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Supporting the development of affordable technologies for cancer detection, diagnosis, and treatment in LMICs

September 30, 2016, by Karen Haney and Paul Pearlman

As the incidence rate of cancer in low- and middle-income countries (LMICs) continues to rise, so do disparities in access to cancer prevention, screening, diagnosis, and treatment technologies. While advances in engineering and cancer biology have contributed to rapid improvements to cancer-relevant technologies in high-resource settings, it is important to focus on translating this progress to clinical settings in LMICs.

For this purpose, NCI’s Center for Global Health (CGH) Affordable Cancer Technologies Program supports the adaptation, application, and validation of point-of-care (POC) technologies. Investigator teams consist of experts in engineering, oncology, and industry, and projects progress through optimization, clinical testing, and business planning for commercialization throughout the course of the funding agreement. The program is pleased to welcome its second cohort of investigator teams this year. You can read more about the first cohort’s projects here.

CGH is excited to announce the addition of the following technologies to the Affordable Cancer Technologies Program, funded under RFA-CA-15-001: Cancer Detection, Diagnosis, and Treatment Technologies for Global Health (UH2/UH3):

  • A radiation planning assistant (RPA) for radiation therapy planning in low-resource settings – Laurence Court, University of Texas MD Anderson Cancer Center;
  • KS-Detect, a diagnostic platform for early stage diagnosis of Kaposi’s sarcoma – David Erickson, Cornell University;
  • A multi-type HPV E6/E7 oncoprotein test for cervical cancer screening and triage – Rolando Herrero, International Agency for Research on Cancer;
  • A hand-held, portable and affordable thermo-coagulator to prevent cervical cancer – Rengaswamy Sankaranarayanan, International Agency for Research on Cancer;
  • A cytology-free point-of-care cervical cancer diagnostic – Kristin Weidemaier, Becton, Dickinson and Company;
  • A smartphone for molecular cancer diagnostics – Ralph Weissleder, Massachusetts General Hospital

Additionally, CGH has partnered with the National Institute of Biomedical Imaging and Bioengineering (NIBIB) to expand funding to sponsor a seventh award to Rongguang Liang at the University of Arizona to develop a low-cost mobile imaging device and analysis platform for the detection of oral cancer in low-resource settings.

Description of Projects

Radiation Planning Assistant (RPA) for radiation therapy planning in low-resource settings

Radiation therapy is a proven, cost-effective therapy for curative cancer treatments in low-resource settings. However, it is estimated that by 2020, the growing need for radiation therapy in LMICs will outpace the number of trained radiation therapy staff by more than 50,000 full-time staff members, to include almost 10,000 medical physicists. By fully automating the treatment planning process, the Court team aims to reduce the gap in required medical physicists by 5,000 people while providing high-quality, automatically generated radiation treatment plans in LMICs. The team will focus on treatment of breast, head/neck, and uterine cervical cancers and will collaborate with partner institutions in South Africa and the Philippines during initial testing and deployment of the RPA.

KS-Detect, a diagnostic platform for early stage diagnosis of Kaposi sarcoma

When detected in the early stages, Kaposi’s sarcoma (KS) is more responsive to traditional therapies. The KS-Detect diagnostic platform is a solar-powered, smartphone technology that can quickly confirm KS diagnosis using a polymerase chain reaction (PCR) based assay, facilitating early detection in patients. Erickson’s team will ruggedize the KS-Detect system by developing a dual-use platform that will enable both field and lab operational capabilities. The team will collaborate with their Ugandan partner site to validate the platform.

Multi-type HPV E6/E7 oncoprotein test for cervical cancer screening and triage

Cytology-based cervical cancer screening tests such as the Pap smear are commonly used in high-resource settings, but these tests require multiple follow-up visits from patients to properly identify and treat those at risk for cervical cancer. Herrero’s team aims to develop an improved HPV test based on detecting E6/E7 oncoprotein activity for the eight most common HPV subtypes associated with cervical cancer. They will assess the test’s potential to be a standalone screening tool for cervical cancer by using pre-existing clinical research networks in Latin America.

Hand-held, portable and affordable thermo-coagulator to prevent cervical cancer

Cervical cancer remains one of the highest-burden cancers for women in LMICs. As screening and early detection programs improve, developing POC treatment technologies is an important aspect of avoiding unnecessary treatment of healthy women and ensuring the best quality treatment for affected women. Rengaswamy’s team will develop, test, and produce lightweight, portable thermal coagulators and evaluate the success rate of thermal coagulation by comparing it to the current standards of cryocautery and Large Loop Excision of the Transformation Zone (also called LEEP). The team will work in Zambia to assess the effectiveness and usability of their device.

Cytology-free point-of-care cervical cancer diagnostic

As previously mentioned, cytology-based methods of diagnosing cervical cancer are difficult to adapt for use in LMICs. Weidemaier’s team will focus on translating a multiplex assay currently used for non-oncology applications by Becton, Dickinson and Company (BD) into a highly specific diagnostic test for cervical cancer. The test will enable detection of cervical cancer associated targets in complex samples, avoiding the need for sample preparation prior to testing. If successful, the test and analysis will require just thirty minutes from sample collection to diagnosis, making it ideal for use in see-and-treat settings.

Smartphone for molecular cancer diagnostics

AIDS related cancers such as Burkitt’s lymphoma create a significant challenge for health systems in sub-Saharan Africa. While patients can respond well to treatment if quickly and correctly diagnosed, the limited availability of pathology instrumentation and specialists often prevents opportunities for therapeutic intervention. Weissleder’s team has developed a low-cost, holography-based molecular detection strategy implemented using smartphones. The smartphone camera captures images of samples and the team’s algorithm provides quantitative measures of malignant cell presence. By using fine needle aspirates, the technology avoids the need for large core or surgical biopsies, sample sectioning and staining, and expert interpretation. The team will expand the current prototype to perform multiplexed sensing essential for lymphoma diagnostics before collaborating with partners in Botswana to conduct clinical trials in lymphoma patients.

Low-cost mobile imaging device and analysis platform for the detection of oral cancer

Oral and oropharyngeal squamous cell carcinoma account for approximately 400,000 new cancer cases each year, and an estimated two-thirds of these cases occur in LMICs. OSCC patients in LMICs face low survival and cure rates, primarily due to delayed diagnosis and advanced progression of disease at initial presentation. Recognizing that early diagnosis of pre-cancerous and cancerous oral lesions will offer patients in LMICs improved prognoses, Liang and his team will work to develop a mobile intra-oral imaging device and image analysis platform to offer a low-cost, portable, and reliable option for oral cancer screening in low-resource settings. The team will collaborate with Carestream Health Inc., one of the largest dental imaging companies in the world, to build and distribute their product. They will work at the Mazumdar – Shaw Cancer Center in Southern India to assess the effectiveness and usability of their device.

The treatment of cancer in LMICs presents unique challenges and design constraints for scientists and engineers. Through this funding opportunity, CGH provides support to investigators as they work within these constraints to develop affordable, innovative technologies that have the potential to reduce the burden of cancer for patients worldwide.

For any additional information about our affordable technology development programs, please email Paul Pearlman at paul.pearlman@nih.gov.

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