March marked an important month in the campaign to raise awareness about different types of cancer – it was both Colorectal Cancer Awareness Month and (Renal) Kidney Cancer Awareness Month.
Colorectal Cancer and Renal Cancer are two of the focus indications of the IMMUcan project, among others. To better understand IMMUcan’s work in these two indications, and how the project is filling in a much needed research gap, we interviewed two leading research groups that are collaborating in the project.
Dr Clélia Coutzac (MD, PhD) and Dr Matthieu Sarabi (MD) are both Gastroenterologists at the Centre Léon Bérard, the Cancer Research Centre of Lyon. As newly joined partners in the IMMUcan consortium, they sat down with us for a conversation about their work, why they are on board the project, and how they hope IMMUcan can contribute to bettering the lives of patients living with and being treated for Colorectal Cancer (CRC).
Can you tell us about your work on CRC within the remit of IMMUcan?
ʺYes, we recently joined the consortium and participated in our first meeting. In IMMUcan, our role is to focus on CRC, metastasis and primary tumours to understand the history of the dissemination of the disease and the tumor. And then, to analyse [the tumor] on multimodal channels observing the situation happening in the microenvironment, and using for example sequencing technologies, or multiplex staining ʺ explained Dr Sarabi.
ʺWe are clinicians, and we also do research in our lab in the Centre Leon Berardʺ shares Dr Coutzac. ʺWe are interested in IMMUcan because we have a lot of information which could be useful for the future. For us it’s a natural partnership.ʺ
What is the ultimate impact of these tools and information being accessible to you? What is the significance of it?
ʺThere are many applications we can see from here,ʺ shares Dr Sarabi. ʺFirst, the therapy – we are always looking for new targets to innovate and treat, and develop new treatments for our patients especially those that have a metastasis. ʺ
ʺSecond, to find characteristics that lead to a better understanding and therefore to progress in all aspects of colorectal cancer management, whether it be diagnosis, prognosis, prediction and even screening. The last twenty years there have been huge efforts to screen patients, and this has paid off as screening has been shown to reduce colorectal cancer mortality. Having new tools at each of these steps would be further progress in CRC care.ʺ
Dr Coutzac adds, ʺthird, if we have another vision, its that of cancer biology as a whole. It wasn’t really reported that you have metastasis and the primary tumor at the same time. With IMMUcan, we have three points: the molecular, the immunological and the spatial point that we are gathering information on. This is very interesting to integrate all the data and see if there is a difference between the primary tumor and the metastasis, and also to improve our knowledge of cancer biology in general.ʺ
So this can be used not only for the primary tumor and are undergoing various phases of tumor, but also screening? How can this help with screening?
ʺOf course,ʺ says Dr Sarabi, ʺit could help to detect early disease but it can also help us after.ʺ
“Screening is only allowed in situations where we know enough about the evolution and biology of a pathology. In the case of CRC, we know that removing all the polyps, during a colonoscopy performed every 3 to 5 years, will decrease the risk of having a CRC: but should we really remove all of them? Can we better define an individual risk precisely enough to stop the surveillance in one person or on the contrary to reinforce it in another person more at risk of CRC?
Another example is that of stage 3 CRCs of which about half will relapse. We need to better identify the people most at risk. I am convinced that improved knowledge of colorectal cancer can be a potential contribution at all steps of its management from screening to the most advanced stages.”
What do you hope to take back to the patients you see from the samples you are analysing?
ʺWe are gastroenterologist and we treat patients with CRC every day. This is why this data is important for us. We work mainly on immunological biomarkers, but we have colleagues that work with molecular data. It can be a good opportunity for us to have this information and validate our prospective data and cohorts, and it can help us have preliminary data for the future, ʺ concludes Dr Coutzac.
