What a year 2018 has been for AICR and cancer research overall. These are exciting times for cancer research across prevention, treatment, and survivorship. While many of the headline-grabbing stories, and even a Nobel Prize, have focused on the treatment of cancer, there have been significant developments in cancer prevention and survivorship that I want to highlight. This year, 2018, has witnessed the convergence of several previously discreet cancer research tracks; now these tracks are seemingly converging on the territory that AICR has been mapping out for almost four decades.
Since 1982, AICR has focused on the role of diet, physical activity and body weight in cancer risk. This commitment has been most clearly demonstrated together with World Cancer Research Fund (WCRF) by our comprehensive First and Second Expert Reports, in 1997 and 2007, respectively. And in 2018, we published Diet, Nutrition Physical Activity and Cancer – a Global Perspective, our Third Expert Report, and the most comprehensive analysis of the worldwide body of evidence on prevention and survivorship through diet, nutrition, and physical activity. The disciplined review and synthesis of the available evidence, presented in each of our Expert Reports, has provided a reliable foundation from which researchers can launch new studies and clarify the gaps in our understanding of risk factors of cancer. With each successive iteration, the deep early skepticism, that making changes in diet, physical activity and body weight could change cancer risk, has been replaced by scientific credibility, mainstream acceptance, and empowerment of patients and populations.
The convergence of immune and metabolic factors with diet, physical activity and obesity are likely to provide deeper insights that could enable more effective treatments and more targeted prevention.
One example of the convergence of research themes concerns the key lifestyle factors that were originally investigated for their role in cancer risk and prevention but are increasingly acknowledged to be instrumental in both cancer treatment and survivorship. We see this synergy emerging between diet, activity and obesity and the most recent revolution in cancer treatment: immunotherapy. The concept of cancer immunotherapy has been around since the late 1800s but the advent of checkpoint inhibitors (molecules that “take the brakes off” the immune response to cancer) and Chimeric Antigen Receptor (CAR) T- cell therapy (in which a patient’s T-cells are collected and genetically modified to recognize cancer cells) have been transformative. Diet, activity, and obesity affect immunotherapy in several ways. The efficacy of immunotherapy is affected by the microbiome – the bacteria in our gastrointestinal tract – which is strongly influenced by diet and obesity. Obesity can also have dramatic effects on the side-effects of immunotherapy. It is likely that the combined lifestyle and immunotherapeutic approaches will be developed to synergistically enhance responses. AICR is already funding research that seeks to address the impact of lifestyle factors on anti-cancer immune responses.
Other aspects at the core of AICR’s mission have also been highlighted in landmark reports repeatedly in the past year. The US Centers for Disease Control reported the rising rates of obesity-related cancers. AICR/WCRF’s Third Expert Report summarized the role of overweight and obesity in cancer risk with strong evidence that obesity increases the risk of 12 types of cancer. Then, in November, AICR published another major report to identify the factors most strongly linked to weight gain, over weight and obesity. The Report, Energy balance, and body fatness – The determinants of weight gain, overweight, and obesity – an umbrella review – conducted meta-analyses of the existing literature. This report supports health professionals and policy makers in advocating lifestyle changes and policy measures that can help individuals and society implement positive actions that promote healthy body weight. Overall, these reports are enormously valuable to the research community and their impact is extended through the conclusions and evidence-based Cancer Prevention Recommendations.
AICR also funds projects that contribute to advancing the field of research in diet, physical activity, obesity, and cancer. In January 2018, we announced the funding of 7 projects that span the full spectrum of research from the laboratory to human studies and cancer prevention to cancer survivorship, all within the areas of diet, physical activity and obesity. We also had a host of grants completed, delivering valuable answers to critical research questions and enhancing our understanding of how lifestyle impacts cancer risk and outcomes.
So, as we approach 2019, the work that AICR conducts and funds looks set to be an even more crucial feature of the research and policy landscape. The convergence of immune and metabolic factors with diet, physical activity and obesity are likely to provide deeper insights that could enable more effective treatments and more targeted prevention. The one thing that seems certain, is that the rate of progress is accelerating every year, as our tools and understanding improve. Exciting times, indeed.