Norway’s Prime Minister Erna Solberg hosted the latest Northern Future Forum 30 October 2018. During the forum, the Prime Ministers of the Nordic and the Baltic countries and the UK came together in Oslo Cancer Cluster Innovation Park to discuss health technologies and the role these crucial technologies can play in the health systems of the future. In this picture, the ministers get a guided tour of Oslo Cancer Cluster Incubator and the laboratories with Ketil Widerberg as their guide. Photo: Kilian Munch/Statsministerens kontor

Let us cooperate on precise health technologies

International cooperation is key to fulfilling our vision of making cancer treatments more precise, and giving the patients new treatments more quickly.

This opinion piece is written by Ketil Widerberg, General Manager at Oslo Cancer Cluster. It was first published in the Norwegian newspaper Today’s Medicine, Dagens Medisin, 30 October 2018. 

The countries in Northern Europe have contributed to developing medical treatments that we today could not imagine living without. From the British discovery of antibiotics to the Danish development of a treatment for diabetes. Once again it is time for Northern European health innovation, this time in the field of health technology. What might the prime ministers from Northern Europe focus on when they meet in Oslo on 30 October to discuss health technology?

They might want to point out concrete and state-of-the-art initiatives from their respective countries. It could be Swedish biobanks, Finnish artificial intelligence, Danish health data, English genomics and Estonian health blockchain. These are exciting initiatives that make medicine more precise. This is particularly important when it comes to cancer because more precise treatments could save lives and limit the late effects resulting from imprecise treatment.

This opinion piece is written by Ketil Widerberg, General Manager at Oslo Cancer Cluster. It was first published in the Norwegian newspaper Today’s Medicine, Dagens Medisin, 30 October 2018.

At the same time, we see the contours of serious challenges arising with more precise medicine, such as each unit becoming more expensive. Smaller patient groups also mean that it is harder to find enough patients to understand the biological processes and the consequences of new medical treatments. As the prime ministers gather in Oslo to discuss health technology and plan the road ahead, it would not be amiss for them to look back in time and find inspiration from another technological development.

Precise through cooperation
In the 1990s, the search engine Yahoo helped us to quality-assure by categorising and being precise when we needed information on the internet. Yahoo thus contributed to the internet changing the world. However, the amount of data soon became enormous and complex, and a never-ending need for resources and experts arose. The traditional categorisation to ensure quality and structure the data became an impossible task.

This is very similar to what is happening in the health field today. We are constantly collecting more data and educating an increasing number of experts. With a few exceptions, every country is now collecting their data in their own registers and using a great deal of resources on assuring the quality of the data. The countries are rightfully proud of their initiatives. In Norway, we are proud of our biobanks and our health registers, such as the Cancer Registry of Norway. At the same time, we need to ask ourselves whether this national strategy really is the smartest way forward.

Let us go back to Yahoo. Towards the end of the 1990s, some engineers in California thought differently about the internet. How about using cooperation as a quality indicator? Instead of categorising, the links between the websites could ensure data quality. This is how Google was born, and we got precision, quality and insight into data that changed the world.

There are different challenges in the health field than on the internet. Data are more sensitive and the consequences for individuals can often be more dire. At the same time, health technology, in many ways, has reached the same point as the internet faced in the 1990s.  We do not have the quantity, the methods for analysis, or the quality to fully exploit the data to gather insight, or for treatment or innovation – yet.

From Yahoo to Google level
One way in which we could tackle the health technology challenges the data present us with is through international cooperation. It is about two things: to gather enough data, and to analyse the data to provide better and more precise treatment. The initiatives so far are promising, but they lack the potential to make the leap from Yahoo to Google.

The Northern European prime ministers can probably acknowledge this. The question is: what can they do? Should they encourage smart young engineers to analyse health data instead of developing the next app? Or should they change the way the hospitals buy technology?

A step in the right direction could be to look at what works best in the other countries. At the same time, we need to avoid new initiatives merely becoming a better horse-drawn carriage. Are there initiatives in existence that are scalable internationally so that we can bring health data up to the next level together? The answer is yes, but it requires visionary initiatives that have not been done anywhere else.

