The Technology Changing Cancer Care
A wave of advanced tools and seriously powerful supercomputers are playing a big role
By Hope Cristol
On the quest to end cancer, a diverse group of engineers, physicists, chemists, and others are making their way through rocky terrain. These are the tool experts: the people building new devices, instruments, and gadgets and inventing new ways to use existing ones.
For some on this path, especially those engineering microscopic particles called nanoparticles, the work is unprecedented. Nanotech may make cancer care easier, faster, and more efficient, but scientists are just getting started. Others on this path are taking advantage of some futuristic technologies, from genome editing tools to cutting-edge diagnostics. Here’s a snapshot of some leading tech-centered science and scientists.
Gene tinkering tools
If you follow science in the news, you may have heard of CRISPR (pronounced “crisper”), an acronym for Clustered Regularly Interspaced Short Palindromic Repeat. It’s a gene splicing and editing tool powered by an enzyme, called Cas9, that can snip out sections of DNA, or cut and paste bits of DNA where scientists want. One hope for cancer researchers is that it can be used to remove damaged DNA that’s associated with cancer development — but that’s a long way off. CRISPR isn’t yet being tested in humans (although a study published in 2014 in Proceedings of the National Academy of Sciences successfully used it to prevent human cells from being infected with HIV).
While CRISPR is celebrated for its precision and flexibility, other genetic tools are making their marks more quietly. A cancer research lab at the University of Minnesota, for instance, was the first to adapt a system called Sleeping Beauty Insertional Mutagenesis for cancer research.
“Imagine there’s a murder in a town of 30,000 people. If you’re investigating it, you don’t want to question all 30,000 people. You want to narrow down the list of likely suspects first,” explains David Largaespada, PhD, who heads the lab. The murderer in this metaphor is cancer, more specifically cancer-causing genetic mutations. Sleeping Beauty is a system used to help researchers find them.
Sleeping Beauty is a transposon, or a piece of DNA that “jumps” around the cell. A normal transposon makes a copy of itself, which then moves to another part of the genome, where the process repeats — usually harmlessly. But Sleeping Beauty isn’t harmless. It’s a man-made transposon designed to damage the genome wherever it lands. Researchers want damage to occur in many sites, so cell mutations can develop and tumors can form. Once that happens, Largaespada and others analyze the tumors’ DNA, hoping to find a pattern of cancer-causing genetic mutations.
In one study of mice that developed gastrointestinal (GI) tract tumors (thanks to genome damage caused by Sleeping Beauty), Largaespada identified 77 possible GI-tract cancer genes. He compared them with mutations in human cancer cells and found that in both the mouse model and human cells, 18 genes are likely to be involved in GI tumors. To frame it in terms of that murder metaphor: These 18 genes are now on his suspect list.
Largaespada says similar results, meaning evidence to link specific genetic mutations to the increased risk of cancer (such as BRCA2 mutations in breast cancer), are being seen in brain tumors, sarcomas, and several other types of cancer.
“The Sleeping Beauty system is used with human studies to figure out what genes are causing cancer,” says Largaespada, who is also an American Cancer Society research professor. “Once we have a good idea of what those genes are, we can start testing treatments on them.” Currently, his team is testing current drugs on two mutations in a type of bone cancer called osteosarcoma.
Nanotech shows big promise
Nanotech is poised to make a major impact in oncology. Nanoparticles are tiny (comparable in size to large biological molecules, such as enzymes and antibodies) and can have magnetic properties. They can be used for early detection, treatments and a combination of the two (the combination approach falls under a niche called theranostics: therapy plus diagnostics).
One of countless exciting applications for nanotech is in the early diagnosis of liver cancer. Current methods for diagnosis, such as MRI and ultrasound, typically detect liver tumors only when they’ve grown to about 5 centimeters in diameter, a little larger than a golf ball. By that point liver cancer can be tough to treat. However, research shows that using iron nanoparticles (given intravenously) can make smaller tumors more visible on MRI, because the iron temporarily accumulates in the liver. Iron-based contrast agents have been approved in the past, but are primarily the subject of ongoing research — not just for liver cancer, but other conditions as well.
In the lab of Daniel Heller, PhD, at Memorial Sloan Kettering Cancer Center in New York City, researchers are working on nanosensors for cancer detection and monitoring.
One of Heller’s most promising projects is an IUD-like sensor for ovarian cancer. Its power comes from tiny particles called carbon nanotubes: “When you shoot red light at them, they glow,” Heller explains. And they glow different colors in the presence of cancer-related proteins, or biomarkers, in the blood. That can provide doctors useful information about whether a patient has ovarian cancer, or whether a treatment is working based on biomarker levels.
Heller is currently testing the sensor, which he describes as “a lot of nanotubes in a capsule,” in mice, but he expects it to be tested in (human) clinical trials in the future. “A doctor could quickly shoot light at the sensor and, depending on the color it glows, figure out levels of cancer biomarkers,” Heller says.
Another nanosensor in the works — though at a very early stage — comes from Daniel Roxbury, PhD. During his recent postdoctoral fellowship at Heller’s lab, he also worked with carbon nanotubes, wrapping them with a substance that can detect cancer biomarkers. Roxbury’s vision is to create an implantable sensor that could be “read” by an external wearable device, such as a fitness tracker. The information would then be sent to a clinician.
As a concept, it’s futuristic but not far-fetched if you consider health tech already on the market. The Withings wireless blood pressure monitor, for instance, syncs with an app that creates reports for patients that doctors can use.
Powerful computing boosts cancer research
Major Silicon Valley companies are stepping up to help accelerate change in the cancer field, especially in a branch of artificial intelligence (AI) called deep learning. The basic idea of deep learning is that software can essentially mimic aspects of human thought via pattern recognition.
One application in the cancer world will be project CANDLE (Cancer Distributed Learning Environment). Visual computing leader Nvidia is teaming up with the National Cancer Institute, the Department of Energy, and several labs to develop this AI supercomputing platform. It’s expected to be a powerful research tool that can perform and visualize complex analyses — such as simulating protein interactions so researchers can see the underlying mechanics of cancer.
Intel is also investing in cancer collaborations, such as a custom-built cancer database that originally began with Oregon Health and Science Institute-Knight Cancer Center. In 2016, two new partners, the Ontario Institute for Cancer Research and the Dana-Farber Cancer Institute, joined Intel’s Collaborative Cancer Cloud, which facilitates data sharing among cancer researchers.
Meanwhile, IBM partnered with the American Cancer Society (ACS), pairing its Watson platform — perhaps best known for beating top human brains in Jeopardy — with ACS data. The goal is to create a service, akin to a virtual advisor, to help patients, survivors, and caregivers navigate cancer resources.
And to help address the global burden of cancer, IBM HealthCorps has partnered with the ACS and the Clinton Health Access Initiative to develop and deploy ChemoQuant. It’s an online chemotherapy forecasting tool that will be used by several countries in Africa to help identify which drugs they’re likely to need and what quantities to order. The tool also offers a price analysis feature. “ChemoQuant can help get affordable chemotherapy drugs in the right number, the right amount, and right type in Africa,” says Richard Wender, MD, chief cancer control officer at ACS.