It’s just after 9am and the June humidity is already making my hair stand up on end after I take my helmet off to enter the Corn Exchange in the centre of Cambridge. Thankfully, the organisers of the Milner Therapeutics Symposium didn’t forget the aircon today (or a delicious white chocolate canoli to go with our morning coffee!). The annual meeting is organised by the Milner Institute, a cross-disciplinary consortium of companies, start-ups, and academic departments all interested in pushing back the boundaries of drug discovery and development in an effort to accelerate new therapies to patients across disease areas. It was standing room only by the time Tony Kouzarides took to the stage to welcome us to the day.
While Repositive’s focus was squarely on the oncology talks presented throughout the day, we also felt that Sara-Jane Dunn from Microsoft Research deserved a shoutout for blowing our minds at 11 o’clock in the morning! Her talk, walking us through the process of applying programming principles and machine learning to cellular decision making and tissue development, was incredible. It made us really excited about the potential for taking her team’s findings from studies in stem cells and developmental networks into other areas of biology and disease intervention - one to watch in the future!
While the morning covered a broad range of topics from women’s health to programming, in the afternoon attendees split off to their tracks of interest. Below, I’ve outlined some of my key takeaways from the cancer-focused talks and posters on offer throughout the day.
The oncology presence at the symposium kicked off with a great talk from Gregory Hannon discussing the role that vascular mimicry plays alongside angiogenesis in tumour growth and metastasis. Investigated using novel imaging techniques, the ability for metastatic tumours to form impromptu vessels which “plug into” the circulatory system is fascinating but offers opportunities for tumours to avoid succumbing to anti-angiogenic therapies. Thanks to Hannon’s ongoing research, new mechanisms for re-sensitizing these types of tumour cells to anti-angiogenic therapies are being developed, but it highlights how much we still have to uncover about tumour migration and behaviour to offer truly effective therapies for patients.
Next up, Salvador Aznar-Benitah discussing the influence of dietary fat on cells with metastatic potential makes both my colleague and I frantically look up exactly which foods contain palmitic acid… Quite a few according to Wikipedia, unfortunately! Still, diving into exactly how metabolism and behaviour changes when cells become malignant is fascinating and highlights an area of research which we’re expecting big things from in the future, particularly in combination with other approaches such as immunotherapies or targeted drugs.
Lifetime Precision Medicine
There is perhaps a better, snappier phrase for this, but one of the key themes emerging from the oncology session centred around the concept of tailoring not just disease treatments to the individual, but screening patterns, prophylactic interventions, as well as building a holistic approach to treatment and monitoring with devices and digital health technologies. Not just precision medicine, but precision health and wellbeing.
For cancer, speakers painted a picture of large-scale monitoring and screening services identifying people at risk or with dysplasia early, before malignancy develops. Patients would then be sorted according to their results, with some requiring therapeutic intervention and others maintained on the monitoring programme. Yet others could be identified as high-risk and likely to benefit from prophylactic chemoprevention measures, from lifestyle changes to medicinal interventions. For example, chemoprevention with canakinumab for patients at risk of lung cancer has shown early promise in sub-analysis of cardiovascular clinical trials.
If a tumour does develop, diagnostics including rapid genome sequencing help to create a picture of the most likely successful therapeutic interventions for an individual based on their tumour profile. All the while, health technologies support continued monitoring, tracking of adherence to lifestyle interventions, and early detection of metastases.
Some of this is already implemented across certain tumour types - large-scale screening already takes place for cervical, breast, and bowel cancer to name a few, while others such as Cytosponge are now in clinical trials. The advent of advanced techniques to interrogate data, a superconnected world of medtech devices, and a shift in attitude in the field are now helping to push this networked management strategy for cancer patients and those at risk toward the clinic.
Not only is this integrated approach likely to result in improved patient outcomes, but as Justin Bryans from Life Arc and Rebecca Fitzgerald noted, it can also help to close the value gap on medicines and therapeutic interventions. The gap is currently a source of massive misalignment between industry and policy, particularly in the NHS so closing it is really key to help patients access the support and treatment they actually need.
Challenging Trials and Evidence
From an entrepreneurial perspective, several speakers described some of the major challenges facing commercialisation efforts for exciting research, namely the need for regulatory authorities to keep pace with changes in technology by offering meaningful guidance, as well as urging scientists to include health economic assessments of interventions as early as possible in the development process.
It was clear the speakers felt regulators are still struggling to keep up with the pace of innovation, particularly in diagnostics and screening technologies, despite the recent release of updated guidelines for drug-device combination products and in vitro diagnostics from the EMA. Bringing regulators and researchers closer together at an earlier stage in the process (such as prior to clinical trial design) is really critical to breaking down these barriers and supporting successful innovation, particularly for those making the jump from academia to start-up life.
Regulatory hurdles aside, there was also a clear message that innovators needed to be considering the economic impacts and opportunities of both therapies and devices earlier in the process and incorporate them into clinical trials (echoed in this recent STAT News article on a successful biodesign program at Stanford) to maximise their chances of successful uptake following positive clinical trial results.
For example, while false positives come with associated treatment costs (both economic and patient-based), Rebecca Fitzgerald highlighted that comprehensive early screening programmes for cancers could save the NHS up to £251 million a year in advanced treatment costs.
Several posters on the day also addressed the challenges with translation from bench to clinic, with the AstraZeneca and Cancer Research UK teams presenting their Functional Genomics Centre initiative to support the progression of basic research into life-changing therapies for oncology patients. We’re looking forward to seeing their new research at next year’s symposium!