UCL Cancer Institute Seminar Series

Prevention of cancer is a priority in an ageing population with access to expensive but often unsuccessful drug treatments.  Many interventions such as smoking cessation and weight control lie outwith to primary area of responsibility of the clinical community.  There has been a longstanding interest in the concept of chemoprevention, now called therapeutic prevention.  The greatest success has been seen with routine use of anti-inflammatory drugs and aspirin in particular.  Long term follow up of old cardiovascular trial patients by Rothwell’s group and the results of the Women’s Health Study and our own CAPP2 trial, both of which had cancer as an endpoint, have produced convincing evidence that aspirin could and should be used routinely, at least in the high risk population.  

CaPP3 is exploring the optimal dose. The results of the CAPP2 study in Lynch syndrome make identification of people prone to mismatch repair deficient cancers more pressing.  This is also driven by the success of PDL-1 blockade which exploits the highly immunogenic nature of the cancers. The release of frameshift peptides by MMR deficient cancers offers an alternative approach which is to use these FSPs as epitopes for vaccine development.  Use of the viral vectors employed successfully in the development of the Ebola vaccine offers a possible approach to a cancer vaccine for MSI high cancers. 

Warfarin seems out of place but may turn out to be another example of potential “repurposing” which could reduce cancer and save the NHS money.  We have reviewed of the case in favour of warfarin over the newer but very expensive direct acting agents in part because we have developed the means to quickly and cheaply identify people who are warfarin sensitive. An unexpected bonus point for the older very cheap agent is a recent analysis of the Norwegian population databases which reveal significant evidence of reduced cancer rates in warfarin users.  A possible biological basis is that the gene AXT6 is sensitive to the effects of vitamin K inhibition and impacts on tumour proliferation. A potential bonus of reversing the current very costly conversion away from warfarin might be to reduce cancer rates.

Hosted by Professor Stephan Beck. This seminar has been sponsored in part by the Biomedical Research Centre and Cancer Research UK.

For further information contact: Veronica Dominguez v.dominguez@ucl.ac.uk