Digital pathology has the potential to improve patient care and support the pathology workforce by making the diagnosis and monitoring of disease much more efficient. Embedding digital pathology lays the foundation for the adoption of artificial intelligence (AI) in diagnostic services.¹

What is digital pathology?

Usual practice involves pathologists looking at a tissue removed during a biopsy on a glass slide through a microscope to check for disease. The move to create digital pathology, involves the slides being scanned to generate digital images that can then be viewed by pathologists on a computer screen.

Digital pathology and efficiency

This digitisation provides flexibility and agility, which makes diagnostic workflows more efficient.

Cases are rapidly transferred between organisations and across pathology networks; access to expert pathologist second opinion is sped up, improving turnaround times and diagnostic pathways and ultimately benefiting patients.

Indeed, digital pathology has the potential to revolutionise the way pathology services are delivered, particularly in cancer diagnostics where the volume and complexity of samples continue to increase.

Access to expert pathologist second
opinion is sped up, improving turnaround
times and diagnostic pathways and
ultimately benefiting patients.

Potential for innovation in pathology

The digital images generated have been used to train algorithms to detect cancer and grade it. Early evaluations of AI for prostate cancer detection are being undertaken in several sites in the UK and the USA.

These evaluations are ongoing to establish where and how AI can help the diagnostic process; for example, by helping to triage cases requiring rapid assessment, ordering additional tests to save time and helping the pathologists evaluate the tissue.

Investment required for digitisation

However, investment is needed in the form of scanners so these glass slides can be digitised. There also needs to be investment in IT to ensure systems can support this digitisation and integrate other vital information that will assist pathologists in making a diagnosis, such as a patient’s clinical history. Only with the creation of this modern digital environment will AI be successfully implemented — and its benefits realised.

[1] The Royal College of Pathologists. RCPath Artificial Intelligence position statement (2023). Digital pathology (rcpath.org)

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Professor Tobias Arkenau

Global Head of Drug Development and Chief Medical Officer, Ellipses Pharma

Graeme Horne

Head of CMC, Ellipses Pharma

Using holistic approaches is helping a major drug developer create and test drugs more quickly and cost-effectively to benefit patients.

Often, years of research can result in failure, with millions of pounds spent without a new drug making it to patients. Drug development company Ellipses Pharma believes its business model streamlines the process and enables pharmaceutical companies to get tried and tested compounds to market quicker.

Patient and drug manufacturer advantage

Focusing on oncology and a core purpose to accelerate development of cancer treatments, CEO and Co-Founder Dr Rajan Jethwa believes the company’s efficient approach has clear benefits to patients and drug manufacturers.

His company acquires drugs in their infancy from other developers and refines them through rigorous testing, research, trialling and problem-solving. They aim to prepare them for sale to pharmaceutical companies.

“If we do it well,” says Dr Jethwa, “we have a much higher chance of those drugs being successful. We improve our chances by engaging specialist cancer doctors and scientists at an early stage and designing the preclinical and clinical development plans, taking their guidance into account.”

De-risking drug development

Given the time-limited span of a patent, which can start well before the drug is commercially available, time saved in medicine development gives pharmaceutical companies a longer exclusive window to sell the product.

That is against a backdrop of changed public perceptions in drug development timescales following the Covid-19 pandemic where a vaccine was developed quickly. The company ethos is designed to de-risk a drug’s development while saving time and money.

Properly funding the development stage is pivotal. “That is our core pillar. We call it uninterrupted development capital, an uninterrupted flow of money that allows us to ensure each drug is funded properly without adding delays by having to stop and restart development with intermittent funding,” Dr Jethwa explains.

“That can save 3–6 years of additional patent life for the drug and leads to patients getting the drug sooner and for longer.” With seven out of every eight potential cancer drugs never reaching patients, de-risking chances of failure increases chances of success.

We are selecting a drug that already has
support from clinicians and designing
a trial that ensures the drug is tested
in the right patient population.

Prof Tobias Arkenau

Designing trials with clinician support

Before acquiring a drug, the company consults its Scientific Affairs Group of 300 global key opinion leaders — doctors, experts, peer reviewers — engaged anonymously via a bespoke digital platform developed by Ellipses for their views on the science and potential development gaps.

