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Combatting cancer – news from the research front

In April the alarm was sounded: There is a risk that the number of cancer cases will double in the next 25 years and, despite major advances, medical science is facing ever greater challenges. At Uppsala University, however, researchers are positive about the future.

The term ‘cancer’ covers more than 200 diseases which are all caused by uncontrolled cell division. Despite major scientific advances, cancer still presents us with great challenges. In April, Cancerfonden (the Swedish Cancer Society) warned that the number of cancer cases could double over the next 25 years unless the proper measures are taken.
“An increase is unavoidable since we live longer and more affluently. Of course, we will work on prevention by sending clear messages such as: ‘Don’t smoke, or eat too much or spend too long in the sun, and remember to exercise.’ But we also have to accept cancer as a phenomenon of the industrialised world and set aside greater resources for research so that we can to increase the frequency of early diagnosis and improve the treatment of extended diseases,” says Bengt Westermark, senior professor of Tumour Biology and the chairman of Cancerfonden for the last ten years.

Bengt Westermark, senior professor of Tumour Biology

Swedish cancer research has a central position in our country’s rich scientific tradition. A major step was taken in 1951 when Cancerfonden was founded. This improved the financial situation for both basic experimental research and clinical research. Leading figures such as Lennart Philipson and Jan Pontén, both at Uppsala University, took their places on the international arena and, at the same time, helped to lay the foundations for the university’s continued success in this field.

“The enduring prominent position of Uppsala University within cancer research may be explained by a number of interacting factors. These include the culture which is characterised by collaboration and good will and also the well-equipped, strategically placed facilities at the Rudbeck Laboratory and the Biomedical Centre. Together, these form a solid base for regeneration, recruiting important personnel and our strong performance when funding calls are announced. This is confirmed by the many domestic and international grants awarded to our researchers,” says Bengt Westermark.

In 2010, Uppsala University set up U-CAN after being assigned by the Swedish government to start creating an infrastructure which would form the basis of a world-leading biobank within cancer research. Six years later the organisation and tools are in place and the total number of patients involved is approaching 10 000. The Swedish Research Council recently gave U-CAN its highest ranking after evaluating strategic research environments around the country.

“By collecting blood samples, tissue samples and information from tumour patients as we follow them through the entire care process, we have created a unique databank. Our evaluation results from the Swedish Research Council were an indication of our strength and confirmed that our strategic direction is both correct and relevant. The time has now arrived for us to turn our material into research and achievements. This is also our obligation to the many, often very ill, cancer patients who do not hesitate to put their energy into helping future patients,” says U-CAN co-ordinator Tobias Sjöblom.

Even if every cancer case is different, experience from previous treatments can mean the difference between life and death for the next person to suffer from it. The number of applications for access to the U-CAN biobank is increasing rapidly and several scientific studies supported by the materials are already in progress. One common feature of these projects is that they include clinically active researchers at Uppsala University who have taken part in the sample collection process.

“Some connection to us is a prerequisite for being granted access. The present heavy demand for patient materials has meant that what U-CAN can offer also helps to strengthen the competitive edge of our researchers. We have recently started marketing our services outside Sweden with the aim of setting up further international collaboration. A French company has already started studies based on biomaterial which is normally difficult to obtain but which we can provide,” says Tobias Sjöblom.

The time has now arrived for us to turn our material into research and achievements, says U-CAN co-ordinator Tobias Sjöblom. PHOTO: MIKAEL WALLERSTEDT

A hundred metres further south along Dag Hammarskjölds väg is U-CARE, another of the government’s strategic research environments. Here, a research team is putting together a digital infrastructure which will use a number of self-help programmes to provide online support and psychological treatment for people with bodily illnesses. The effects of the therapy will also be studied for scientific purposes.

“Treatment takes place exclusively over the internet and is primarily an interaction between patients and the portal. Of course, there is some human contact but the therapist’s role is only 10-20 percent when compared to traditional treatment. The model is better suited to certain groups which means that we have to regulate our selection of participants but we also have to be better at identifying every patient’s individual driving force and then apply the data to the one undergoing therapy,” says Sven Alfonsson, psychologist and doctoral student at the Department of Public Health and Caring Sciences.

The treatments U-CARE currently provides fall within the framework of ten studies at Uppsala University. The Swedish Research Council states in an evaluation that U-CARE is making good use of its resources in order to establish itself as a research environment – but the path to a workable tool has not been entirely without problems.

“In a study of young cancer sufferers, we found it difficult to attract participants and it wasn’t until the panel discussions with our target group that we realised what was needed to get teenagers involved. This showed how important it is to work with those we work for. Since then, we always involve the care receivers throughout the entire process. We have even employed the relative of a previous patient whose experiences are important for filling in some of the gaps in our work to make the portal fit the needs of the users. Soon we will have a finished product which we also hope to integrate into the health service,” says Helena Grönqvist, researcher at the Department of Public Health and Caring Sciences.