Common clinical studies
An area that the prime ministers will be able to highlight is a Northern European initiative for clinical studies. Together, the countries have a large number of patients, which gives researchers and doctors a better basis in their studies to understand more and provide better treatment. Such an initiative could also use health data from the national health services collected on a daily basis in several countries, known as real world data, instead of eventual clinical studies with patients over several years. This would be both quicker and much cheaper.

The prime ministers might also agree on cooperating on Northern European genetics. For 13 years, we collaborated on mapping our genes in the international  Human Genome Project. Now we need to get together to understand genes and treat the patients. With prioritised funding, genetics will soon be a part of the everyday clinical life in England. We can learn a lot from their experience.

Artificial intelligence
Lastly, the Northern European prime ministers may wish to collaborate on artificial intelligence in the health field. Today, cancer treatment, for instance, often only works on three out of ten patients. Artificial intelligence will change how we understand diseases such as cancer and how we treat the patients. The experiences from Finland of introducing artificial intelligence will help other countries to understand where the barriers are and where help might be needed first.

Oslo Cancer Cluster’s vision is to make cancer treatment more precise and provide new treatments more quickly to the patients. We see that international cooperation is key to obtaining this goal. As a result, we could also discover diseases more quickly and reduce the costs of the national health services. We hope the Northern European prime ministers will delve into these issues when they meet to discuss the health technologies of the future here with us.

By Ketil Widerberg, General Manager at Oslo Cancer Cluster.

Ketil Widerberg, General Manager at Oslo Cancer Cluster, opened the meeting on intelligent and personalized algorithms to prevent cancer 20 September 2018.

American tech and Norwegian health data

Combining country scale population data with world class computer systems and algorithms will push the boundaries of precision medicine.

This is a story about the unique American-Norwegian collaboration that combines the best health data with the most powerful computers in a pioneer project run by Cancer Registry of Norway and Lawrence Livermore National Laboratory.

Data to screen cancer 
The ongoing project was initiated after a talk on tech between the General Manager of Oslo Cancer Cluster and a Senior Scientist from Lawrence Livermore National Laboratory. Some months later, in San Francisco, a meeting room was filled with some of the world’s best minds on cancer and technology. The Norwegians knew cancer and the Americans knew computing. The outcome was unknown. 

They identified a concrete challenge. Can we see patterns in data to screen cancer more precisely?

The quest resulted in a successful cooperation between Lawrence Livermore and the Cancer Registry in January 2016 where a team from the Cancer Registry started the first project on cervical cancer. If successful, they would potentially identify and screen high risk patients earlier and leave the low risk patients unburdened. 

Now there are two ongoing projects, one on cervical cancer and one on multitask learning for cancer. The goal is to make predictions more accurate and improve precision medicine. 

– If successful we can potentially identify and screen high risk earlier and leave the low risk unburdened. The individual and social impact of such a strategy is significant. This may be the reason why Joe Biden mentioned details from this project at a UN Assembly last year, Widerberg said.

Former Vice President Joe Biden led the American cancer initiative known as the Cancer Moonshot Blue Ribbon Panel. Two years ago, when the collaborative project between Norway and the USA had just started, the Blue Ribbon Panel released a report describing ten transformative research recommendations for achieving the Cancer Moonshot’s ambitious goal of making a decade’s worth of progress in cancer prevention, diagnosis, and treatment in just 5 years.

One of the ten recommendations was to expand use of proven cancer prevention and early detection strategies.

The major research questions
– One of the major research questions right now is How do we design the optimal screening programs? Another is how to actually take advantage of the registry data that we have, said Giske Ursin, Director of the Cancer Registry of Norway.

In Norway, and similarly in the other Nordic countries, we have registries on various diseases, pregnancy/births, vaccinations, work history/unemployment, income and much more. We have data sets dating from the 1950s. That is unique in the world. 

– If you look at enough data, you can find interesting links that can be explored in the clinical world or elsewhere. For instance; how do other diseases affect cancer diseases? We need international expertise to cover areas we are not experts on ourselves, she said, showing a picture of one of the super computers at Lawrence Livermore.

Cancer and national security
Lawrence Livermore National Laboratory is a national security laboratory and part of the U.S Department of Energy. The laboratory has over 5000 employees, of which at least half are engineers and researchers.

