Medicine 2019: Innovation plenary

Day 2 of the RCP annual conference included a plenary session focusing on innovation, chaired by the RCP president Professor Andrew Goddard.

The session was wide-ranging and began with Dr Mariam Jamal-Hanjani, senior clinical lecturer and consultant medical oncologist at UCL Cancer Institute and UCL Hospital, presenting on cancer today – tumour evolution and clinical implications.

Her key messages on tumour evolution:

  • as tumour cells’ replication is deregulated, they develop further mutations – ie ‘evolve’ – as the tumour grows, leading to a heterogeneous tumour with different mutations in different regions of the tumour (subclones)
  • this tumour evolution and intratumour heterogeneity can limit treatment stratification and response
  • heterogeneous tumours may act as ideal substrates for selection of resistant subclones under selection pressures such as chemotherapy, resulting in therapeutic resistance and failure
  • longitudinal sampling studies have the potential to inform evolutionary trajectories, and the process of metastatic disease
  • novel drug development strategies need to consider tumour evolution, such that pathways facilitating and constraining cancer evolution may be predicted and harnessed.

In the future, Dr Jamal-Hanjani suggested, we hope to be able to offer patients combined therapies and be one step ahead of the tumour. Advancements in non-invasive techniques, such as measuring biomarkers in circulating tumour DNA, mean that we can follow and predict the evolution of a tumour within an individual, leading to better outcomes.

This was followed by Prof Eric Alton, professor of gene therapy and respiratory medicine at Imperial College London and an honorary consultant physician at the Royal Brompton Hospital, who focused on developments in gene therapy for people with cystic fibrosis 30 years since the identification of the CF gene.

Prof Alton outlined the process and results of the clinical trial for people with cystic fibrosis, which highlighted that:

  • proof of concept that gene therapy can provide clinical benefit for patients with cystic fibrosis has been established through clinical trials
  • a novel lentiviral vector is being developed which appears to have considerably increased efficiency compared with non-viral vectors
  • it appears that it can be given more than once with no loss in efficacy.

Prof Alton concluded by saying that having been established for some time, gene therapy is now starting to be considered as a good option rather than an experimental treatment.

Finally, Dr Chris Booth discussed taking organ donation beyond 2020 and what future innovations may bring. A consultant in intensive care medicine, Dr Booth is also the regional clinical lead for organ donation in the North West.

He looked back over the history of organ donation from early transplants in the 1950s, to the more recent non-beating heart transplant.

The UK is a world leader in donation after circulatory death (DCD), leading to increased organs available for transplant and an improvement in the waiting list. There is greater potential for organ donation after death, and innovation is helping with organ reconditioning to make this possible.

Dr Booth said, ‘The future could be an ICU full of organs on machines being reconditioned before being transplanted into patients.’

Changes to the law will also help to increase consent rates for organ donation. In spring 2020, legislation in England will change to deemed consent for adults over 18, which will shift the presumption towards consent for donation, unless they opt out.

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