“The aim is to get consensus around how good the science behind a drug is,” explains Prof Tobias Arkenau, Global Head of Drug Development. “The next stage is designing the clinical trial in the right way; patient stratification, making sure the right patients go into the right trial for the right drug at the right time is hugely important,” he adds.

“These two things help to de-risk drug development; we are selecting a drug that already has support from clinicians and designing a trial that ensures the drug is tested in the right patient population. All of that should lead to a better success rate.”

Processes to help patients survive longer

Ellipses follows defined processes to tackle various challenges: determining the right amount of active compound, assessing environmental impact, scalability, patient-friendliness, regulatory compliance and evaluating toxicity and side effects. “We navigate these processes in parallel to get to a point in advance of first-in-human trials, knowing all the problems have been solved,” says Dr Graeme Horne, Head of CMC.

“The pillars of de-risking, asset selection and how a trial is built and designed, coupled with uninterrupted flow of capital and executing a clinical trial efficiently and effectively leads to more drugs developed in a faster timeline with a higher rate of success,” adds Dr Jethwa.

Moreover, he points to a plethora of benefits for patients who get a drug sooner. “The drugs have been rigorously tested, are shown to be safer and efficacious in treating disease for longer. Ultimately, we want patients to survive longer with a better quality of life.”

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Professor Tobias Arkenau

Global Head of Drug Development and Chief Medical Officer, Ellipses Pharma

Clinical trials of novel therapies for leukaemia, breast and lung cancer are showing promising signs in treating these cancers in patients today.

A number of cancer therapies in development are showing promising results in clinical trials and emerging as potential alternatives when existing treatments falter or fail.

Ellipses Pharma, a precision drug development company focused on oncology and aiming to accelerate the development of new cancer medicines and treatments, is developing next-generation targeted therapies for patients with leukaemia, breast and lung cancer.

Rigorous testing and assessment in global clinical trials

Chairman and Co-Founder Prof Sir Chris Evans OBE explains how the company acquires promising new drugs from other organisations before they go into human testing and then develops them into potential new treatments in clinical trials so that patients have more options on their cancer journey.

“The drugs being developed at Ellipses are next-generation therapies to effectively target genetic abnormalities found in certain tumours. Each potential medicine undergoes rigorous testing and assessment in specialist cancer centres around the world,” he says.

Next-generation selective RET inhibitor for lung and other cancers

One of the new drugs for lung and other cancers targets a dysfunctional protein called RET (rearranged during transfection). Prof Tobias Arkenau, Chief Medical Officer and Global Head of Drug Development, outlines how the drug inhibits the protein, stops the uncontrolled division of the cells and destroys cells that are part of a tumour. “By inhibiting the RET protein that is driving the cancer’s growth, it is stopping the cancer from growing,” he says.

The drug is a next-generation selective RET inhibitor and has completed a phase 1 trial in patients with RET positive cancers, ascertaining what the most effective doses look like, and is now entering phase 2 studies having acquired orphan drug and fast-track designation in the US, which should accelerate the process towards wider patient use.

Prof Arkenau says it is showing encouraging results in patients who have become resistant to first-generation RET inhibitors or whose cancer has spread from the lungs to the brain and other organs.

By inhibiting the RET protein that is
driving the cancer’s growth, it is
stopping the cancer from growing.

Prof Tobias Arkenau

New drug for patients with hormone receptor-positive breast cancer

In the area of advanced breast cancer that has returned or progressed after initial treatment and moved outside of the breast, Prof Arkenau believes there remains a ‘high unmet need’ for specific patient groups.

The company is currently enrolling breast cancer in patients who have progressed on current hormonal therapies into their new selective androgen receptor modulator (SARM) trial that has returned promising results in patients whose cancer expresses both oestrogen and androgen receptors.

“This works by ‘fuelling’ the androgen receptors, almost starving the cancer of its oestrogen signalling and subsequently leading to cancer cell death,” he adds. “We expect to combine this new SARM with existing therapies to see even better responses in patients and for longer,” continues Prof Arkenau. The drug is now going into combination studies in the US, Europe and the UK.

