given tumor or organ type are frequently found in other organs. This is relevant, since tumour behavior is largely dictated by the mutations that a tumor carries rather than the site at which the tumour originates. “This is


largely established,” he continues, “but


matching tumor treatment with the presence of specific DNA mutations is a relatively young field of research, even if personalised treatment in itself is not new.” Medema shares an example of how NKI is working


with this knowledge in the case of certain colon cancers, which have not responded to a certain drug as many thought they would respond, but when the pathways were examined in the group lead by Professor Rene Bernards at the NKI and two drugs were combined,


tests


successful. This study is now undergoing clinical trials at the NKI and although Medema admits that it is early days for this treatment, he is confident of some success. “It’s a drug combination,” he explains. “So a drug that


this work being done at the NKI. “And to understand cancer, we need to do a lot of fundamental cancer research, which we then turn into useable knowledge that translates into clinical application. “This has always been the case,” he continues. “But,


historically, the fundamental research programmes have been quite far from clinical application because we simply didn’t understand that much about cancer. As a consequence the translational research programmes have been more limited because we simply didn’t have a lot to translate. We are now seeing results from fundamental research programmes


that lead


“Historically, the fundamental


research programmes have been quite far from clinical


application because we simply didn’t understand that


much about cancer”


directly to clinical trials.” It is this “usable knowledge” that is key to Medema’s


work. By gaining more of an understanding about the pathways cancer cells take and what, essentially, has gone wrong with those cells he will be able to “translate” that knowledge into how it can be best applied to specific types of cancer. “We are moving away from seeing things as organ-


specific types of cancer,” he explains. “It is equally likely that we find a prostate cancer and a breast cancer that are alike as the chances of finding two breast cancers that are alike in terms of the way that they respond to drugs.” This has significant implications for the way different


cancers are treated, meaning that treatments are increasingly tailored specifically for the patient, rather than to the type of cancer, something of a holy grail for all working in this field, as Medema explains: “What the cancer biology community has uncovered


is that the number of DNA mutations in a cancer cell can be quite extensive,” he says. “There is not always a specific link between a type of mutation and a particular organ - and certain mutations found in a


www.projectsmagazine.eu.com


we would have predicted, initially based on mutational profile, to be effective for these colon cancers turned out not to be effective so Bernards went back to the lab and asked why not? His team looked to see if another pathway was co-activated in these tumours, and when they found it was, they used a drug for that pathway and this turned out to be effective. Now whether this is truly a useful therapy, remains to be seen, but patients are being studied in clinical trials right now.” “Trial and error” has been commonplace in clinical


trials over the years, but Medema points out that what has changed is the useful


information fundamental


research is providing for direct clinical application and the time it takes to move from fundamental research in the lab to clinical trials. The colon cancer testing, for example, took just nine months from the discovery in the lab to the first patient being enrolled in the clinical trial. “Historically, that’s a major accomplishment in terms of time,” he says. Another main focus of


the NKI under Professor


Medema is to address the possibilities for cancer treatment within the immune system. Many researchers and institutes around the world are doing similar work


in trying to discover whether


immunotherapy can increase and improve cancer therapies and Medema believes we are now starting see the benefits of this work. “One example of


this is the work Professor John


Haanen is doing on metastatic melanoma,” explains Medema. “His group is using immune therapies to try to dampen tumor growth, sometimes very successfully. Now researchers at our institute are looking to try to combine this with radiotherapy,” he continues. “In radiotherapy a lot of the tumour material will be dead so we are looking to exploit this dead material to activate the immune system, allowing it to give radiotherapy that extra boost. We are hoping to be able to implement this into trials in the near future. “Another focus for us in this work is attempting to better understand drug resistance,” he


continues.


“This is one of the major problems in the treatment of cancer, so our research at NKI is aimed very much at


27


in rats have proved them to be


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68