Thomas R. Cox, Jun 2016
Fibrosis and Cancer: Partners in Crime or Opposing Forces?
Our recent forum discussing the importance of cancer associated fibrosis in pancreatic cancer has just been published in Trends in Cancer
What is cancer associated fibrosis?
Fibrosis is the generation of excess fibrous tissue in and around organs and tissues. We can see this in real life when we look at scarring in our skin following an injury. In some types of cancer, and in particular pancreatic cancer, the growth of the tumour is accompanied by a similar sort of fibrosis.
In pancreatic cancer, this cancer associated fibrosis (also called desmoplasia) can be clearly seen by doctors using routine hospital histological tests. Looking at the patterns of fibrosis can be helpful in determining how might be best to treat a patient.
Scientifically however, the relationship between fibrosis and cancer at the molecular level, and the importance to tumour progression and patient outcome, as well as response to treatment, has long been debated.
Cancer associated fibrosis – good or bad?
Over the years, there has been a significant amount of research into whether cancer associated fibrosis is a good or bad thing for the tumour and, ultimately, the patient.
Whilst it is clear that cancer associated fibrosis is doing something, there are still several unanswered questions as to exactly what it is doing, and when. Clinical studies have shown there is a strong relationship between cancer associated fibrosis being there in the tumour, and poor patient prognosis.
Research has shown that this fibrosis can make the tumours more aggressive, growing faster and spreading round the body (metastasising), as well as decreasing the efficiency of our anti-cancer drugs. With this in mind, scientists and clinicians generally agree that if we can treat, or block, this accompanying fibrosis, as well as treating the tumour we can improve patient outcome.
Recently however, several studies have illustrated just how complicated it is to target this accompanying fibrosis. In our article we discuss the most recent scientific reports which have utilised several different strategies. Each has advantages and disadvantages, and we discuss what we have learnt so far and where we should go next.
Current and future treatments
In our paper, we also discuss the clinical trials currently underway in pancreatic cancer which have focused on targeting cancer associated fibrosis, their successes and how they reflect the biology of the disease as we understand it.
In general, it is accepted that treating cancer associated fibrosis will indeed improve patient outcome. Now scientists are working toward finding the best way to do this and we discuss the concept of tissue re-normalisation as a promising therapeutic strategy.
Despite different, and sometimes contradictory findings, all of the studies are helping to shape an exciting area of research which will soon see us treating primary tumours and cancer associated fibrosis simultaneously in patients.
To read our article in full, see the links below.
For readers without access, please contact me via my contact page
The relation between fibrosis and cancer has long been debated, specifically whether desmoplasia precedes, accompanies, or succeeds tumourigenesis, progression, and metastasis. Recent reports have published opposing data, adding to the perplexity. However, what is emerging is that it is likely the specific properties of the extracellular matrix (ECM) that determine the paradoxical nature of cancer-associated fibrosis.
View the article on Trends in Cancer homepage
Cox TR and Erler JT. Fibrosis and Cancer: Partners in Crime or Opposing Forces?
Trends in Cancer (2016) | doi: 10.1016/j.trecan.2016.05.004