 "Small victories over cancer")
A team of researchers from the Massachusetts Institute of Technology, or MIT, has taken a significant step towards developing a method that can help detect cancer within minutes through a simple urine test. Far away in Hyderabad, a startup company has arrived at another uncomplicated and quick technique for diagnosis. It has developed a kit to detect breast cancer through a simple blood test. The finding is crucial, considering that breast cancer is the most common cancer in Indian women, killing one out of every two cancer patients.
The two researches, coming within a span of less than a month, are being watched closely by oncologists in India where cancer has become one of the ten topmost causes of death. The World Cancer Report 2014, published by World Health Organisation’s cancer agency, the International Agency for Research on Cancer, indicates that globally the number of cancer cases will increase by a startling 70 per cent over the next 20 years. Developing countries will be the most hit. Already about 70 per cent of the world’s cancer deaths take place in Africa, Asia, and Central and South America.
Which is why early detection, which can be made possible by the two tests, is critical.
The technology developed by MIT professor and Howard Hughes Medical Institute investigator Sangeeta Bhatia is like the pregnancy paper test. Through a urine sample test, it can reveal within minutes whether a person has cancer or not. Graduate student Andrew D Warren, the lead author of a paper on the technique published in scientific journal Proceedings of the National Academy of Sciences and co-authored by Bhatia, explains how the test works. “The test uses the intravenously injected nanoparticles called ‘synthetic biomarkers’. These nanoparticles are designed to passively hone onto sites of the disease and interact with proteases (the enzyme needed to digest protein). When disease-associated proteases cut pieces off the nanoparticles, the cut pieces (called ‘reporters’) are small enough to filter into the urine, where we can easily detect them with our low-cost paper test.” Higher concentrations of ‘reporters’ in the urine indicates the presence of the disease.
Conventional diagnostic tools for cancer such as colonoscopy or magnetic resonance imaging (MRI) are costly and require highly trained physicians and expensive equipment. The paper test is, in comparison, low cost and doesn’t require expensive equipment or training to use. The researchers who have run the paper test on mice with human-like tumours have found it to be quite accurate. “The test is 90 per cent sensitive (the likelihood that the results will be abnormal in people with the disease) and 80 per cent specific (the likelihood that results will be normal in people without the disease),” says Warren.
The research around the paper strip test, which started in the beginning of 2012, is in the early stage yet and uses mice. “There are still many difficult clinical studies necessary before our test could be used in people,” says Warren. So at this point, while it is impossible to guess the final cost of the test on humans, the researchers are determined to design it so that it is as inexpensive as possible.
As of now, the test focuses on the detection of colorectal cancer. But with slight changes in the synthetic biomarkers, it will be suitable for detecting several other kinds of cancers, the researcher adds.
The blood test for breast cancer, which claimed 70,218 lives in India in 2012, is, meanwhile, expected to be available commercially in five years from now. Developed by Hyderabad-based startup, Fournira Optime Diagnostics, the blood test would be about ten times cheaper than the currently available tests such as mammography, MRI and ultrasound. And its results would be available within an hour.
Early, accurate and affordable diagnoses are the three key factors that this test hopes to cover. A routine breast check, during which a woman might detect a suspicious lump, is what often leads to the first visit to the doctor. But it is often at a later stage that that evident symptom of breast cancer develops. The blood test makes an earlier diagnosis possible. The technology detects the cancerous biomarkers, if they are present in the blood, by lighting them up.
MAGIC BULLETS
Several laboratories in different parts of the world are also engaged in developing molecules that target the cancer cells specifically and in certain cases, serve as an alternative to chemotherapy. The doctors call them ‘magic bullets’. “The ‘magic bullet’ is nothing but target therapy,” says Ullas Batra, consultant, medical oncology, Rajiv Gandhi Cancer Institute and Research Centre. “In 20 to 30 per cent of the cancers, a single gene gets mutated. If we are able to identify and target that gene, then it is very effective.”
So while chemotherapy is like a bomb, which destroys everything around it, the ‘magic bullet’ is like a missile that hits a specific target, he explains. “Every year, two or three molecules are coming up for cancer that we call ‘magic bullets’. Many of these are for lymphoma, lung and liver cancer.”