Leukaemia drug for patients not responding to current treatment

A third drug under development is for patients with acute myeloid leukaemia (AML), where leukaemia cells growing in the bone marrow replace healthy red and white blood cells and subsequently result in bone marrow failure.

“AML is a very complicated blood cancer,” says Prof Arkenau. “Often driven by multiple genetic abnormalities.” He notes that leukaemic cells can become resistant to standard therapies even after stem cell therapy, and relapse is common. The drug being trialled is a dual inhibitor targeting a specific set of proteins that are known to be involved in cancer resistance and progression.

Patients at the relapsed-refractory stage, where standard treatment has consistently failed, have been participating in a phase 1 trial. The results were very encouraging which allows progression of the study to combine Ellipses’s drug with other approved therapies in a phase 2 trial.

It marks yet another stage of the company’s ongoing development of drugs aiming to improve the quality of life for cancer patients.

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Abigal Tomlins

Consultant Breast Surgeon, Gloucestershire Royal Hospital,
British Association of Surgical Oncology – The Association for Cancer Surgery

Discover the latest in personalised breast cancer care and treatment options. Learn about imaging advancements and targeted therapies for improved outcomes.

Breast cancer, the most prevalent cancer globally, has seen enhanced survival rates following collaborative efforts and targeted therapy breakthroughs. Personalised care tailors treatment and prevention to individuals, considering genetic tumour variations, lifestyle factors and health conditions.

Imaging increasingly guides decision-making and treatment planning — from diagnosis to management of advanced disease, reducing the extent of surgical treatment and minimising cosmetic impact and potential long-term sequelae.

Personalised breast screening and early diagnosis

Breast screening has traditionally been via mammogram with geographical variations in the intensity and age groups screened. Variations in breast density, even in postmenopausal women, increasing use of HRT and rising incidence of breast cancer in perimenopausal women question the validity of this approach and the need for density-stratified/adapted breast screening.

The BRAID trial is evaluating modalities such as MRI, CESM and ABUS. High-risk surveillance using MRI for those with genetic alterations facilitates earlier diagnosis.

Imaging is crucial for breast screening in developed nations, yet, it is impractical in many countries. Early diagnosis through patient education and adequate healthcare resources are key to reducing breast cancer mortality.

Oncoplastic treatment choices and de-escalation of treatment

DBT, CESM and MRI enhance surgeons’ confidence in extending breast conservation through wider adoption of oncoplastic breast conservation surgery techniques, improving patient quality of life.

Wire-guided localisation of impalpable lesions has broadly been replaced by modern techniques like RFID, magnetic and radar localisation for increased patient comfort and theatre efficiency.

De-escalating axillary surgery, supported by evidence, can reduce complications such as lymphoedema; and MRI has been shown to predict response to neoadjuvant chemotherapy, driving down the need for mastectomy.

Imaging is crucial for breast
screening in developed nations,
yet, it is impractical in many countries.

Targeted therapies must be cost-effective for global access

The development and adoption of genomic assays for ER-positive and HER2-negative cancers to assess chemotherapy benefits has been a big step forward for personalised care. The advent of targeted therapies (anti-HER2) and immunotherapy (for ER-positive and triple-negative cancers) can potentially improve outcomes for breast cancers. The cost of these therapies must be decreased to allow ‘all-inclusive’ global access to minimise variation.

Role in advanced disease management

PET-CT enhances distant disease assessment over standard imaging, identifying oligometastatic disease treatable with modalities such as SABR, potentially improving curative outcomes and duration of progression-free survival.

The rising incidence of breast cancer, coupled with better treatment, means more people are living longer. Individualising cancer care, minimising morbidity and maximising benefits through early diagnosis and tailored therapies can lead to optimised, evidence-based breast cancer management.

The post Personalising breast cancer care: ways to minimise negative impacts of treatment appeared first on Health Awareness.

It is increasingly vital to boost the cancer care workforce in the NHS and encourage new students to take up training.

Medical physicists, technologists and clinical engineers are the backbone of cancer care delivery. These highly trained scientists diagnose and treat patients and are an essential part of the healthcare team alongside radiographers, oncologists and nurses.

