Breakthroughs in Cancer Treatment

Despite the developments in cancer treatment over the last several decades, some cancers are still difficult to treat, especially when diagnosed at a late stage. Cancers that initially respond to treatment may develop resistance over time which results in loss of control over cancer.

Key takeaways:
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    Technological advancements such as PIPAC and RefleXionTM X1 may improve the outcomes of patients with advanced cancers soon.
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    CRISPR gene editing is a promising technology for the development of targeted cancer treatments.
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    New molecules (such as ERX-41) targeting different elements of cancer cells are constantly being discovered.
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    Natural invaders such as bacteria can be helpful in cancer treatment, e.g., for the delivery of drugs to cancer sites.

Immunotherapy and targeted therapy provide a chance to control aggressive and advanced cancers, but they do not work for every patient. Thus, a proportion of cancer patients still have minimal treatment options.

Cancer is one of the most extensive research areas in human health. This article reviews some innovations in cancer treatment that have become available in recent years.

Innovations being implemented in practice

PIPAC for advanced cancers in the abdominal region

Some cancers, e.g., ovarian, uterine, gastric, or colon, tend to spread to the lining surrounding the abdominal and pelvic organs. This area of the body is extremely hard to reach for chemotherapy drugs given through the vein.

Standard treatment for such patients is a combination of surgery and chemotherapy. Unfortunately, surgery is not feasible for all patients. A new method to deliver chemotherapy drugs into the abdominal cavity called pressurized intraperitoneal aerosolized chemotherapy (PIPAC) was designed for patients who cannot handle the surgery.

The surgeon makes a hole in the abdomen (like in minimally invasive laparoscopic surgery) and inserts a high-pressure pump that converts liquid chemotherapy drugs into an aerosolized spray that can reach the furthest areas of the cavity.

Lower chemotherapy doses are required, and patients generally experience fewer side effects with this method. In an Indian study, PIPAC was found safe and helpful for patients with advanced ovarian cancer.

Patients receiving PIPAC had better responses and higher quality of life compared with those receiving intravenous chemotherapy.

RefleXionTM X1 for diagnosing and treating cancer at the same time

The RefleXionTM X1 is a novel technology to deliver radiation to cancer sites more precisely. This system consists of a linear accelerator that produces high-energy radiation beams equipped with computed tomography (CT) and positron emission tomography (PET).

CT imaging combined with PET scanning that detects the increased metabolic activity of cancer help to visualize cancer lesions that are to be irradiated. In short, the machine detects and treats cancer at the same time.

Furthermore, it allows doctors to account for body and organ movement (e.g., due to breathing or bowel movement) and thus administers radiation more precisely, limiting damage to surrounding tissues. Currently, radiation therapy is reserved for patients with just one or two tumors.

With the RefleXionTM X1 machine, patients with multiple tumors may be eligible for this kind of cancer therapy. The registry to assess the outcomes of this technology is being launched by the manufacturer.

Innovations with encouraging results in preliminary human studies

Gene editing with CRISPR

CRISPR, a gene-editing tool also called “DNA scissors,” can be used to delete, insert, or edit specific segments of DNA molecules in human cells.

In a small clinical study of sixteen patients with cancers that did not respond to other treatments, CRISPR technology was used to genetically engineer patients‘ T cells so they would recognize cancer and initiate a response against it in the whole patient‘s immune system.

Scientists took blood samples from each patient and used CRISPR to delete genes encoding natural T cell receptors and insert the genes encoding the receptors specific to patients‘ cancer. Generally, the engineered T cells were well tolerated, with only two patients experiencing severe side effects.

Five patients had their disease stabilized. After infusion, genetically engineered T cells were detected not only in blood but also in cancer biopsies indicating their ability to travel to cancer sites.

This study gave valuable knowledge of the T cell genome editing, manufacturing of engineered T cells, the safety of infusing them in patients, and the ability of the engineered T cells to traffic to the patient‘s cancer sites which lays a solid foundation for further studies.

Innovations with encouraging results in animals and cell cultures

ERX-41 for the treatment of triple-negative breast cancer

Triple-negative breast cancer is an aggressive form of breast cancer that does not have any of the specific receptors (estrogen, progesterone, or human epidermal growth factor HER2).

This form of cancer does not respond to targeted therapy; it is harder to treat and frequently comes back. ERX-41 is a newly discovered small molecule that binds to a specific enzyme located in the so-called endoplasmatic reticulum (a network of membranes where the proteins and other molecules are processed) of a cancer cell.

ERX-41 disorganizes the protein structure of cancer cells, which results in their death. So far, this has been demonstrated only in cultured cells of human breast cancer and in mice. The new drug efficiently killed cancer cells, especially those without estrogen receptors, but left healthy cells intact.

Scientists think this drug may work not only for breast but also for other cancers (brain, pancreatic, and ovarian). However, more extensive research is required.

“Magnetotactic” bacteria for cancer treatment

Viruses have already been successfully employed in the treatment of cancer. Now scientists are investigating whether certain bacteria could have a similar potential. Bacteria belonging to the Magneto spirillum genus contain some iron oxide.

The movement of these bacteria responds to the applied magnetic field, and thus such bacteria are called “magnetotactic” or even “microbots.” One potential use of “magnetotactic” bacteria in cancer treatment could be the delivery of anticancer drugs directly to the cancer site.

Scientists have achieved success in manipulating these bacteria in such a way that upon infusion, they could effectively cross the blood vessel walls. Once the bacteria pass through the blood vessel wall, they can move to the cancer sites independently.

Indeed, after intravenous injection in mice, with the application of a magnetic field, scientists were able to direct these bacteria to cancer sites. Administration of anticancer drugs directly to the cancer site could enhance their efficacy and limit the toxic effects on healthy cells.

Developments in technology, genetic engineering, molecular biology, and even microbiology can all be used to improve cancer treatment. Breakthroughs in cancer treatment are being achieved every year. They start in scientists' laboratories, progress to animal studies, and human trials, and finally are translated into practice.

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