Minutes of All Party Parliamentary Group on Pancreatic Cancer’s AGM

25th March 2014

MPs and Peers attendees:

• Eric Ollerenshaw MP (Chair) (EO)
• Baroness Morgan (Vice Chair) (BM)
• Lord Patel (Secretary) (LP)
• Mike Weatherley MP (MW)
• Richard Benyon MP (RB)
• Bishop of Bristol (BB)
• Tim Howard, Office of Baroness Finlay MP (TH)
• Lord Aberdare (LA)

Pancreatic Cancer UK/Whitehouse Consultancy

• Debbie Wells, Pancreatic Cancer UK (DW)
• Clara Mackay, Pancreatic Cancer UK (CM)
• David Park, Pancreatic Cancer UK (DP)
• Laura Tosney, Pancreatic Cancer UK (LT)
• Frances Powrie, The Whitehouse Consultancy (FP)
• Julia Ogiehor, The Whitehouse Consultancy (JO)

Voices and other attendees

• Dr Jo Tod (guest speaker) (JD)
• John Lancaster (JL)
• Doug Goodman (DG)
• Celia Goodman (CG)
• Susan Jefferd (SJ)
• Sophie Noble (SN)
• Ali Stunt, Pancreatic Cancer Action (AS)
• Maggie Blanks, Pancreatic Cancer Research Fund (MB)
• Giuseppe Fusai (GF)
• Tim Elliot (TE)
• Victoria Coupland (VC)
• Geri Keane (GK)
• Satvinder Mudan (SM)
• Andrew Miller (AM)

Minutes

AGM – election of officers for 2014/15

The AGM portion of the meeting took place first. The following officers were elected for 2014-15.

• Eric Ollerenshaw MP was elected as Chair
• Baroness Morgan – was elected as Vice Chair
• Nic Dakin MP – was elected as Vice Chair
• Lord Patel – was elected as Secretary

Update on APPG’s last report, Time to Change the Story: A Plan of Action for Pancreatic Cancer

EO welcomed the attendees and thanked everyone for their work which had led to Abraxane being included the Cancer Drugs Fund. He praised the work of Pancreatic Cancer UK on the ‘Two More Moths Campaign’ as well as the work of Pancreatic Cancer Action. He informed the meeting that the APPG will contact the Cancer Drugs Funds in 12 months’ time to see what has happened with regards to the use of the drug.

EO then updated the meeting on the APPG’s recent report, Time to Change the Story: A Plan of Action for Pancreatic Cancer. He informed the meeting that a letter had been sent to the Department of Health asking for a response to the report, and that he had received a short response to this. However he had returned to the Department of Health requesting a more substantial reply, which he still awaiting.

EO suggested that the APPG formally invite a Minister in a couple of months, after a proper response has been received, to give more details on how the Department of Health intends to take forward the recommendations made in the report.

Confirmation of the terms of reference for a follow up inquiry into pancreatic cancer research

EO updated that the APPG will be launching a follow-up inquiry into pancreatic cancer research, looking at the barriers to increasing the level of research into pancreatic cancer, as well as building on work undertaken by organisations within the sector, such as Pancreatic Cancer UK’s A cancer of unmet need: the pancreatic cancer research challenge.

EO introduced the terms of reference for the inquiry and provided copies to the attendees.

EO briefly gave an outline of the terms of reference and asked the meeting to consider these. He said that once written submissions were received, the APPG would look to hold oral evidence sessions to hear from specialists in this area. EO asked the meeting to take copies away to study and welcomed any particular comments or initial thoughts on who the APPG should be talking to.

Some initial comments were received on the terms of reference:

• CM highlighted that the inquiry could cover the general scope of clinical trials and access to clinical trial into pancreatic cancer. She added that pancreatic cancer patients have less access to clinical trials compared to other types of cancers. The inquiry could therefore look at the national variance with regards to distance in trials, which could be an important indicator into early diagnosis. AS agreed.

• One of the attendees added that he was pleased to see structural barriers to increasing pancreatic cancer research included in the terms of reference. He said that progress will not be made until there is sufficient research funding.

• AM stressed the need for educational research to be included in the inquiry, saying that it is the best way to educate GPs on how best to identify and deal with pancreatic cancer. EO noted that this would come under the “role of research in improving early diagnosis” arm of the Terms of Reference.

• AS suggested that the inquiry look into what has been happening in the US, saying that though the structures are different, it will be interesting to compare research funding.

• GF added that identifying standard criteria and producing consensus documents for when cancer is and isn’t operable would be important.

• MB said she was not sure whether this point came under the research umbrella the inquiry intends to focus on.

• EO noted that this point could come under the “role of regional specialist pancreatic cancer centres”, which the inquiry is looking to consider in terms of what the guidelines are operating under.

EO concluded discussions on the terms of reference, asking all in attendance to review their copies and return with comments.

