Filenews 28 October 2024
An important international meeting, in which leading scientists, graduate and postgraduate students and specialized professionals from the field of oncology and biology will take place in Paphos from 28 October to 2 November 2024 to share the latest developments in cancer research. This is the conference entitled "International Conference on Tumour Microenvironment and Cell Stress" (TMCS2024), which aims to provide a platform for discussion on new technologies and discoveries that can lead to innovative therapeutic interventions.
The main organizer of the conference is Professor Constantinos Koumenis, Director of the Department of Radio-Oncology Research at the University of Pennsylvania and Visiting Professor at the University of Cyprus and the Technical University of Athens in Athens. With many years of experience in research, Professor Koumenis and his team have made important discoveries, such as the use of proton radiation in FLASH format for cancer treatments, and aim to collaborate and develop research potential in Cyprus. Co-organisers are also the Cyprus Biological Society (CBS), represented by Dr Maria A. Tsiarli, President of the CBS Research and Higher Education Committee, Triantafyllos Stylianopoulos, Associate Professor at the Department of Mechanical and Manufacturing Engineering of the University of Cyprus, and Ms Erato Stylianou-Markides, Medical Physicist at the Bank of Cyprus Oncology Foundation.
Cyprus as an important centre of cancer oncology research and treatment
On the occasion of the arrival in Cyprus of many scientists from leading institutions for this Conference, a substantial conversation took place with Professor Koumenis, who answered several questions, enlightening us more broadly about both the Conference and the latest developments on the issue of cancer.
What is the main objective of the conference "Tumor Microenvironment and Cell Stress" and how do you think it will contribute to the advancement of cancer research?
First of all, thank you very much for the honour of presenting my views and the opportunity to promote this conference. The TMCS2024 is the 10th in a series on the cancer microenvironment. It started in 2011 with a conference in Crete (Aegean Conferences) and for the first time we manage to bring it to Cyprus which is essentially the place I come from. Its aim is to bring together established scientists and young students specializing in cancer research and innovative treatment to exchange ideas, showcase their work to their colleagues and receive criticism before the results are even published. Such conferences are an important and irreplaceable step in the progress of research. Many new ideas and important collaborations between research groups start from such conferences.
Your research focuses on the use of proton radiation to treat cancer. Can you explain what are the main advantages of this method over traditional treatments?
Radiotherapy is now one of the three main pillars of cancer treatment (the other two being chemotherapy with or without immunotherapy and surgical removal of tumours). Usually the patient can take a combination of these. Radiotherapy has been used for over a century for this purpose. When we talk about radiotherapy, we mean using rays of high-energy particles that target tumours to destroy genetic material (DNA), kill it, or stop it from multiplying. It is given in many fractions (sessions), ranging from three to four to 40 that last 5-10 minutes each, meaning the treatment can last up to one to one and a half months. The most widespread form of radiotherapy consists of high-energy X-rays from linear accelerators (so-called linear accelerators or Linacs). Now, proton ray radiotherapy is recommended by hydrogen nuclei, which are accelerated by circular accelerators and directed to solid tumours. It is a relatively more recent discovery and treatment (from the mid-60s) and what they offer is a more accurate deposition of energy in cancer cells than in normal tissues. This is largely due to the physical properties of protons, which enter the body, deposit their energy in the tumour and stop (that is, they do not have an exit dose). This helps a lot in treating tumours near critical tissues and organs, such as the spinal cord, optic nerve, brain, heart, etc. Theoretically, therefore, they offer the same effectiveness as X-rays with fewer side effects. Several clinical studies have begun to confirm these theories, and their use is expanding significantly every year. There are 105 centers worldwide, 30 in Europe (UK, Italy, France, Spain, Germany, but also Czech Republic, Georgia, Egypt), construction has begun in Bulgaria and Israel. A small scientific team has recently promoted the idea of installing the first proton center in Cyprus and Greece and we hope that our effort will be successful within the next two to three years. Several patients from Cyprus and Greece go abroad every year for proton therapy. We believe that these patients will now be able to receive the treatment here.
Understanding the tumour microenvironment has begun to change the way we perceive cancer. What are the main discoveries in this area and how do they influence therapeutic approaches?
The tumour microenvironment plays a very important role in the genesis, progression and metastasis of the tumor, as well as in its response to its treatment. When we say "Tumor Microenvironment" we refer to other, non-malignant cells that surround the tumour and provide support or fight the tumour. These include immune cells (anti- or pro-oncogenetic), fibroblasts, as well as substances produced or secreted by these cells, such as cytokines and collagen. Over the past two decades, scientists have discovered that this environment is as important as the genetic makeup of the cancer cells themselves. For example, cancer cells must overcome and inhibit the inhibitory effects of our immune system in order to grow and spread. Conversely, if we strengthen our immune system with specific drugs, we can re-stimulate these immune cells to fight tumours.
