer cells and deliver a drug-laden warhead. This requires a target on the surface of the cancer cells that isn’t present on normal tissue. Scientists have been searching for these targets for many years and many so-called targeted cancer treatments have been developed, with varying degrees of success. </p>
<p>The idea that one such cancer target might be found in the placenta of pregnant women, as is the case for this latest discovery, may seem at first glance to be rather bizarre. However, researchers have believed for many years that the secrets associated with the initiation and progression of cancer, may be hidden in the way that the foetus develops from a simple pre-embryonic clump of cells and the <a href="http://www.scientificamerican.com/article/cancer-clues-from-embryos/">changes that occur</a> in the placenta during the baby’s development in the womb.</p>
<p>Understanding some of these normal development processes might lead to a groundbreaking discovery in cancer research, such as has been reported by these researchers. In this instance, the protein found on the surface of the malaria parasite was found to bind to targets on the placenta. This allowed the parasite to associate itself with the placenta, which can lead to a common complication of malaria infection in pregnancy. But the subsequent discovery that it also binds to specific sugar targets on the surface of cancer cells was exploited by the scientists.</p>
<h2>Sugar carries important information</h2>
<p>Although largely neglected by the scientific community, over many years, complex sugars are rapidly being seen as some of the most <a href="http://www.ncbi.nlm.nih.gov/books/NBK1963/">important molecules</a> on the surface of normal and cancerous cells. In many ways the information carried by sugars is far more complex than that carried in the DNA of your genes. And perhaps the most important advance in this new study is really the sugar target itself.</p>
<p>Previous attempts to use complex sugars as a target for cancer treatment have had been encouraging, however, most of these have involved work in <a href="http://www.nature.com/nrd/journal/v9/n4/full/nrd3012.html">cancer vaccines</a>. So the identification of proteins that can seek out sugars only found on the surface of cancer cells could be a major step forward in our ability to target cancer with protein-drug complexes.</p>
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<img alt="" src="https://images.theconversation.com/files/100146/original/image-20151029-15365-13jha5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/100146/original/image-20151029-15365-13jha5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100146/original/image-20151029-15365-13jha5t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100146/original/image-20151029-15365-13jha5t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100146/original/image-20151029-15365-13jha5t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=559&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100146/original/image-20151029-15365-13jha5t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=559&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100146/original/image-20151029-15365-13jha5t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=559&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Animal studies aren’t perfect.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
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</figure>
<p>So will this new “protein guided” drug delivery system really deliver cancer drugs to human tumours and minimise the risk of damage to the patient’s healthy tissue? Evidence from <a href="http://www.cell.com/cancer-cell/abstract/S1535-6108(15)00334-7">an experiment</a> with mice suggests that it will. Unfortunately, experiments on animals do not always translate into the successful treatment of patients, and we must be cautious in interpreting these kinds of findings. The number of different sugar structures on the surface of normal and cancerous cells is also vast and small differences can lead to their success or failure as a cancer-specific target. A relatively insignificant change in the structure of the sugars between the non-human models and patients could easily lead to the protein drug complex hitting normal cells as well as the cancer, causing considerable harm to the patient. </p>
<p>Although the results of this recent study are exciting, it will be a long time before we can determine its full impact on the field of targeted cancer treatment. Scientists and people with cancer will undoubtedly watch with great interest as these protein-drug complexes move into clinical trials.</p><img src="https://counter.theconversation.com/content/49607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Pye does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Targeting the complex sugars on cancer cells is receiving renewed attention.David Pye, Scientific Director of the Kidscan Childrens Cancer Research Charity, University of SalfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/479062015-09-23T16:36:52Z2015-09-23T16:36:52ZStarving cancer cells of sugar could be the key to future treatment<figure><img src="https://images.theconversation.com/files/95882/original/image-20150923-2617-1frwddr.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C736%2C547&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is sugar the answer for tackling cancer cells?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/wellcomeimages/5814247339/">Flickr/Wellcome Images</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>All the cells in our bodies are programmed to die. As they get older, our cells accumulate toxic molecules that make them sick. In response, they eventually break down, clearing the way for new, healthy cells to grow. This “<a href="http://www.ncbi.nlm.nih.gov/books/NBK26873/">programmed cell death</a>” is a natural and essential part of our wellbeing. Every day, billions of cells die like this in order for the whole organism to continue functioning as it is supposed to.</p>