– We have the mandate from the government to push the forefront on subjects like bio security. Precision medicine is alined with the bio security mission, but it is even more relevant to the super computing research mandate. What are the next types of problems that will move this forward? Biomedical data complexity. That is why we are in this, Ana Paula de Oliveira Sales from Lawrence Livermore National Laboratory said in her presentation. 

Some ingredients of the project on cervical cancer is to improve cancer outcome prediction by combining disparate cancer types. The preliminary results are encouraging.

 

Break down barriers
John-Arne Røttingen, CEO of the Research Council of Norway, gave a talk on how collaborations between the Nordic countries and other countries are important for population based clinical research and health research.

– Personalized medicine is full of promise and we want to contribute to this progress, but we cannot do this only with our data. We have to collaborate with other countries and with different fields of research, he said.

One important country in that respect is of course the USA.

Kenneth J. Braithwaite, U.S Ambassador to Norway, talked about the opportunities with the Norwegian databases in a meeting in the Oslo Cancer Cluster innovation park 20 September 2018.

— I have learned the past few years that data is king, and we need to wrap our arms around this. I think there is a responsibility from the governments to begin to break down the barriers and truly find a cure to cancer. That’s what we are up against, said U.S. Ambassador to Norway Kenneth J. Braithwaite, who is Rear Admiral of United States Navy (Retired).

— As we say in the Navy, full speed ahead!

Photocure Expansion Accepted by FDA

Oslo Cancer Cluster member Photocure recently announced that the U.S. Food and Drug Administration (FDA) has accepted an expansion of the bladder cancer detection system “Cysview”.

The FDA has accepted a supplemental New Drug Application (NDA) for “Cysview”. Photocure, the Norwegian company behind the drug-device system, has now been allowed to expand the system to include “Flexible Cystoscopes”, these are used in the ongoing surveillance of patients with bladder cancer. According to Photocure, this is the only combination of drug and device approved for the detection of bladder cancer.

How Cysview Detects Cancer
Cysview is a method of detecting bladder cancer using photodynamic technology and is the only FDA-approved product for use with blue light cystoscopy, where a device called a cystoscope is used to detect cancer inside the bladder.

Cysview is injected into the bladder through a catheter. It accumulates differentially in malignant cells. When illuminated with blue light from the cystoscope, the cancerous lesions fluoresce red, highlighting the malignant areas.

An important Tool
Bladder cancer is one of the most expensive cancers to manage, accounting for approximately 3.7 billion USD in direct costs each year in the US. Being able to expand “Cysview” with flexible Cystoscopes will substantially decrease costs and give patients a more effective treatment. Good news for both company and bladder cancer patients.

— This approval is an important milestone for Photocure. With 1.2 million surveillance cystoscopies performed annually in the U.S., this represents a significant opportunity for the company and allows us to bring solutions to current clinical challenges, says Kjetil Hestdal M.D. Ph.D., President and CEO, Photocure.

The expanded indication includes the combination of “Cysview” with the KARL STORZ PDD Flexible Blue Light Videoscope System. The approval also expands the indication for the current rigid setting by including the detection of the pre-cancer state carcinoma in situ (CIS) in patients, as well as the repeated use of Blue Light cystoscope with Cysview.

 

About Photocure:

Photocure, the world leader in photodynamic technology, is a Norwegian based specialty pharmaceutical company. Photocure develop and commercialize highly selective and effective solutions in several disease areas such as bladder cancer, HPV and precancerous lesions of the cervix and acne.

Their aim is to improve patient care and quality of life by making solutions based on Photocure Technology™ accessible to patients worldwide.

Photocure was founded by the Norwegian Radium Hospital in 1997. Today, the company, headquartered in Oslo, Norway, has over 60 highly skilled employees and operates in Norway, Sweden, Denmark, Finland and the United States.

Follow the 10th Cancer Crosslinks: Stream and Program

Thursday January the 18th it’s time for the 10th Cancer Crosslinks here at Oslo Cancer Cluster Innovation Park. Hospital personnel, researchers and everybody interested get together for an update on – and to discuss – the latest within cancer research.

 

This year’s conference will focus on Precision Treatment in cancer research with the headline: Exploiting Recent Advances – Fast and Furious?

Check out the program here.

Follow the stream
Registration for the event is now closed, but the whole event will be streamed and broadcasted here at the website. Just follow this link and you can follow the event live:

Follow the stream here.