Medical physicists, technologists and clinical engineers

Dr Anna Barnes, Consultant Clinical Scientist and President of the Institute of Physics and Engineering in Medicine (IPEM), says: “These roles are both multifaceted and crucial for the safe and effective delivery of a multitude of services underpinning the NHS.”

They carry out technical assurance tests, radiation safety checks, implementing quality control measures and optimising machinery with the use of computer-aided design. “They programme how treatment delivery machines provide the exact amount of radiotherapy needed while avoiding non-cancerous cells,” she adds.

Referring to their role as ‘the oil in the wheel,’ Dr Barnes explains they are a vital part of designing and planning treatment schedules within radiotherapy, molecular radiotherapy and nuclear medicine while translating research into clinical workflow. According to IPEM, medical physicists and clinical engineers contribute to 45% of all treatments within NHS hospitals.

The UK does not have enough
healthcare scientists, engineers and
technologists to deliver essential services.

Challenges of the workforce

Dr Barnes explains: “The UK does not have enough healthcare scientists, engineers and technologists to deliver essential services.” While those currently in the workforce are asked to ‘do more and more with less and less,’ it is also increasingly difficult to train new members of staff.

“To maintain this extraordinary level of expertise, it is essential that we have enough new people coming through science, technology, engineering and mathematics (STEM) education and into training routes now,” she insists.

Supporting healthcare scientist roles

Dr Barnes, passionate about addressing these challenges, speaks of IPEM’s role as the workforce’s professional body. “We provide a community for healthcare scientists, industry and academic colleagues to share ideas and best practices, to promote the profession and encourage more people to consider it as a career,” she says. Additional funding and student uptake can help tackle workforce shortages and recruitment issues, helping this ‘hidden workforce’ to be recognised.

The post Addressing shortfalls within the ‘hidden’ cancer care workforce appeared first on Health Awareness.

Digital diagnostic innovations can tackle UK cancer treatment backlogs, saving lives and meeting patient demands. Technology enables early detection and treatment.

Digital diagnostic innovations can help an understaffed and under-resourced health service to prevent a possible 20,000 avoidable cancer deaths annually by 2040. It can also ensure Britain meets the growing demand from cancer patients for early diagnosis and treatments. 

Harnessing technology for cancer detection innovation

Recent technological innovations, such as the AI platform being developed by Dell and the University of Limerick, will showcase how predictive and diagnostic research in oncology can significantly improve early cancer detection and alleviate NHS backlogs.

The Department for Health and Social Care’s (DHSC) adoption of digital pathology to screen for certain cancer types is a timely step to accelerate cancer detection and treatment by improving lab efficiency, enabling second opinions on samples and expediting diagnosis. Digital pathology is a crucial component of the DHSC’s 2023 ‘Medtech Strategy,’ which sets out how medtech innovations can improve assessments of health risks.

With a general election approaching, the next
government has clear incentives to continue
developing a long-term cancer strategy.

Investing in diagnostics cuts wait times

Research and investment in innovative technology have also enabled the DHSC to highlight the benefits of early cancer diagnosis. According to recent official figures from the DHSC and the NHS, increased investment in community diagnostic centres through the Centres for Disease Control and Prevention (CDC) programme has helped reduce waiting times in the past two years.

Cancer Research UK have also highlighted the economic benefits of improvements in cancer research; prevention and care help to reduce health and social care costs and can improve workforce productivity and quality of life.

Government urged to prioritise cancer strategy

With a general election approaching, the next government has clear incentives to continue developing a long-term cancer strategy that complements and builds on the ‘Medtech Strategy’ to enable the early adoption of diagnostic innovations. The UK’s ambitions to lead in science and innovation may yet depend on the Government’s ability to define this strategy.

Early adoption of digital innovation can relieve the NHS backlog, increase the resources and professional bandwidth of healthcare professionals and, crucially, serve patients promptly to increase survival rates. 

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As AI makes waves in medicine, radiologists must position themselves to embrace this new technology, safeguard their profession and redefine the future of medical imaging.

Artificial intelligence (AI) is revolutionising radiology. It is the new kid on the block — a disruptor in the field. For some, this is a tool to be feared. For others, it offers a wealth of opportunity. Unlike many other medical fields, radiology has its origins rooted in technology. The radiologist has always embraced the latest innovations to diagnose the patient more effectively and efficiently. The rise of AI should be treated no differently.

