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Opinion

How Darwin’s Theory inspired a new approach to treat incurable cancers

How Darwin’s Theory inspired a new approach to treat incurable cancers

The Anticancer Fund recently decided to support research on patient-specific adaptive therapies. ‘Patient-specific adaptive therapies’, now that’s a mouthful. Let me explain. Historically, it was assumed that incurable patients would need continuous high-dose therapy to shrink the tumour as much as possible to keep the cancer controlled. What’s gone is gone, right? As knowledge evolves, we got familiar with the issue of tumour resistance. This means that after a while, the tumour outsmarts the treatment and finds alternative paths for growth. The resistant cancer cells get to dominate the sensitive cancer cells and the tumour doesn’t respond to the treatment anymore.

What does Darwin has to do with this?

Back in 2009, the research group of Bob Gatenby (1) at Lee Moffitt in Florida, US, discovered that when you give just the necessary amount of treatment to control the tumour and then pause, that the tumour keeps its sensitivity to the treatment. This is because the balance between the resistant and the sensitive cancer cells remains in favour of the cancer cells that are sensitive to the treatment (2). This treatment strategy is called adaptive therapy.

This new approach of treating cancer was inspired on Darwin's Theory of Evolution. Amazing how Darwin’s findings still have an impact on clinical trials today.

Since there is no commercial interest in this kind of research, it is up to the Anticancer Fund to make sure that those strategies are being studied in well-designed clinical trials. And, to fund these trials which are ‘outside-the-box’. In 2021, we launched a call for clinical trials on adaptive therapies. From this call, two trials were selected: the ANZADAPT trial and the ACTOv trial.

We support these trials testing adaptive therapies

We announced the start of ANZadapt in Australia and in The Netherlands earlier this year. It’s a trial for the treatment of prostate cancer, the most common type of cancer in men. The trial aims at personalising the treatment with an on/off-strategy, also known as adaptive therapy. Earlier studies have shown that pausing the therapy when the cancer is stable, can prolong the response to the treatment by delaying the emergence of resistant cancer cells. In other words, if the outcome of this treatment strategy is positive, the patient will receive the treatment for a longer period of time and thus survive longer.

ACTOv uses a similar tactic for patients diagnosed with ovarian cancer, a type of cancer that affects approximately 314.000 women worldwide every year. The ACTOv-trial (Adaptive ChemoTherapy for Ovarian cancer) investigates a personalised treatment approach for ovarian cancer that has returned after previous chemotherapy. The trial is recruiting patients as we speak.

Discover the podcast

Intrigued by how we involve Darwin in our trials? Would you like to know more?
One of the investigators of the ANZADAPT trial, Associate Professor Craig Gedye, nicely explains the concept in a podcast of Oncology News:

https://oncologynews.com.au/tumour-stream/prostate-cancer-featured-news/what-is-adaptive-therapy-anzadapt-trial-with-craig-gedye/

Enjoy the listening, and please let me know what you think of this innovative therapy strategy inspired by Darwin's Theory.

(1) Bob Gatenby is member of the Board of Advisors of the Anticancer Fund

(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728826/ 

Useful links:

More about ANZadapt

More about ACTOv

Klara Rombauts
author

Klara Rombauts (MSc) is Research Manager and HR Coordinator of the Anticancer Fund. In the role of research manager, she has been answering questions from patients since the inception of the ACF and is passionate about empowering patients with the right information. Previously, she worked as a researcher in the pharmaceutical industry.