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Third Cohort joins NCI’s Affordable Cancer Technologies Program: supporting the development of affordable technologies for cancer detection, diagnosis, and treatment in LMICs

February 6, 2017, by Paul Pearlman & Karen Haney

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. CGH is pleased to welcome the third cohort of investigator teams this year. You can read more about the first and second cohorts’ projects on CGH’s Spotlight Blog.

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 cost-effective radiation treatment delivery system for low- and middle-income countries – Eric Ford, University of Washington;
  • Rapid Point-of-Care Detection of HPV-Associated Malignancies – Karen Anderson and Dean Brenner, Arizona State University - Tempe;
  • Facile screening for esophageal cancer in LMICs – Stephen Meltzer and Tza-Huei Wang, Johns Hopkins University;
  • Digital PCR quantification of BCR-ABL for CML diagnosis and monitoring in LMIC settings – Daniel Chiu, University of Washington;
  • Smartphone Enabled Point-of-Care Detection of Serum Markers of Liver Cancer – Ashutosh Chilkoti and Nelson Chao, Duke University;
  • Field-deployable platform for prognostic hepatic cancer screening in low-resource settings – Marc Porter and Courtney Scaife, University of Utah

In addition, CGH partnered with the National Institute of Biomedical Imaging and Bioengineering (NIBIB) to expand funding to sponsor a seventh award to Peter Kingham, Olusegun Alatise, Philip Castle, and Richard Fedorak at the Sloan-Kettering Institute for Cancer Research to develop a point-of-care, real-time metabolomics test to diagnose colorectal cancers and polyps in low- and middle-income countries.

Description of Projects

A cost-effective radiation treatment delivery system for low- and middle-income countries: The striking global disparities in cancer outcomes are due, in a large part, to the inability of patients in low- and middle-income countries to access treatments that are considered standard-of-care in other parts of the world. One of the most common and cost-effective treatments for cancer is radiation therapy, and yet it remains out-of-reach for most would-be patients in low- and middle-income countries because the technology is too complex and costly. The goal of this project is to develop a simple, sustainable system for delivering radiation therapy that rivals the quality of those used in industrialized countries but at a small fraction of the cost. The team will test the performance and efficiency of their system in clinical operation at their partner site cancer clinic in Chennai, India.

Rapid Point-of-Care Detection of HPV-Associated Malignancies: Despite the development of effective HPV vaccines, it has been estimated that there will be over 200,000 new cases and over 100,000 deaths due to cervical cancer by 2020 in India, which has 25% of the global burden of cases. Cervical cancer screening by Pap smears and HPV DNA testing has become standard of care in the US and Europe, but has been too expensive and logistically challenging in LMICs. A simple, point-of-care biomarker panel for high-grade dysplasia and cervical cancer could provide a cost-effective means for triage of cervical disease in these countries. This project will leverage protein microarray technology with advances in fluorescent technologies to enable a multiplexed, serologic ELISA assay for HPV-specific antibodies. The team aims to develop and demonstrate a prototype assay with high analytical sensitivity for the simultaneous detection of 16 individual HPV-specific serologic biomarkers from a single finger stick-sized patient blood sample which can be manufactured for a total reagent cost of less than $1/patient sample. The team will then transfer and evaluate this technology, screening 13,000 patients in India, with a team of collaborators in the All India Institute of Medical Sciences (AIIMS) in New Delhi, India.

Facile screening for esophageal cancer in LMICs: Esophageal squamous cell carcinoma (ESCC) ranks sixth among all cancers worldwide, with 450,000 new cases diagnosed per year. Low-cost, minimally invasive methods of detection are badly needed, particularly in LMICs. This project will work to develop an early ESCC diagnostic strategy comprising of a single-use, swallowed sponge to collect esophageal specimens, coupled with a smartphone-manipulated microfluidic chip for automated sample processing and methylation detection. The strategy is low-cost, can be administered by healthcare workers with a range of training levels, and is less invasive and easier to perform than endoscopy. The team will conduct a diagnostic trial in Uganda during their testing phase.

Digital PCR quantification of BCR-ABL for CML diagnosis and monitoring in LMIC settings: This project will develop a digital PCR instrument to detect BCR-ABL transcript for the detection and monitoring of chronic myeloid leukemia (CML) patients in low- and middle- income countries (LMICs) who are eligible for tyrosine kinase inhibitor (TKI) therapy. Such an instrument coupled with the Novartis drug (Gleevec or Glivec) donation program can significantly improve the outcome of CML patients in LMIC settings. The team will test their device at clinical sites in Nigeria, Malawi, and Uganda.

Smartphone Enabled Point-of-Care Detection of Serum Markers of Liver Cancer: This project will develop a new point-of-care clinical test for diagnosis of liver cancer that is simple, cheap, robust, and portable, and requires no user intervention. In this assay, adding a drop of blood to the surface of a thin polymer film allows a biomarker that is present in the patient’s blood –and diagnostic of liver disease– to bind to “stable” capture spots of capture antibodies, and the complete assay will result in a visible signal that is captured by a smart phone camera. This technology will have broad impact by offering an affordable, scalable, and sustainable approach to cancer screening in countries with limited medical infrastructure. The team will test their device at a clinical site in Guangzhou, China.

Field-deployable platform for prognostic hepatic cancer screening in low-resource settings: Early detection of hepatic cancer is imperative to successful treatment outcomes. However, routine physician visits and preventative screening is not common in global healthcare. Many communities have limited access to healthcare due to geographical location, underfunded health plans, and a lack of outreach programs, resulting in a high mortality rate due to these factors. This project seeks to reach these populations through the development of a portable, easy-to-use, point-of-care platform for prognostic screening of patients for hepatocellular carcinoma (HCC) and for Hepatitis B (HBV) and Hepatitis C (HCV), both of which have been closely linked to cancer of the liver. The team will work to test their platform in collaboration with partners in Mongolia.

Point-of-care, real-time metabolomics test to diagnose colorectal cancers and polyps in low- and middle-income countries: This project will use the research network that the investigators have built in Nigeria to implement a unique urine-based POC metabolomics test that can be performed in centers in LMICs to diagnose patients with early-stage colorectal cancer and/or precancerous polyps. Their goal is to validate the sensitive, affordable handheld biosensor device by refining the metabolite signature and pilot testing the device at clinical sites in Nigeria in patients with colorectal cancer, polyps, and normal colons.

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 additional information about CGH's affordable technology development programs, please email Paul Pearlman at paul.pearlman@nih.gov.

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