AI enhancing radiology practice

To give the cold shoulder to this emerging technology at this crucial moment would be to let a huge opportunity slip through our fingers — an opportunity to create a symbiotic relationship with AI. This symbiosis has the potential to strengthen, not weaken the radiologists’ role in medicine and, ultimately, take medical imaging to the next level.

AI will not replace radiologists; it will enhance their practice. Just as a plane would never be left on autopilot without the oversight of an actual pilot, we cannot leave AI to its own devices when it comes to providing accurate diagnosis and effective treatment paths for the patient. This technology is here to stay and will only grow more powerful with time, but radiologists can become the captains of AI in imaging if we are open to adaptation.

To remain the key stakeholders in radiology, we must use our wealth of knowledge and experience to ensure we control the direction of our field. Radiologists can ignore the elephant in the room — or we can embrace it, shape it and harness its extraordinary power.

AI will not replace radiologists;
it will enhance their practice.

Collaboration to strengthen radiology

How do we cultivate and grow this symbiotic relationship and ensure that it is fit for purpose? Radiologists must act now, collaborating with industry partners, international organisations, governments, our medical colleagues and the patient to establish efficient workflows, clear guidelines and revised training programmes to help integrate AI into our daily working lives.

At the European Congress of Radiology 2024, attendees had one of the best opportunities for such collaboration. With its theme of ‘Next Generation Radiology,’ the congress brought many of these stakeholders together under one roof, offering radiologists and health partners from across the world a unique chance to interact, learn and define the future of our profession together.

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Learn about the evolution of radiotherapy precision with image-guided technology and how it enhances treatment accuracy and minimises side effects.

Radiotherapy uses cutting-edge technology to precisely deliver radiation exactly where it’s needed: inside the tumour. In addition to advanced diagnostic imaging before treatment, image-guided radiotherapy (IGRT) is now also performed during treatment delivery — our answer to ‘seeing’ inside the patient during treatment.

Before image-guided radiotherapy

Not long ago, imaging wasn’t used during treatment. Instead, we relied on skin marks for guidance. Then, we started using the treatment beam itself, acquiring 2D images inside the body, making placement more accurate.

However, the physics is against us when using these beams, giving poor image quality and clarity. Now, we use separate lower energy X-ray beam equipment attached to the treatment machine to produce the staple of modern IGRT — a cone-beam computed tomography image; visualising inside the body in 3D and enabling positioning with submillimetre precision.

IGRT enhances treatment effectiveness

The more accurately we can direct the treatment beams, the more effective the treatment becomes. By treating a much smaller volume of tissue (focusing on just the tumour) we can reduce the dose to the normal tissues nearby, sustaining quality of life and reducing short- and long-term side effects.

The more accurately we can direct the treatment
beams, the more effective the treatment becomes.

Precision without extra radiation

Sounds easy; but it’s taken decades to perfect, and the story continues. We can now combine the treatment machine with magnetic resonance imaging — giving even better clarity, without any extra radiation. With such advances, alongside improving computing power, we can now do more than just ensure the planned beam is well-aligned. We can adapt the treatment on a daily basis with each, new image, optimising treatment by accommodating individual changes including weight loss or bladder filling.

Surface-guided radiotherapy efficiencies

Are old methods obsolete? Not quite; the patient’s skin surface may still help. Surface-guided radiotherapy integrates advanced 3D surface monitoring techniques for on-treatment verification; hastening the patient setup process and monitoring motion throughout treatment.

Techniques boosting radiotherapy precision

These techniques form the present and future of IGRT for our patients. As these developments progress, more patients will benefit from enhanced treatment efficacy. Meanwhile, artificial intelligence is enhancing image quality, aiding adaptive processes and even tracking/compensating for internal motion. Coupled with particle beam therapy, rather than X-ray-based therapy, we’re entering a new era in radiotherapy efficacy — bolstering our fight against cancer.

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Smart early detection programmes mark a paradigm shift in prostate cancer, placing the patient’s wellbeing front and centre.

