In his State of the Union address in 2016, President Obama pledged a new national effort to find a cure for cancer. This is the cancer “moonshot.” Last year, he announced the launch of the Precision Medicine Initiative — a bold new research effort to revolutionize how we improve health and treat disease. These two strategies together hold the promise of curing cancer or, at least, transforming it into a manageable chronic disease.
Negotiations and collaborations are launching now to decide which research trends and areas deserve the most support. Only disruptive innovations will be able to transform the status quo in cancer, leading patients to get more personalized and faster cancer care, while letting physicians do their job more effectively. Here are the technologies and trends that could help achieve the cancer moonshot.
Prevention and diagnosis
Cancer diagnosis must be early and accurate. Many cancer types cannot be detected early enough at the moment, while others are detected in time, but treated too severely. This notion requires not only great healthcare facilities and new diagnosis technologies, but also the proactivity of patients.
During cancer treatments, re-biopsies are needed many times. It means a new sample from the ever-changing tumor must be obtained to define the next step of the therapy. With the current, invasive biopsy techniques, this is a huge challenge not only for patients, but also for caregivers. Fluid biopsy extracts cancer cells from a simple blood sample. As Illumina, the DNA sequencer giant, just announced a spin-off focused solely on making fluid biopsy commercially viable, it might be the next big thing in oncology.
Real-time cancer diagnostics
An intelligent surgical knife (the iKnife) was developed by Zoltan Takats of Imperial College London and works by using an old technology where an electrical current heats tissue to make incisions with minimal blood loss, but with iKnife the vaporized smoke is analyzed by a mass spectrometer to detect the chemicals in the biological sample. This allows real-time identification of malignant tissue. Surgeons will love this surgical Jedi knife which can significantly reduce the length of operations in oncology.
Understanding genetic and lifestyle causes of diseases
By getting a clear knowledge about what genetic and environmental factors lead to the different types of cancers, including the given patient’s own genetic makeup, it would be possible to catch cancer in its infancy. This requires process innovation in healthcare, as well as more precise and specific cancer biomarkers supported by better screening technologies. Cancer Research UK’s Cancer Grand Challenges feature a call for researchers to discover new, previously unknown carcinogenic events, bringing this trend closer to reality.
Today, we either use chemotherapy to destroy any reproducing cells causing serious side effects; or targeted therapies which show low rates of response due to heterogeneity of the tumor and the poor accuracy of matching treatments to patients. The price of new drugs is going up steeply, and personalized drugs cost even more, while effective cancer care be widely available to everyone.
Next-generation targeted therapies
In the case of AIDS, combining drugs with different targets resulted in the treatment that finally put a dent in the disease. Research shows the same applies to cancer, but combining the increasing number of cancer therapies has so far proven difficult due to the sheer number of possible combinations. New approaches in the field of systems biology that use computer models to predict therapy effects are promising to cut through this complexity, and deliver effective combinational therapies in the coming years. All the while, new approaches like immunotherapies put emphasis on making the patient’s immune system sensitive to cancer cells again, this way letting the immune system fight back.
Molecular cancer diagnostics
Companies like Foundation Medicine are creating customized treatment plans based on the genetic makeup of the patient’s tumor. They sequence DNA from the patient’s tumor, and try to match the key mutations to drugs on the market or clinical trials already on the way. Over time, this will become the standard for assigning cancer treatment regimes.
Artificial intelligence based therapy design
Even if we can extract tumor cells from blood and sequence their DNA as fast as possible, making a decision about which treatment to choose next is still a struggle. No oncologist can see through the millions of studies and thousands of clinical trials by keeping all of the patient’s parameters and mutations in mind. Artificial intelligence algorithms can. IBM’s supercomputer Watson has been used in oncology for years, finding the most personalized treatment by sifting through all available evidence in minutes.
Without doubt, the future belongs to interdisciplinary innovations. Neurosurgeons at the University of California, San Diego School of Medicine and UC San Diego Moores Cancer Center used magnetic resonance imaging (MRI) guidance for delivering gene therapy as a potential treatment for brain tumors. Similar innovations in treatment delivery would decrease side effects significantly while boosting treatment effectiveness.
In silico trials
Current clinical trials take years and cost more than 2 billion dollars for every approved treatment. The number of failed drug candidates is enormous, so spending years and millions on a clinical trial is no guarantee it will lead to an approved treatment. This is a huge risk for pharma companies. In silico trials using advanced biological networks, or the organs-on-a-chip technique would enable analysing on hundreds of thousands of drug candidates on billions of virtual human physiological models in seconds with supercomputers. It would make drug discovery faster than ever.
Most cancer treatments today destroy not only cancerous cells, but also healthy ones. The ultimate goal is delivering drugs only to cells that need to be treated. Using DNA cages holding a payload of drugs might be the answer. This method could be used in clinical trials soon. Cancer cells can trigger the DNA cage to open and thus the drug could only make an impact on those cells, but not the healthy ones.
Surgeons using surgical robots such as DaVinci are capable of performing operations with previously unachievable precision. By making the robot an extension of the surgeon’s mind and skills, operating tumors in early stages, or tumors in close proximity to sensitive organs might become more feasible than ever.
Monitoring and providing care
The diagnosis of cancer is a huge event in someone’s life – there’s a reason cancer patients consider their life after to be “the New Normal”. Although patients meet their caregivers in person many times, they are left to cope with chronic pain and powerful side effects for the rest of the year. New technologies could improve their experience forever.
Embedded, implanted and digestible sensors
In many cases, measuring health parameters at home would be a huge addition to cancer care. Measuring body temperature, for example, is a key in monitoring the effects of chemotherapy. What if a sensor on the patient’s skin could constantly measure body temperature and notify the patient when fever goes up? Digestible pillcams could be used to perform non-invasive routine checkups on the digestive system at home. Implanted sensors or digital tattoos could monitor every important vital sign, triggering an alarm to both the patient and the caregiver, so interventions can be planned as quickly as possible.
Measuring lab markers at home
Another important element of cancer care is blood tests. During chemotherapy, blood markers, especially, white blood cell count must be checked routinely to make sure the patient’s immune system is still intact. Qloudlab plans to roll out a device that would allow patients to check blood cell counts at home.
Social media networks
Networking sites such as SmartPatients and Inspire were designed to help patients find and support each other without geographical limitations. These patients can discuss symptoms, offer advice and moral support, and help cope with treatment side-effects like never before. The feeling of community and seeing others cope with the same hardships can boost not just the mental, but the physical well-being of cancer patients as well.
Cancer and its treatments can induce extreme, chronic pain, and in the past, cancer patients were relegated to continuous, increasing doses of painkillers. Companies are now developing devices that help ease symptoms and side effects. A good example is Quell, a wearable technology with intensive nerve stimulation that is clinically proven to help manage chronic pain. Its use is FDA approved during the day while the patient is active, as well as at night during sleep.
All these technologies show amazing promise, and some of them are already in use. We need to keep on pushing the limits to get to a stage where the diagnosis of cancer is not a life-altering event that often brings an untimely end to a patient’s life, but, at least, a manageable, chronic condition.
Bertalan Mesko is the medical futurist and author of The Guide to the Future of Medicine and My Health: Upgraded: Revolutionary Technologies To Bring A Healthier Future. He can be reached at the Medical Futurist.
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