Pioneering technology delivers early cancer diagnosis and treatment The early identification and treatment of cancer is critical to patient survival. New transformative technology has been shown to identify tiny bladder cancer tumours – and at the same time eradicate them. Health © shidlovski/stock.adobe.com Bladder cancer is the 10th most common cancer globally, affecting around half a million people every year. It is however one of the most expensive cancers to treat over the lifetime of patients. “One reason for this expense is the high frequency of cancer relapse,” notes EDIT project coordinator Massimo Alfano from San Raffaele Hospital (website in Italian) in Italy. “Patients have to undergo endless follow-ups, weekly treatments and multiple rounds of surgery. Routine cystoscopies – a procedure to look inside the bladder using a thin camera – must also be carried out.” Challenges to tackling bladder cancer As with other conditions involving abnormal tissue growth, early detection and treatment is critical to improving health outcomes, survival rates and the quality of life of patients. Effectively tackling bladder cancer has however been hampered by two as yet unmet clinical needs. “The first is that there are no diagnostic imaging techniques capable of detecting abnormal tissue masses smaller than 1 mm in size,” explains Alfano. “This can result in the incomplete tumour removal, and the presence of residual disease after surgery.” Secondly, intravesical therapy after surgery – where treatments are put directly into the bladder through a catheter – fails in around 50 % of all patients. ‘Theranostic’ approach to patient care The EU-funded EDIT project sought to address these challenges through developing a technology capable of detecting and removing bladder cancer lesions smaller than 1 mm. The technology was designed to be both minimally invasive and ‘theranostic’, i.e. therapeutic and diagnostic at the same time. “This was achieved by integrating ultrasound with photoacoustic imaging,” explains Alfano. “We used gold nanorods as contrast agents. These nanorods were manufactured in a way that makes them stable in the presence of urine.” Alfano and his team were able to identify a target that is expressed only by the bladder cancer cells, and not by normal bladder cells. The gold nanorods were combined with a peptide specific to this tumoural marker. Photoacoustic imaging was found to deliver incredibly high resolution. Switching the type of laser light used to irradiate the gold nanorods enabled the team to deliver thermal therapy, while at the same time carrying out imaging. Transforming bladder cancer treatment The feasibility of this technology was successfully demonstrated in preclinical models of bladder cancer. The EDIT consortium was able to show that the intravesical introduction of targeted gold nanorods could be safely carried out. “We were also able to show how the photoacoustic imaging of targeted gold nanorods allows us to detect flat bladder cancer lesions smaller than 0.5 mm,” says Alfano. “The gold nanorods also successfully assisted in inducing necrosis of tumours.” These results underline the clinical potential of this technology to reduce the frequency of bladder tumour relapse, by diagnosing and treating bladder cancer much earlier than has previously been possible. This will have a hugely positive impact on the quality of life of patients, while reducing the need for later surgical interventions. The EDIT consortium also sees potential in applying this theranostic application against small lesions in other hollow human organs. “The next step will be to bring the EDIT solution into clinical settings,” Alfano adds. “This will involve validation through clinical trials. We are confident that the EDIT solution will dramatically change how bladder cancer is diagnosed and treated.” Keywords EDIT, cancer, bladder, diagnosis, cystoscopies, photoacoustic, nanorods, intravesical
