TECHNOLOGY HAS HELPED TO EXPAND scientists’ understanding of cancer, upgrade detection methods and develop new therapies. Constantly improving tech will continue to move oncology forward in the coming years, but next-generation tools may not come in the form you’d expect.
“When we use the word technology, it conjures up a lot of ideas about large machines, ‘Star Trek’ kind of things, but in fact, we’re going to need to reframe our thinking somewhat,” said Anna Barker, chief strategy officer of the Ellison Institute for Transformative Medicine in Los Angeles. Rather, the new technologies that will impact cancer research and care will be algorithms and analytics, she said.
Barker’s comments kicked off a Virtual Patient Advocate Forum titled “The Impact of Advanced Technologies on Cancer Research” hosted by the American Association for Cancer Research, which publishes Cancer Today. The Feb. 28 forum introduced patients to several tools gaining traction in oncology: artificial intelligence, liquid biopsy, digital pathology and long-read genome sequencing.
Cancer survivor and patient advocate Grace Cordovano discussed how artificial intelligence chatbots could improve the patient experience. These chatbots, such as ChatGBT, use algorithms to replicate interactions with another human, generating content that could streamline administrative burden. For example, patients could use a chatbot to ask questions about side effects, get connected to resources, receive patient navigation services or draft insurance appeals.
“It’s not perfect. There are flaws here. It still needs to be tested,” Cordovano said, but chatbots can allow patients to get detailed information without searching several sources. “This could become a very powerful open access tool that should become second nature when someone is diagnosed with cancer.”
Cordovano said the new technologies featured throughout the forum will improve cancer care by providing patients with more data and empowering them to make informed, timely decisions. “It’s a cultural change where we’re shifting from ‘doctor knows best’ to ‘doctor and patient knows best.’”
Luis Alberto Diaz Jr., the head of solid tumor oncology at the Memorial Sloan Kettering Cancer Center in New York City, spoke about a tool designed to diagnose cancer earlier than previously possible: liquid biopsy.
Cancer develops when a cell undergoes a mutation, or a change in its DNA, that causes it to grow and spread uncontrollably. Scientists have developed ways to find these mutations for nearly all tumor types, Diaz said, leading to the question: Is it possible to discover these mutations early and prevent cancer from advancing? Liquid biopsy aims to do just that by testing a patient’s blood or other bodily fluids for the presence of biomarkers released from a tumor in a quick, minimally invasive manner. “It allows you to see a snapshot of what’s going on in the entire body,” Diaz said.
Liquid biopsy could detect cancer much earlier than other methods, potentially increasing the number of cancers found in early stages when there are more treatment options. “Shifting toward detecting cancer early can really improve the cure rates,” Diaz said.
This tool also could be particularly useful in monitoring patients who no longer have any evidence of disease because it could detect a recurrence earlier than a CT scan, according to Diaz.
He predicted liquid biopsy will have its first impact in detecting colon and lung cancers, while brain cancer detection will lag behind since cancer biomarkers typically do not cross the blood-brain barrier.
When a pathologist examines a tumor sample, there can be millions of cells present. It’s impossible to analyze each individual cell, but digital pathology is changing all that, according to Joel Saltz, associate director of the Stony Brook Cancer Center in New York. “We have the ability to take an image … and break it into individual cells, classify them, look at patterns of information, and really form and develop new ways of potentially steering treatment and predicting outcomes.”
This technology has important implications for immunotherapy, particularly therapies involving tumor-infiltrating lymphocytes (TILs), according to Saltz. Lymphocytes, or white blood cells, can recognize cancer and penetrate the tumor, killing cancer cells, but the immune system often prevents them from doing so. In TIL therapy, lymphocytes that have entered the tumor are extracted from the patient, multiplied in a lab, and reintroduced into the patient to intensify their ability to attack the cancer. Deep-learning models can map out where immune cells and tumor activity are located, according to Saltz. “This capability is making it possible to understand for each patient what is going on with the immune-tumor interactions,” he said. This technology also can help doctors determine which patients would benefit from immunotherapy and their risk of toxicity.
While it won’t replace traditional pathology, digital pathology adds an additional layer of nuance by allowing pathologists to recognize patterns, according to Saltz. “This is really one tool in a growing armamentarium of methods to diagnose and steer treatment.”
Long-read Genome Sequencing
While short-read sequencing has been the dominant technique in genetics, long-read sequencing is beginning to offer geneticists better insights into DNA, according to Elaine Mardis, co-executive director of the Institute for Genomic Medicine at Nationwide Children’s Hospital in Columbus, Ohio.
In short-read sequencing, DNA is divided into small fragments, which are then copied and sequenced together for analysis. Meanwhile, long-read sequencing uses much larger fragments—sometimes 100 times longer. By doing so, it provides a more accurate representation of the DNA and increases the likelihood a mutation will be identified.
“These methods do require larger amounts of DNA and RNA than short-read sequencing, and we also need quality to be very high; this is often not the case in cancer tissues,” Mardis said. Additionally, long-read sequencing is a lengthy process with a higher price tag, she acknowledged, but researchers are working to overcome these barriers. “Hopefully we’ll be able to bring this to more analysis of patient genomes in the future.”
Barker noted only 8% of cancer patients have their DNA sequenced. “If you have to be a little aggressive to get your tumor sequenced, do it,” she said.
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