EO then introduced Dr Jo Tod, a Clinical Research Fellow at Southampton University, who gave a presentation on her current research into how pancreatic cancer spreads.

Presentation from Dr Jo Tod, Clinical Research Fellow, University of Southampton on “The challenges of pancreatic cancer from a research perspective.”

Dr Tod introduced herself and her role at Southampton University, thanking the APPG’s officers and Pancreatic Cancer UK for inviting her to present.

She then gave an overview of the development and spread of pancreatic cancer, the various forms of well-known treatments, and why pancreatic cancer is difficult to treat.

The presentation discussed the significance of tissue which surrounds the tumour cells (the stroma) – which is more prominent in pancreatic cancer than other cancers and noted how patients with more stromal tissue had a shorter survival time.

Dr Tod explained the tumour stroma consists of; including increased number of different types of immune and inflammatory cells that has been collected by the tumour, to help it grow; and the pancreatic stellate cells. She noted that the majority of research focuses on the cancer cells rather than the stromal cells although this area has been growing in recent years.

The pancreatic stellate cells are inactive cells that become activated by several factors, including alcohol (In the case of chronic pancreatitis for example), but mainly ‘TGFB’ in pancreatic cancer, a factor which is produced by both the cancer cells and ‘activated’ pancreatic stellate cells. She explained how pancreatic stellate cells are critical to tumour growth and metastatic spread and how pancreatic stellate cells have been shown to travel to sites of tumour spread. She discussed the presence of immune cells in the tumour which aid tumour growth and the relative lack of immune cells which ‘fight’ against the cancer.

Dr Tod then briefly explained requirement for new blood vessels in order for pancreatic cancers to grow, showing the audience how the development of the blood vessels – around the edges of the tumour, as opposed to the tumour core – makes it difficult for drugs treatment delivered in the blood to get access to the centre of the tumour.

She noted that clinical trials into increasing tumour blood supply and therefore drug delivery has already begun. Other clinical trials currently taken place includes research into the immune and pancreatic stellate cells. Targeting the stroma cells has the benefit that the cells are ‘normal’ unlike the cancer cells which are genetically unstable.

She also noted the challenges – such as the difficulties in obtaining adequate tumour biopsies, the short survival time of patients, and the availability of research funding – facing research into pancreatic cancer.

The presentation was concluded by Dr Tod highlighting the activities in the tissue around the pancreatic cancer cells (‘the tumour microenvironment’) which are critical to the disease’s progression, and this is where research must focus in order to achieve more early diagnosis and gain a better understanding of new treatments of pancreatic cancer.

Questions and answers from Parliamentarians and other audience members

Dr Jo Tod took questions from a range of audience members.

One of the attendees asked why patients who have died from pancreatic cancer have not previously been approached for tissue samples for research.

Dr Tod responded and said that up until recently, there had not been a system in place where tissues were taken from patients with inoperable metastatic cancer, which was a flaw in research, although these are now being collected.

MB interjected and said that Pancreatic Research Fund is funding a national tissue bank that will provide researchers with more data into the area. Once this is established, the Pancreatic Research Fund will look into the possibility of getting tissues from patients after death; this is something the inquiry should also explore in more detail.

LP added that tissue banks are key to research into pancreatic cancer. He then asked Dr Tod why pancreatic cancer cells stimulated the pancreatic stellate cells.

Dr Jo Tod responded and said that scientists are now more aware of the factors stimulating the pancreatic stellate cells which have been secreted by the cancer cells in the tumour and research are being carried out to reverse these activities in the pancreatic stellate cells to stop it from progressing.

LP then noted the drugs that had been developed to do just this and commended Dr Tod on a good presentation.

BM noted that tissue banking is essential as it will enable what is learnt in one area to be applied in another, and urged the APPG to encourage and support it.

Dr Tod responded and highlighted the difficulty in obtaining tissue from patients with inoperable cancer.

BM mentioned a project in Manchester where the researchers are collecting liquid biopsies to identify circulating tumour cells from blood samples, and through advanced technologies and expertise, the doctors are able extract information from the smallest of cells, which can be used in assessing the best kind of treatment of pancreatic cancer.

AM added that he would urge research centres to work together and co-ordinate research. He said that it is positive to see centres such as Royal Holloway, London Cancer and the London Cancer Alliance all consolidating and coordinating their faculties and research.

GF informed the meeting of a national tissue bank currently being set up – subject to ethical approval – to collect tissue, saliva, blood and urine. He suggested that the APPG might want to feed into this.

Concluding remarks
In closing, EO thanked Dr Jo Tod for her time and presentation. He then informed the meeting that a series of dates will be sent out for inquiry sessions once comments on the terms of reference have been received. He thanked attendees for their support of the APPG on Pancreatic Cancer and for their attendance.

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