Prostate cancer is the most common male cancer in Europe, with about 450,000 Europeans diagnosed every year, but it can often go unnoticed. Earlier stages of prostate cancer can be asymptomatic for a long time or remain without symptoms. Some cases may not require treatment beyond active surveillance.

However, delaying diagnosis for aggressive forms allows the cancer to spread through the body and become more deadly. Regular check-ups, akin to breast and colorectal cancer screening, are crucial for early detection — even without symptoms.

Prostate cancer’s controversial past with early detection

Some past prostate cancer screening programmes have faced criticism for overdiagnosis, resulting in overtreatment without considering the patient’s quality of life. These programmes prioritised diagnosing the presence of cancer rather than the risk it posed to the patients.

When patients are confronted with a cancer diagnosis, many demand immediate action, regardless of whether treatment is necessary. Sometimes, treatments do more harm than good. Even successful prostate cancer treatment can negatively impact a patient’s quality of life — affecting the patient’s urinary, bowel and sexual functioning, plus the emotional burden of a cancer diagnosis.

Newer programmes not only have the potential
to redefine how clinicians diagnose and treat
prostate cancer but also how patients
experience living with cancer.

Smart early detection is shaping prostate cancer care

Modern prostate cancer screening now incorporates risk-based strategies. These algorithms assess the patient’s cancer risk to tailor treatment decisions effectively. Newer programmes not only have the potential to redefine how clinicians diagnose and treat prostate cancer but also how patients experience living with cancer. Not every diagnosis is terminal; understanding that is important to the patient’s participation in their own care.

Patient-centric prostate cancer detection

These methods are not theoretical; they are already being applied. Sweden has been trialling an early detection programme. The ‘Organised Prostate Cancer Testing Programme (OPT), first concentrated on rural areas and, following that success, is expanding across Sweden. A European Union co-funded project, PRAISE-U, expands on these successful screening trials with five pilot sites across Europe. It aims to assess the feasibility of the risk-based approach, including psychosocial effects.

Smart early detection programmes are a shift in prostate cancer care and part of a growing movement towards more patient-centric care.

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Learn what needs to be done to tackle NHS cancer testing challenges, including addressing workforce capacity and rising demand for pathology services.

There are growing concerns that the current model for cancer testing (and the workforce) is unable to keep up with the increasing demand for pathology services across the NHS. The Institute of Biomedical Science and AstraZeneca teamed up to develop a six-step framework for creating the capacity the NHS needs for the future of cancer testing:

 
1. Grow the workforce

As well as investing in and training a pipeline of talent, the NHS should support pathologists in playing a key role in multidisciplinary teams. Enable biomedical and clinical scientists to operate at the top of their licence — developing and using specialist and expert skills and knowledge.

2. Bring cancer testing together

We should ensure testing is organised according to the needs of patients and multidisciplinary teams, delivering commonly used or established tests closer to patients and at the quality and scale required.

3. Enable providers to deliver

Services should be patient and clinician-focused. When centralised testing services are unable to provide a timely, high-quality service, other providers should be supported to lend additional capacity — providing the right test at the right time. Where this happens, it will be important that tests are delivered according to the necessary criteria, as well as in line with appropriate quality measures and at a comparable cost.

Unsuitable use of buildings, overstretched
courier services and inefficient information
transfer hinder cancer testing services.

4. Improve data

Ensuring data is collected consistently and can be shared across systems is vital to improving quality and unlocking capacity. The publication of a genomics informatics implementation plan, as committed to in NHS England’s genomic medicine strategy, is a vital first step. Data on cancer testing is also vital for enabling accountability, supporting timely and joined-up patient care and informing research.

5. Develop a cancer testing accountability framework

Quality measures should be established — to which all NHS cancer testing providers adhere, with comparable data published on performance. The framework should inform future commissioning decisions and be used to identify good practices across the system.

6. Invest in the fundamentals

Testing advances can be inaccessible due to outdated or inadequate physical infrastructure. Unsuitable use of buildings, overstretched courier services and inefficient information transfer hinder cancer testing services. Investing properly in the fundamentals of infrastructure and logistics would enable services to deliver high-quality tests with rapid turnaround times and support the expansion of services.

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