The speaker was Professor Bob Pinedo, the doughty head of the VU Medisch Centrum (Cancer Centre) of Amsterdam at a media briefing held on Monday by the European Commission’s Directorate-General Joint Research Centre.
The highlight of the one-day meeting was the announcement that an innovative treatment, known as Boron Neutron Capture Therapy, has been applied for the first time in Europe as a prospective cure in a clinical stage 1 trial for a patient suffering from brain metastases induced by a specific type of skin cancer.
At a less technical level, the meeting highlighted the prospects of modern research in Europe in the fight against cancer.
What seems to be clear is that the fight is now moving from finding out how the different types of cancer occur (and also what can prevent them) to bringing the screening techniques and early diagnoses to the masses through the delivery of a healthcare that can sustain this huge increase in cost.
The way the new technique has been developed shows both the ability of modern science to find solutions previously thought impossible and, at the same time, the difficulties involved in bringing such developments to the masses.
Following a morning of presentations at the Medisch Centrum, we were taken to a high flux reactor, in other words a nuclear reactor, at the JRC Institute for Energy at Petten, some 60 kilometres north of Amsterdam, on the shores of the North Sea. As we gazed into the reactor, we were told this new cure that is being experimented consists in bombarding a patient with brain metastases with a type of radiotherapy that is only obtainable at a high flux reactor.
Boron Neutron Capture Therapy
The classical treatments for cancer are surgery, radiation and drugs. Unfortunately these therapies have side-effects as the treatment that targets tumours will invariably affect healthy tissue as well. This damage to healthy tissue often limits the application of the treatment modality. For example, a surgeon cannot operate on multiple liver metastases, a radiation oncologist cannot irradiate a tumour inside a radiosensitive structure and a medical oncologist cannot cure most of the solid tumours because of the toxicity of the drug.
To overcome these limits, “targeted therapies” have to be developed that will selectively damage the tumour cells, but spare the healthy cells. One promising approach is Boron Neutron Capture Therapy (BNCT).
BNCT uses the born-10 isotope, which, when irradiated with a beam of low energy neutrons, emits high-energy particles with a high biological effectiveness and a low range in tissue limited to the diameter of one cell only. A selective uptake of the boronated drug will lead to precise targeting of tumours and offers an innovative option to improve the health and quality of life of cancer patients.
Nearly a million EU citizens die each year from cancer – an illness that remains a major research challenge. Developing effective treatment involves sensitive scientific, political, social and economic concerns.
A virtual European hospital
Clinical research is necessary to develop new treatments and to translate results from the laboratory to the patient. Clinical research always includes patients who are submitted to these new modalities with concomitant unknown benefits and risks. Therefore, clinical studies must be carried out that conform to and fulfil strict regulations on quality assurance, good clinical practice and legal requirements.
For BNCT, this was a specially challenging task because of the use of a non-hospital based, experimental radiation facility and the application of new drugs that are not supported by the pharmaceutical industry.
Furthermore, the treatment of patients starts in several European countries, who then go to The Netherlands and are treated by German radiotherapists at a European research facility.
In addition, BNCT is multi-disciplinary, requiring the cooperation of clinicians, radiotherapists, medical physicists, nuclear scientists, mathematicians, radiobiologists, pharmacists and chemists. To overcome all these hurdles, support from the authorities of all the participating countries was necessary. Then, a cross-border hospital was organised.
The BNCT project has demonstrated the successful implementation of a virtual European hospital, with operating theatres in Nice, Graz, Amsterdam, Munich, Bremen and Essen, a radiotherapy department in Essen, a radiation unit in Petten, a patient ward in Amsterdam, a pharmacy in Amsterdam, a radiodiagnostic department in Frankfurt, a department of pathology in Bonn, with documentation and data management performed in Amsterdam and Brussels. The multi-national patient treatment is performed following recognised international standards for quality assurance, which was supported under the supervision of independent experts.
Developing diagnostic and therapeutic tools
In addition to BNCT, the media briefing provided the latest insights into a range of JRC and partner organisations’ cancer research projects.
These included Alpha-immunotherapy: radioactive ‘bullets’ attacking cancer at its source.
JRC is boosting the efficacy of targeted radionuclide cancer therapy by improving safety and reliability. It has patented several ways of producing alpha-emitting actinium-225, increased its availability and developed a hospital-friendly radionuclide generator.
This continuing research involves university hospitals and cancer research centres in Belgium, France, Germany and the USA.
Over the next five years, rapid expansion is predicted for treatment of other tumours and possibly non-malignant conditions
Radionuclides are increasingly important in cancer therapy, as they contribute significantly to managing curative and palliative conditions. Research into new therapeutic treatments and diagnostic agents will significantly increase demand for radioisotopes.
Illuminating cancer diagnosis
Living tissues emit fluorescent radiation when stimulated by light of particular wavelengths. Changes occurring in the matrix of cells – as a result of inflammation, for example – cause the colour of this ‘autofluorescence’ to change. JRC has invented a technique and developed innovative instrumentation that enables the effect to be detected by using a miniature endoscope inserted into the living body. Known as fluorescence endoscopy, the technique shows great promise in the non-invasive early diagnosis of cancer and as a visual aid to safer, more effective surgical intervention.
As Europe’s population ages, the incidence of many diseases and various medical conditions requiring intervention is also escalating. Early diagnosis of cancer is critical for survival. Screening techniques to detect potential problems are also needed to undertake appropriate prevention.
The JRC prototype comprises a computer-controlled rigid endoscope fitted with a laser-excitation source for fluorescence imaging, and a white light source for normal viewing and navigation.
A notable innovation is the incorporation of advanced tuneable filter technology that ensures the highest degree of flexibility and performance. An infinite choice of spectrum-sampling schemes can be selected for specific analyses, making the device far more versatile than existing alternatives that generally rely on fixed optical filters with narrowband coverage.
Facilitating cancer diagnosis
Together with Amersham Health, JRC has set up production facilities for one of the key substances for cancer diagnosis 18F-FDG.
The location of tumours can be detected using a Positron Emission Tomography (PET) medical imaging after 18F-FDG has been administered to patients. However, because of its short half-life, 18F-FDG normally must be produced either locally or on-site by the hospital using it.
The JRC Cyclotron facility hosts the first radiopharmaceutical laboratory in Italy licensed to produce an isotope-labelled substance for medical use. Now, access to the life-saving technique has become more freely available to hospitals in northern Italy that do not own the costly cyclotron facilities.
If injected into a patient, 18F-FDG is transported around the body like glucose, but accumulates in particular tissues such as cancerous tumours, the heart and the brain. Its exact location can be mapped by PET scanners, which produce images of the body including the sites where 18F-FDG accumulates.
This imaging technology is a powerful diagnostic tool for early cancer detection, enabling decisions to be made on treatment at an early stage. 18F-FDG has other uses in cardiology and neurology to examine glucose metabolism also.