<p>But as with any programme, errors can occur and injured cells that are supposed to die continue to grow and divide. These damaged cells can eventually become malignant and generate tumours. In order to <a href="http://www.ncbi.nlm.nih.gov/pubmed/19351640">avoid their programmed cell death</a> in this way, cancer cells reorganise their metabolism so they can cheat death and proliferate indefinitely.</p>
<p>Cancer researchers have <a href="http://www.ncbi.nlm.nih.gov/pubmed/19460998">known for decades</a> that tumours use a faster metabolism than normal cells in our body. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19029908">One classic example</a> of this is that cancer cells increase their consumption of glucose to fuel their rapid growth and strike against programmed cell death. This means that limiting glucose consumption in cancer cells is becoming an <a href="http://www.ncbi.nlm.nih.gov/pubmed/16892078">attractive tool</a> for cancer treatments.</p>
<h2>A new hope?</h2>
<p>You may have seen <a href="http://www.dailymail.co.uk/home/you/article-1025497/The-anti-cancer-diet--introducing-healthy-new-way-life.html">articles</a> or <a href="http://www.canceractive.com/cancer-active-page-link.aspx?n=3087">websites advocating</a> that starving patients of sugar is crucial for getting rid of tumours or that eating less sugar reduces the risk of cancer. The story is not that simple. Cancer cells always <a href="http://www.ncbi.nlm.nih.gov/pubmed/23177934">find alternatives</a> to fuel their tank of glucose, no matter how little sugar we ingest. There is not a direct connection between eating sugar and getting cancer and it is always advisable to talk to your doctor if you have doubt about your diet. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95887/original/image-20150923-2648-1vrhcpm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Chemotherapy – the most common cancer treatment.</span>
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<p>Researchers <a href="http://www.ncbi.nlm.nih.gov/pubmed/19270154">have demonstrated</a> that cancer cells use glucose to generate the building blocks of the cellular compounds needed for rapid tumour growth. They also use it to <a href="http://www.ncbi.nlm.nih.gov/pubmed/19029908">generate molecules</a> that guard against the toxic accumulation of reactive oxygen species, the cell-damaging molecules that activate programmed cell death. This means that glucose serves as a master protector against cell death.</p>
<p>If the amount of sugar we eat doesn’t affect this process, the question we need to answer is how the cancer cells are instructed to consume more glucose. Who is filling the fuel tank? We have discovered that what allows tumours to evade their natural cause of death in this way is a protein that is overproduced in virtually every human cancer but not in normal cells.</p>
<h2>Turbocharged growth</h2>
<p>In a <a href="http://www.nature.com/ncomms/2015/150810/ncomms8882/full/ncomms8882.html">recent study</a> published in Nature Communications we showed that cancer cells stimulate the over-production of the protein known as PARP14, enabling them to use glucose to turbocharge their growth and override the natural check of cell death. Using a combination of genetic and molecular biology approaches, we have also demonstrated that inhibiting or reducing levels of PARP14 in cancer cells starves them to death.</p>
<p>The best news is that by comparing cancer tissues (biopsies) from patients that has survived cancer and those that have died, we have found that levels of PARP14 were significantly higher in those patients that have died. This means that levels of PARP14 in cancer tissues could also predict how aggressive the cancer would be and what the chances are of a patient’s survival.</p>
<p>This means that a treatment which could block the protein could represent a significant revolution in the future of cancer treatment. What’s more, unlike traditional chemotherapy and radiotherapy, the use of PARP14 inhibitors would only kill cancer cells and not healthy ones. The next step is to design and generate new drugs that can block this protein and work out how to use them safely in patients.</p><img src="https://counter.theconversation.com/content/47906/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Concetta Bubici receives funding from Key Kendall Leukaemia Fund. </span></em></p><p class="fine-print"><em><span>Salvatore Papa receives funding from Foundation for Liver Research and AMMF-Cholangiocarcinoma Charity</span></em></p>Eating less sugar isn’t enough to stop glucose-hungry cancer cells but new research points the way to how we might starve them to death.Concetta Bubici, Lecturer in biomedical science, Brunel University LondonSalvatore Papa, Senior scientist, Institute of Hepatology, Birkbeck, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/434942015-06-22T13:07:28Z2015-06-22T13:07:28ZHow weaponising the body’s immune system can deliver a cure for cancer<figure><img src="https://images.theconversation.com/files/85907/original/image-20150622-17736-1499am9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fighting back</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>We’re beginning to treat cancer in a whole new way. Rather than killing cancer cells directly with chemo or radiotherapy, the latest treatments are designed to promote the body’s natural immune control over the disease.</p>