The ‘magic bullet’ is usually used in Stage IV of the cancer and can be used in place of chemotherapy or in addition to chemotherapy. “In 20 to 25 per cent of lung cancer cases, especially in women and non-smokers, the ‘magic bullet’ is used upfront,” says Batra. Oncologists say it is found to be doubly effective than chemotherapy. It can control the disease with very good quality of life, doctors say. “If chemotherapy gives the person another eight months to live, the ‘magic bullet’ keeps him going for another two to two-and-a-half years,” says Batra. it requires no hospitalisation and unlike chemotherapy, causes no hair loss or loss of appetite. “It is simply an oral tablet to be taken every day,” says Batra. A month’s dose can cost between Rs 1,800 to Rs 5,000.
CANCER VACCINES
The World Cancer Report points out that the population in developing countries, which have high prevalence of cancers such as those of the cervix, hardly believes in regular screening, such as going in for the pap smear test, for commonly found cancers. And, there is little focus on cancer vaccines — the Human Papilloma Virus (HPV) vaccine.
“Gardasil and Cervarix, the vaccines for cervical cancer, have been around for at least four years,” says Jai Gopal Sharma, head of the preventive oncology department at Rajiv Gandhi Cancer Institute and Research Centre. With time, these are gradually becoming popular. In India, while no data has been published to assess the effectiveness of the vaccines, clinical trials have shown a decrease in the development of HPV associated with some diseases after the vaccine, he adds.
The overall consensus is that while nine to 26 is the ideal and most effective age, “the vaccine can be given to a woman of any age before she attains menopause,” says Sharma. Vineet Talwar, senior consultant, oncology, Rajiv Gandhi Cancer Institute and Research Centre, adds that HPV strains 16 and 18 have been found to be the most prevalent strains that cause the cancer. “When a person is infected with HPV, it takes about 18 to 20 years to develop cervical cancer. And then too, all people do not develop cancer,” adds Talwar.
QUICK FACTS
The two researches, coming within a span of less than a month, are being watched closely by oncologists in India where cancer has become one of the ten topmost causes of death. The World Cancer Report 2014, published by World Health Organisation’s cancer agency, the International Agency for Research on Cancer, indicates that globally the number of cancer cases will increase by a startling 70 per cent over the next 20 years. Developing countries will be the most hit. Already about 70 per cent of the world’s cancer deaths take place in Africa, Asia, and Central and South America.
Which is why early detection, which can be made possible by the two tests, is critical.
The technology developed by MIT professor and Howard Hughes Medical Institute investigator Sangeeta Bhatia is like the pregnancy paper test. Through a urine sample test, it can reveal within minutes whether a person has cancer or not. Graduate student Andrew D Warren, the lead author of a paper on the technique published in scientific journal Proceedings of the National Academy of Sciences and co-authored by Bhatia, explains how the test works. “The test uses the intravenously injected nanoparticles called ‘synthetic biomarkers’. These nanoparticles are designed to passively hone onto sites of the disease and interact with proteases (the enzyme needed to digest protein). When disease-associated proteases cut pieces off the nanoparticles, the cut pieces (called ‘reporters’) are small enough to filter into the urine, where we can easily detect them with our low-cost paper test.” Higher concentrations of ‘reporters’ in the urine indicates the presence of the disease.
Conventional diagnostic tools for cancer such as colonoscopy or magnetic resonance imaging (MRI) are costly and require highly trained physicians and expensive equipment. The paper test is, in comparison, low cost and doesn’t require expensive equipment or training to use. The researchers who have run the paper test on mice with human-like tumours have found it to be quite accurate. “The test is 90 per cent sensitive (the likelihood that the results will be abnormal in people with the disease) and 80 per cent specific (the likelihood that results will be normal in people without the disease),” says Warren.
The research around the paper strip test, which started in the beginning of 2012, is in the early stage yet and uses mice. “There are still many difficult clinical studies necessary before our test could be used in people,” says Warren. So at this point, while it is impossible to guess the final cost of the test on humans, the researchers are determined to design it so that it is as inexpensive as possible.
