"Apoptosis – programmed cell death – is fundamental to life," said Arwyn Tomos Jones of Cardiff University. He described how cancer ravages organisms by upsetting the fine balance between cell death and cell division, and highlighted some recent advances aimed at preventing the imbalance from spreading.

Jones explained that with the need to minimize debilitating side effects and boost the efficacy of cancer drugs, simply delivering a drug into the human body isn’t enough. Even drugs delivered directly to the cancerous part of the body can miss the mark. Modern techniques aim to deliver large therapeutic molecules to the right components within the actual cells affected by the disease.

All this may seem a tall order, but Jones’s group at the Cardiff School of Pharmacy and Pharmaceutical Science is among those that have been making serious headway. With the use of antibodies and receptor crosslinking, Jones explained how cancer cells can be tricked into internalizing cancer-targeting antibodies and their therapeutic cargo. Once inside cells, they are delivered to lysosomes that release the drug from the antibody to allow it to reach its cell target.

Other speakers also highlighted the power of nanocarriers, which package therapeutic agents within a protective vesicle to target cancer cells while leaving healthy cells unharmed. Kathryn Hill from AstraZeneca described drug carriers that allow carefully controlled diffusion out through a polymer shell; Christine Dufés at the University of Strathclyde explained how tumour-targeting dendriplexes can be used to deliver therapeutic DNA; and Maya Thanou at King's College London reported how heat-sensitive liposomes can release their cargo when highly focused ultrasound beams raise the temperature to a critical 42 °C.

Minimizing the grief of surgery

Nanomedicine is also helping when surgery becomes the only viable option. In particular, the development of nanoparticle tracers is making it easier for surgeons to remove malignant tissues while leaving healthy tissues intact.

An example is the metastases that migrate from the main tumour and become trapped within the lymphatic system as individual cells are caught in the mesh of the lymph node filter meshes. In the past, surgical treatments for breast cancer would have removed up to 30 ‘potentially cancerous’ lymph nodes from the patient - causing great discomfort and possibly nerve damage or lymphedema. Today, surgeons can use radioactive tracers to guide the removal of just two or three lymph nodes, allowing them to achieve better patient outcomes while still halting the disease.

The only problem is that not all hospitals have nuclear medicine units. In those that do, scheduling is often a problem because the unit can be quite far from the operating theatres – such costs and workflow issues around new therapeutic tools were a recurring theme throughout the talks and panel discussion. Patients are generally injected with the radioactive tracers before undergoing anaesthesia, which many find frightening. As Eric Mayes CEO of Endomag pointed out, when you ask patients what they hate the most it’s having the injection.

Endomag’s hand-held probe tracks the company’s magnetic nanoparticle tracer Sienna+. Because the Sienna+ tracer is not radioactive, the surgeons can inject it themselves to patients already aneasthetized. “Surgeons love to have this control and for the patients it’s less discomfort,” says Mayes. The Endomag technology has already helped 10,000 cancer patients across the world.

Nip it in the bud

While prevention is always better than cure, tackling the disease in its early stages is the next best thing for cancer patients. For many types of cancer, a greater than 90% 5-year survival when caught in the early stages dwindles to less than 10% for treatments of more progressed forms of the disease.

Billy Boyle, co-founder of Owlstone Medical, stressed the need to make patients comply with diagnostic tests for early-stage cancer. He highlighted the fecal tests that are traditionally used to detect colorectal cancer, where the accuracy is only 66% and only 48% of patients take the test. “If it’s invasive or unpleasant people don’t show up,” said Boyle.

Instead, Owlstone Medical has developed biosensors that can detect early-stage cancer from patients’ breath. “At first as an engineer I was looking to improve the chip,” said Boyle. “But it turns out it’s not just how good the test is, but also the nature of the test.”

The company’s breathalysers detect colorectal and lung cancer using a mass-spectrometry-type technology that measures the mobility of different molecules, and offer a sensitivity of 88% for a screening population. The device is in clinical trials, and Boyle is now looking into how the breathalyser technology would be best deployed. Despite the appeal of self-contained point-of-care devices, a centralized base for the analysis would lower costs for clinics that have limited resources to invest in specialized care for a handful of patients.

Show me the money

Regulation is another major hurdle for any new innovation in cancer research. One thing in favour of the Owlstone breathalyser is that it is a device that makes the regulatory clearance much more straightforward. Endomag’s magnetic nanoparticle tracer technology was also classified as a device because it is transported mechanically by the lymph node, as opposed to chemically or biologically.

For treatments classified as drugs, the regulatory hurdles are far greater, which presents murky territory in nanomedicine where the physical versus chemical nature of an interaction may be debatable. Yet whether a company’s funds are sufficient to see it through the regulatory process may hinge on this distinction. “If Endomag’s technology had been classified as a drug, I don’t see how we could have done it,” admits Mayes.

Securing funding to start a company can be no mean feat, and there was a consensus during the panel discussion that different types of technologies fall in and out of popularity with investors, who are generally risk averse. The new Pioneer Award from Cancer Research aims to accelerate innovation in cancer research by offering £200,000 over two years to successful applicants. It brings a welcome note of optimism for those hoping to get their ideas off the ground.

For more on the latest developments in the application of physical sciences in cancer research, visit the journal Convergent Science Physical Oncology.