What are the most recent research results of your team at the University of Pennsylvania and which ones do you think could have a significant impact on clinical practice in the coming years?
My group and I are working on two main issues. On the one hand, we study at the molecular level the biology of cancer cells to understand the mechanisms that allow them to multiply and spread (i.e. metastasize). The other issue concerns the use of innovative forms of radiotherapy such as proton beams. In the first area, we showed that a class of normal cells in the tumour microenvironment called myofibroblasts are activated by pressures in the environment and begin to secrete a lot of collagen. This in turn triggers the production of new blood vessels that bring more oxygen to the tumour and also promote its growth and metastasis. We have also identified a protein called ATF4, which plays an important role in this process. Now, our efforts are focused on targeting ATF4 to stop this process. In the second area, I and my team are promoting studies of the new form of radiotherapy, the so-called FLASH Proton Therapy. This form is based on the administration of the entire radiation dose in 1-5 fractions, each lasting less than a second, i.e. we are talking about a total treatment time from one day to a week. Experimental studies in laboratory animals and pets with cancer have shown that this greatly reduces the side effects of radiation, e.g. destruction of epithelial cells leading to diseases of the mucous glands, dry mouth and dysphagia, fibrosis in the intestine and heart resulting in ineffective organ function over time, etc. Clinical trials have already begun on this form of treatment in humans, and we (my team and radiology doctors) at my University will begin within the next 4 to 5 months, after getting approval from the U.S. Drug Administration.
What message would you like to send to young scientists who wish to engage in research in the field of oncology? What skills do you consider essential for success in this field?
Cancer will be with us for a long time. It is an inevitable fact of life. The goal is to turn it into a chronic, manageable disease. So, if young people are interested in biomedical research as a career, oncology is a great choice. I believe that in the next two decades, as more and more people live many years with cancer, important areas will be minimizing damage to normal tissues and reducing toxicity from treatments.
Given that this conference is taking place for the first time in Cyprus, what opportunities do you see for the development of the scientific community on the island in terms of cancer research? Already in Cyprus there are several notable groups involved in cancer research. These include teams from the University of Cyprus, the Cyprus Institute for Cancer Research (CCRI), the Institute of Neurology & Genetics, the German Oncology Centre and the Bank of Cyprus Oncology Centre. Additional efforts have been launched at private universities, such as the University of Nicosia and the European University. The challenge is to properly coordinate such efforts, strengthen cooperation and establish Cyprus as an important centre for cancer oncology research and treatment.
Do you believe that Cyprus has the potential to play a greater role in this area internationally? Indeed, Cyprus can play an important role in oncology research worldwide. First, it has excellent scientists already working in this field in international institutions. It is also important that it has intelligent and enthusiastic young people who want to enter scientific research – I see this from the multiple applications at my university and discussing with them at various conferences. In terms of infrastructure, as I said before, there are several basic facilities. These, of course, need to be further developed and strengthened. Finally, due to Cyprus' central position in the Middle East and its membership of the European Union, access to important funding programs is allowed, offering opportunities to attract talent from abroad to work and live here and at the same time to contribute to high-quality research.
What are the main obstacles to overcome to enhance research cooperation and what could Cyprus do to attract more scientific programmes and funding for oncology research?
I believe that, like all scientific research, cancer research must be supported by the state and private bodies. It is, I think, a matter of choices and decisions. We want our country to be just a tourist destination, with all the negatives that this implies, such as overtourism, environmental pollution and total dependence on the political and economic data of the moment or we want to diversify our economy and develop better opportunities for smart, young scientists who can have a positive impact on people's health and at the same time make Cyprus a center of research and medical tourism in the wider region;
What is your vision for the future of cancer treatment? Do you think we are close to breakthroughs that will radically change the way we treat cancer?
In the last two decades of my scientific career, I have seen tremendous progress in understanding cancer as a disease and developing new diagnostic tools and innovative treatments. This is evidenced by the fact that death rates from some cancers have dropped significantly, while others that were considered incurable are now being treated with significant improvements in 5- and 10-year survival rates. Significant advances in harnessing the immune system to attack cancers, the development of "smart" drugs and better ways to target radiotherapy are, I believe, among the most impressive developments. In addition, the pioneering development of effective anti-obesity drugs over the past five years will undoubtedly bring about a further reduction in rates of new cancers in the near future. Therefore, we are slowly but surely moving towards the transformation of cancer into a disease that the patient will be able to live with for several years, such as various infections and chronic diseases, e.g. hypertension. This is my "dream", as I believe it is a dream for every scientist working in this field.
From today, 28 October until 2 November 2024, all eyes are on Paphos, where a large number of distinguished experts in the field of biology, oncology and cancer treatment have gathered to discuss groundbreaking discoveries and new technologies that have the potential to open new paths for therapeutic intervention. There are also exhibition spaces at the conference, where participants will be able to attend presentations and take part in discussions with leading researchers, helping to create new collaborations in the field of oncology and biology.