Renal (Kidney) Cancer
Dr Pablo Maroto (PhD MD) is presently a Medical Oncologist working in the Hospital Sant Pau, Barcelona; he is an Associate Professor of the Universidad Autonoma de Barcelona, and has been working in the Genitourinary (GU) arena for the last 25 years. Most recently, Dr Maroto was appointed Chair of the EORTC GU working group.
In this interview, he shares with us the importance of IMMUcan for the area of Renal Cancers, and how he hopes the project can expand our understanding of how to best treat patients.
Can you tell us more about your work within the IMMUcan project?
ʺI think academic research and translational research are an important part in the treatment of patients with cancer in general and specifically Renal Cancer. This is something we don’t often see in life-sciences industry research –a new way to introduce new therapies, and better select patients for a specific therapy.ʺ
ʺFor the last 25 years I have been working with patients with Renal Cancers. I’ve had the opportunity of seeing the development of a large number of new therapies. The number of therapies we had in the old times for metastatic kidney cancer were limited and not easily tolerated by patients. But since about 2005 we have seen the development of anti-angiogenics, and later new and modern immune therapy, which has completely changed the treatment paradigm of this disease. Unfortunately, not all patients respond well to the same therapy. In addition, if you have available more treatments, you must choose in order to provide the best risk/benefit ratio for your patient, and ideally based on an objective biomarker. IMMUcan may help to develop such biomarkers.ʺ
Can you tell me about your role as chair of the EORTC GU group, and how this relates to IMMUcan?
ʺI’ve been collaborating with the EORTC for the last 20 years and in the last months have been appointed the chair of the GU group. One of our targets is to increase patient recruitment in the IMMUcan project. The Group understands the importance of conducting translational research for the development of new therapies and biomarkers for patients under immunotherapy, in this case specifically for kidney cancer.ʺ
ʺOur work is just getting started. Our objective is to notify clinicians in the EU group of the IMMUcan project, and to emphasise the importance of translational research to our members. We’ve increased recruitment in our hospital, through a better communication with our team. We want to increase recruitment within the GU group through improved communication. As a token example, in our next meeting, we will make a presentation to support our recruitment efforts; newsletters and workshops may be the next steps.ʺ
How does these impact patients?
ʺ We have two barriers to recruitment – first, our role is to help the patients understand the importance of informed consent and permissions to go ahead with the study. And try to explain how this project may help themselves or other patients in the future. The second one is for doctors. We need GU doctors to be aware and understand the study and inform them of the importance of the project and how including more patients in the study can help their patients.ʺ
What happens next? Is the aim to process the samples and produce a molecular report?
ʺIts more than that – we will get a huge amount of information (tumour, plasma of patients….). In the future we can do even more things with that material we have collected. Yes, we would have a first report, but if we have that material in the future when we may have better tools, we can do even more studies. The long term goal is to do more research in the future. This applies for existing technologies as well as future technologies. For example, if we identify in the future an important biomarker, we can go back and check on that idea.ʺ
Is there a special importance for renal cancers to participate in a study like IMMUcan?
ʺWe have now an increased number of new therapies, but we still need biomarkers to better select patients and identify the best therapy for a specific patient and relate it to a new therapy that is being used. Not all patients respond to new therapies so this is the challenge. Moreover, treatments may be toxic and they are expensive. To better select patients we need translational research to give the information that allows us to better select patients for a specific therapy. This is the main objective for us in renal cancer for IMMUcan. To help us to understand why in some patients immunotherapy works, in order to better select patients that will respond to this therapy. ʺ
ʺKidney cancer is a large number of different diseases. So working on the molecular level and biomarkers level, and selecting patients will increase the information we have to better select therapies for these patients.ʺ
How does this add to our knowledge of how immunotherapies are used in the treatment of kidney cancer?
ʺRecently we’ve seen positive trials in an adjuvant therapy – this is not approved in Europe yet, but immunotherapy is slowly moving earlier in the treatment of the disease. More information about what patients respond better to immunotherapy could even help us to better select patients for adjuvant trials. Right now the main indication is for metastatic patients.ʺ