by ecancer reporter Audrey Nailor

The 10th Annual Meeting of the National Cancer Research Institute (NCRI) Conference has concluded, with sessions on trial results, cancer evolution and mouse model development providing clinical depth to the previously broad scope.

Themes of debate that emerged included the use of smartphone technology, the implications of tumour heterogeneity and the definition of cancer stem cells.

One definition of cancer stem cells proposed by Professor Luis Parada of the University of Texas Southwestern Medical Centre: "Cancer stem cells are at the apex of the hierarchy of heterogeneous tumour cells, which maintains the tumour and leads recurrence."

Replacing solid-tissue biopsies with blood samples - "liquid" biopsies - was another trend of discussion, as circulating biomarkers become increasingly valuable diagnostic techniques.

Virtual biopsies are one future of clinical trials

"Far from being dead, dying or impotent, clinical trials are alive, well, and potent," said Professor Andrew Hughes of AstraZeneca and the University of Manchester in his celebratory talk.

However, new methods such as smart devices and "virtual biopsies" will need to revolutionise the system.

Hughes noted that ten years ago, twenty-three patients had to be enrolled and screened for every patient found eligible for a clinical trial. The number has remained virtually the same, at a cost of about £23,000 spent for every patient screened.

This may also result in patient disillusionment, as well as artificially inflating the "rarity" of common tumours, forcing a multi-centre approach to trial design.

Further, as other talks at this year's NCRI suggested, tissue biopsies of heterogeneous tumours - previously the gold standard of clinical trial selection and design - may not represent an accurate picture of the disease.

Hughes suggested that alternatives, such as using smartphone technology to allow patients to record and transmit their own experiences and examining fresh liquid biopsies rather than 'fossilised' tissue, may streamline the process.