As of now, the test focuses on the detection of colorectal cancer. But with slight changes in the synthetic biomarkers, it will be suitable for detecting several other kinds of cancers, the researcher adds.
The blood test for breast cancer, which claimed 70,218 lives in India in 2012, is, meanwhile, expected to be available commercially in five years from now. Developed by Hyderabad-based startup, Fournira Optime Diagnostics, the blood test would be about ten times cheaper than the currently available tests such as mammography, MRI and ultrasound. And its results would be available within an hour.
Early, accurate and affordable diagnoses are the three key factors that this test hopes to cover. A routine breast check, during which a woman might detect a suspicious lump, is what often leads to the first visit to the doctor. But it is often at a later stage that that evident symptom of breast cancer develops. The blood test makes an earlier diagnosis possible. The technology detects the cancerous biomarkers, if they are present in the blood, by lighting them up.
MAGIC BULLETS
Several laboratories in different parts of the world are also engaged in developing molecules that target the cancer cells specifically and in certain cases, serve as an alternative to chemotherapy. The doctors call them ‘magic bullets’. “The ‘magic bullet’ is nothing but target therapy,” says Ullas Batra, consultant, medical oncology, Rajiv Gandhi Cancer Institute and Research Centre. “In 20 to 30 per cent of the cancers, a single gene gets mutated. If we are able to identify and target that gene, then it is very effective.”
So while chemotherapy is like a bomb, which destroys everything around it, the ‘magic bullet’ is like a missile that hits a specific target, he explains. “Every year, two or three molecules are coming up for cancer that we call ‘magic bullets’. Many of these are for lymphoma, lung and liver cancer.”
The ‘magic bullet’ is usually used in Stage IV of the cancer and can be used in place of chemotherapy or in addition to chemotherapy. “In 20 to 25 per cent of lung cancer cases, especially in women and non-smokers, the ‘magic bullet’ is used upfront,” says Batra. Oncologists say it is found to be doubly effective than chemotherapy. It can control the disease with very good quality of life, doctors say. “If chemotherapy gives the person another eight months to live, the ‘magic bullet’ keeps him going for another two to two-and-a-half years,” says Batra. it requires no hospitalisation and unlike chemotherapy, causes no hair loss or loss of appetite. “It is simply an oral tablet to be taken every day,” says Batra. A month’s dose can cost between Rs 1,800 to Rs 5,000.
CANCER VACCINES
The World Cancer Report points out that the population in developing countries, which have high prevalence of cancers such as those of the cervix, hardly believes in regular screening, such as going in for the pap smear test, for commonly found cancers. And, there is little focus on cancer vaccines — the Human Papilloma Virus (HPV) vaccine.
“Gardasil and Cervarix, the vaccines for cervical cancer, have been around for at least four years,” says Jai Gopal Sharma, head of the preventive oncology department at Rajiv Gandhi Cancer Institute and Research Centre. With time, these are gradually becoming popular. In India, while no data has been published to assess the effectiveness of the vaccines, clinical trials have shown a decrease in the development of HPV associated with some diseases after the vaccine, he adds.
The overall consensus is that while nine to 26 is the ideal and most effective age, “the vaccine can be given to a woman of any age before she attains menopause,” says Sharma. Vineet Talwar, senior consultant, oncology, Rajiv Gandhi Cancer Institute and Research Centre, adds that HPV strains 16 and 18 have been found to be the most prevalent strains that cause the cancer. “When a person is infected with HPV, it takes about 18 to 20 years to develop cervical cancer. And then too, all people do not develop cancer,” adds Talwar.
QUICK FACTS
- Vaccine: Cervarix from GlaxoSmithKline and Gardasil from Merck & Co
- Meant for: Cervical cancer
- Cost: Cervarix, Rs 2,000 per dosage and Gardasil, Rs 2,800 per dosage
- Dosage: Three doses within six months
- Age group: 9 to 26 years or till the woman is not sexually active
- Availability: Easily available in every hospital
Note: Gardasil protects against four HPV types or strains (6, 11, 16, and 18) and Cervarix targets HPV types 16 and 18. Gardasil is more recommended