<p><a href="https://theconversation.com/explainer-what-is-cancer-immunotherapy-24476">So-called immunotherapy</a> works to stimulate the body’s own immune system to destroy the cancer. It is not a new concept and was first described more than a century ago, but for the first time it is beginning to deliver long-lasting responses, which some are <a href="http://www.telegraph.co.uk/news/health/news/11641771/Cure-for-terminal-cancer-found-in-game-changing-drugs.html">daring to call cures</a>.</p>
<p>Behind these advances has been a more sophisticated understanding of the relationship between the immune system and cancer, particularly how the cancer is seen as a danger by the body and can disguise itself from immune attack. The most promising immunotherapies are <a href="http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/immunotherapy/immunotherapy-monoclonal-antibodies">antibody drugs</a>, which target key switches on immune cells and fall into two main classes: checkpoint blockers such as ipilimumab and nivolumab, which remove the cancer’s ability to switch off the immune system, and immunostimulators such as anti-CD40 and anti-4-1BB, which promote active immune responses from the body.</p>
<h2>Immunotherapy advantages</h2>
<p>There are several key reasons why weaponising the immune system in this way shows such promise in the fight against cancer. First, the immune system is mobile. Its ability to patrol the whole body means it is able to recognise cancer cells wherever they are. And cancer’s ability to spread is frequently the cause of recurrence following other treatments.</p>
<p>Second, the immune system is self-amplifying. It is able to increase its response as required to tackle large, advanced cancers. This property means that it will sometimes work better the more cancer is present, responding to a larger immune stimulation.</p>
<p>Third, the immune system can evolve and adapt to changes in the cancer. Cancers are genetically unstable, meaning that they can change and “escape” from conventional treatments. This situation is exactly what the immune system has evolved to cope with in its battle with pathogens. So as the tumour changes, the immune system can also change in parallel, keeping the cancer cells locked down.</p>
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<span class="caption">Searching for a cure.</span>
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<p>Fourth, the immune system can recognise an almost limitless number of target molecules on the cancer. This ability to recognise so many targets at once makes it much more difficult for rare variant cancer cells to escape out of immune control by changing their appearance. It also broadens the types of cancer that may be susceptible to immunotherapy.</p>
<p>Finally, the immune system has memory. We see this with infectious diseases, with protection against a second round of infection from a particular germ. This is what provides us with life-long protection from some diseases after catching them as children or receiving vaccinations. For cancer, this means that the immune system can be “immunised” to the cancer cells and detect and delete them if they try to grow back. Most cancer treatments only work while they are being given: an immune response can last a lifetime.</p>
<p>These five features of immunotherapy combine to deliver major benefits, including the ability to deliver durable, perhaps life-long responses, tantamount to cures, even in advanced, previously fatal cancers.</p>
<h2>Future challenges</h2>
<p>The challenge now is to understand why some people, and some cancers, respond much better to these therapies than others and how to increase the proportion of people who experience good responses. Data reported <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1504030">only last month</a> shows that combining immunotherapy treatments by giving two checkpoint-blocking antibodies at the same time extends the number of patients with effective and lasting responses. Unfortunately, it also increases the unwanted side effects from immune attack on some of the body’s normal tissues.</p>
<p>While the results from the recent clinical trials are incredibly promising, it is clear that we are just at the beginning of our journey to understand the immune system and harness its power to destroy cancer. We already know that the complex interplay between the genetic make-up of the tumour, the status of someone’s immune system, and the interaction between the two will sculpt the immune response <a href="https://theconversation.com/number-of-immune-cells-in-tumours-could-soon-help-predict-and-treat-cancers-31806">in different ways</a>.</p>
<p>How, then, to best boost the immune system? We recognise that large multidisciplinary teams– comprising clinicians, immunologists, molecular biologists, geneticists and others – with concentrated resources are required. In Southampton, this will coalesce around a new purpose-built <a href="http://www.southampton.ac.uk/youreit/">Centre for Cancer Immunology</a>, which will open in 2017 with the aim of bringing the right people together and providing cutting edge facilities.</p>
<p>With the development of such centres, our understanding of the immune system in health and disease will continue the rapid expansion of immunotherapy, leading to many new opportunities for treatment. Soon these will become more specific, effective and safe – leading us into a new era of cancer treatment.</p><img src="https://counter.theconversation.com/content/43494/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Cragg consults for Bioinvent International and receives grant funding from CR UK, LLR, Kay Kendall Leukaemia Fund, MRC, BBSRC as well as Bioinvent International, GSK and Roche</span></em></p>New immunotherapy drugs that enhance the body’s natural ability to fight cancer offer several key advantages over previous treatments.Mark Cragg, Professor of Experimental Cancer Research, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.