Intraoperative detection of tumors: the next big thing in oncology?

Intraoperative detection of cancer cells is a new and innovative form of interventional oncology. 15 years ago, interventional oncology started to be used in some cancers and utilization has been increasing until today. The original technique is principally based on advances in imaging techniques such as ultrasound, MRI or CT being used to position different types of equipment into organs that would otherwise be difficult to reach. It has been applied in diagnosis, treatment or symptom easement and brings along minimal invasive procedures and precision medicine approaches in need of multiple biopsies. The next step of advancement comes with intraoperative detection of cancer cells. In this article we will walk you through some reasons why this approach is so innovative and will describe some interesting players engaged in the field.

What is intraoperative detection of tumor cells all about and what are the benefits?

Surgery is one key pillar in treating solid tumors however its success depends on full depletion of cancer cells during surgery. If this cannot be achieved, there is a high risk of recurrence, which stands as one of the strongest unmet needs regarding cancer surgeries. Intraoperative detection of tumor cells is a way to improve the surgical oncology outcome.

Molecular-image guided surgery is an innovative emerging multidisciplinary technique. The development includes surgeons, oncologists, mathematicians and other specialties. Now, different methods to intraoperatively detect tumor cells exist. The imaging often works by injecting a fluorescent label attached to a marker (e.g. a monoclonal antibody), which specifically and selectively binds to tumor cells or infiltrates the tumor. By applying specific light sources, the technology helps the surgeon ‘see’ the tumor or metastatic tissue in real time during the surgery. The technology literally shows the surgeon where exactly the tumor herds are located, helps in tumor margin detection, and ultimately allows for a correct excision of the tumor. Fluorescent markers can be used with a wide range of procedures, including open surgery, laparoscopic surgery, and diagnostic procedures such as colonoscopy.  Patients benefit from this technique through reduction of recurrence and the need for 2^nd surgeries. Pathologists can also benefit from it as knowing if the tumor has entirely been removed is easier with the technology.

Who is working in the field of intraoperative detection of cancer cells?

Many companies, often start-ups as well as academia, are working in this exciting field. Without any claim of completeness, we highlighted 4 approaches or players with promising approaches.

1. Surgimab

Surgimab is a company presenting its approach as a technology that can “decrease both under- and over-treatment by providing oncologic surgeons with a clear delineation of tumors within a healthy environment”. The technology is based on near infrared fluorescence imaging using a tumor-specific antibody either targeting Carcinoembryonic antigen (CEA) or Anti-Müllerian Hormone Receptor 2 (AMHR2). In both cases, the molecule is conjugated to a fluorescent dye. Besides assessing tumor margins, the technology aims at cancer staging and detection of metastases. The technology is currently starting phase 3 trials with one product in colorectal- and breast cancers, a second product is in pre-clinical setups for ovarian cancer. Development is done in collaboration with many partners, among the image-guided surgery group at LUMC (Leiden University Medical Center).

2. SurgVision

Another player in the field is SurgVision, who was acquired by Bracco Imaging in 2017. SurgVision developed an innovative real-time fluorescence image-guided surgery platform combining a targeted imaging agent in combination with a device to visualize tumor herds during surgery. The device is to be used in specific diseases such as breast conserving surgery, peritoneal carcinomatosis and esophageal cancer. Clinical trials are ongoing.

3. Lumicell

Lumicell developed systems to illuminate cancer during surgery in order to improve patient outcome. The Lumicell technology is based on an investigational onco-fluorescent agent that targets the tumor microenvironment. The fluorescence is activated by proteases when the agent gets close to tumor cells. Besides the fluorescent agent, the device is composed of a light, hand-held imaging device to visualize tumor margins in lumpectomies. The technology will start a pivotal study in breast cancer soon and is currently being clinically tested in many other cancer types.

4. Penn Medicine

Penn Medicine has developed the TumorGlow technology. This technology claims to “prevent cancer recurrence by improving the detection of residual cells during surgery”. The system uses fluorescent agents that have an organic tropism for cancer cells. When cancer cells absorb the agent, certain light conditions make them shine, helping surgeons easily identify cancerogenous tissue. The technology is investigational and clinically tested.

The potential of the described technologies and players is enormous as the clinical needs are strong. Over- or under-treatment is an issue originating from false-positive or -negative pathology decisions. Surgical oncology and patients will benefit from intraoperative detection of tumors: they will avoid second surgery, wrong treatments and reduced quality of life. Future applications can also include improved diagnostic procedures, identification of metastases, or even the prediction of treatment success, all for the benefit for the patient. Big players like Bracco getting involved with these technologies gives an indication on how groundbreaking these kinds of new generation innovations are for the healthcare industry, and the way care will be delivered in the future. Beyond this article, many more technologies under development exist! Our objective? Helping you to stay up to date with the fast development of the market!

Interested in this subject? Discover our position paper on Innovation in Oncology: a Promising Future for Patients and our achievements in business development consulting in Healthcare!

About the author

Volker, Great Explorer Oncology in Alcimed’s Healthcare team in Germany