“Soon we will have a finished product,” says Helena Grönqvist.

U-CARE is one of many initiatives resulting from Sweden’s increasingly over-burdened health care resources. The need for health-economic perspectives is growing. The effects of treatment must be weighed against its price and so new, more cost-efficient alternatives are being tested. The question is whether the trend in recent years for research focused upon tailored medication and individual treatments really has a bearing upon the economic reality of the health service.

“In my opinion, we’ve pinned too much hope on such things. In reality, the health service can manage standardised examinations which may then categorise patients for tailored treatments,” says Peter Nygren, professor of Oncology.
“We’re making progress but at the current rate it will take several decades before we get where we want to be and there are many challenges to overcome on the way: Lack of finance, the gap between pre-clinical and clinical research and difficulties in reproducing results are just some of them. On the other hand, Sweden in general and Uppsala University in particular are among the leaders. There is a good return on every krona invested and if the financial situation remains viable there is hope that we can increase the pace of progress.”

Cancer research costs and finding the money to fully finance studies is a challenge many will recognise. For financial reasons, many promising projects never get out of the laboratory. This sometimes leads to creative solutions being sought. In Uppsala, professor Magnus Essand’s team developed a tumour-destroying (oncolytic) virus but the shortage of funds for clinical studies meant that the virus was literally put on ice – in the freezer. Much later, the Telegraph drew attention to the virus and this led to a global charitable fund. In March 2016, the first test was started on a patient with neuroendocrine cancer.

Professor Magnus Essand’s team developed a tumour-destroying (oncolytic) virus but the shortage of funds for clinical studies meant that the virus was literally put on ice – in the freezer. PHOTO: MIKAEL WALLERSTEDT

This form of so-called crowd-funding where the donors themselves choose which project to support is seen by some as a democratisation of research funding while others point out the risk that professional appraisal will be lost.

“I see it as a compliment. In the pre-clinical phase, our benefactors included the Swedish Research Council, the Swedish Cancer Society, the Swedish Childhood Cancer Foundation and the Gunnar Nilsson Cancer Foundation. But none of these can provide sufficient funding for clinical testing. What we received in our case was new money which would otherwise not have gone to Swedish research,” says Magnus Essand.

Bengt Westermark, who has both formulated and assessed innumerable funding applications, shares Essand’s opinion in favour of direct financing as long as the watchwords remain free competition, critical scrutiny and scientific diversity.

“Research funding is invested mainly where it will do good or where it is needed. As a researcher into  brain tumours, a relatively rare cause of death which attracts many grants, I am in a favourable position. The situation for, say, lung cancer is the opposite. However, the deliberations undertaken before funds are distributed are now better. State strategic research investments have now come along and within the EU we are among those competing for the major grants awarded by the European Research Council (ERC).

The fact is that when the EU Commission reported on the outcome of  the Seventh Framework Programme for Research and Technology with a budget of more than EUR 50 billion for the period 2007-2013, Uppsala University placed seventh among the largest receivers of research support in the calls for  health-related project funds, ahead of both Cambridge and King’s College.

Fredrik Swartling studies brain tumours in children.

A few years ago, Fredrik Swartling, a researcher at the Department of Immunology, Genetics and Pathology, was awarded a Starting Grant of EUR 1.5 million by the ERC.

“This means that, in collaboration with other people and organisations in North America and Europe, we can do long-term work on learning more about how children develop brain tumours. Personally, I see these kinds of large, targeted investments in younger researchers as necessary if we are to make an impact  internationally and in my opinion our chances have improved,” says Fredrik Swartling.

Cancer research at Uppsala University has clear reasons to be positive about the future and despite a half century serving science, Bengt Westermark has no plans to swap the laboratory for a rocking chair.

“The fact is that there are more ideas for every year that passes. Just recently some colleagues and I applied for an animal clinic for experimental treatments and we are also discussing with the hospital management ways of taking brain tumour  research to the next level. Simply put, this is a very exciting and inspirational environment to be in. More than anything, I like to see to all these younger, fantastic researchers coming along and carrying on the work of previous generations!

Magnus Alsne

Further reading

U-CAN prepares to take the next step
Six years have passed since U-CAN was tasked with seting up a unique biobank for our most common forms of cancer by the government – but are they ready to make Uppsala a global hub for leading cancer research?

U-CARE brings psychology into the digital age
Through close cooperation with patients and relatives, U-CARE has developed and established an online portal for research on psychological support and treatment in a short span of time. Now, the portal is on the verge of being integrated into the Swedish healthcare system.