A panel conversation about how personalised medicine can create value in the national health service. From left to right: Åsmund Flobakk, oncologist at St Olavs hospital, Siri Børø, Medical Advisor Oncology at Merck, Giske Ursin, director at the Cancer Registry of Norway and Ulrich Spreng, Chief Medical Officer of Helse Sør-Øst.

Personalised medicine to relieve the health service

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Smaller patient groups and targeted treatments are the future of cancer care in Norway.

It is no longer a question of if but when personalised medicine will be a reality for all cancer patients in Norway. This was a key message in a recent meeting arranged by the public-private consortium CONNECT during Arendalsuka, where the resource crisis in the health service was discussed.

Forward-looking health authorities

Ulrich Spreng, Chief Medical Officer of the South-Eastern Regional Health Authority (Helse Sør-Øst), underlined how critical personalised treatments will be in the future. Spreng sits in the Decision Forum of New Methods, the national system that manages the introduction of new treatments in Norway. The Decision Forum looks at three criteria; the severity of the disease, the effect of the treatment and the resources it requires.

“If you can target treatment better according to an individual patient’s genetic profile, there will be a greater effect. This makes it easier to implement that drug since it is a different relationship between resources and effect than when you treat a large patient group where many do not have an effect. It is important for us to separate a total patient group into subgroups according to their genetic profile. This is very exciting for New Methods!” Spreng commented.

Urgent lack of resources

The Norwegian health service faces a lack of resources and personnel, according to an investigation by the Health Personnel Commission in 2022. Gro Live Fagereng, Coordinator Precision Cancer Medicine at Oslo University Hospital, agreed this is a major challenge:

“We have limited time and finances in the health service, so we must prioritise the available resources. Both personalised medicine and research in general form the basis for making the best priorities. We need to invest in research to make the most of our resources. I hope and believe we will have a more systematic and learning health service in the future; that we will learn more from patients, so we can update treatments and make better priorities.”

Åsmund Flobak, oncologist at St. Olavs Hospital, explained how personalised medicine enables us to learn from patients:

“Traditionally, we have treated patients on a group level, but we know that patients are different; some respond and some do not. The goal is to find out which biomarkers relate to which treatments. We have worked to establish publicly financed precision diagnostics through InPreD and we give patients precision treatment through IMPRESS. A third of us will at some point get cancer, so we must implement better treatments.”

Watch this video (in Norwegian) to understand personalised medicine:

Health economists also agree that this strategy can help to save resources.

“When a patient gets the right treatment, you avoid giving a treatment that doesn’t work well enough first and there are fewer side effects. The consequence is less use of resources in the health service and we can live better lives,” commented Erik Magnus Sæther, Partner at Oslo Economics.

Public-private collaboration needed

Karoline Knutsen, Manager Market Access at Legemiddelindustrien (LMI), said that the vision for the future looks grim:

“The number of people of working age will decrease, while there will be more elderly in need of health services. We will see more chronically ill people with complex diseases. We believe new technologies and treatments are part of the solution, so more of us can keep working. The success of implementation of personalised medicine relies not just on financial investments, but also on contributions from many key players and stakeholders. Everyone must sit around the same table.”

CONNECT was set up to be that table, as a public-private consortium driving the implementation of precision cancer medicine in Norway. Since 2020, CONNECT has gathered 30 partners, including industry, patient organisations, university hospitals and several governmental institutions.

“We need to nurture this collaboration, develop it and use it in more areas,” commented Thomas Axelsen, Head of Politics at the Norwegian Cancer Society. “Personalised medicine in cancer needs to happen, no matter what. It is just about how fast we want it to happen. If we do it faster, we can save patients’ lives.”

Political ambitions

The government’s ambition is also high in this area, as seen in the Strategy for Personalised Medicine launched in January 2022.

“Personalised medicine should be an integrated part of the specialist health service. We need to develop the health service in a way that maximises value creation, both for the individual and for society as a whole,” said Truls Vasvik, State Secretary of the Ministry of Health and Care Services.

“Our doors are always open. We need to talk together about the development of competences, research and new price models; how we can get documentation of small patient groups and single treatments with uncertain long-term effects,” added Vasvik.

The post Personalised medicine to relieve the health service first appeared on Oslo Cancer Cluster.

The expert panel discussed how Norway can implement a Cancer Mission. From left to right: Idar Kreutzer (NHO), Cathrine Lofthus (Ministry of Health and Care Services), Jónas Einarsson (Radforsk / Oslo Cancer Cluster), Astrid Bjerke (Norwegian Cancer Society), Erik Aasheim (moderator, Primus Productions).

Arendalsuka: – We need to attract the big companies

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Norway needs more big companies to deliver on the Mission on Cancer.

The European Union has launched the Mission on Cancer with the goal to improve the lives of 3 million Europeans. In the recent meeting Fremtidens kreftbehandling during Arendalsuka, key experts and politicians gathered to discuss the implications of this for Norway. See the meeting here. See the meeting here. 

“With missions, we need to mobilise all resources in society towards a common goal. This is a new way to work and it challenges the established system. It is a historic investment from the EU; they are leaving no stone unturned in the fight against cancer,” said Astrid Bjerke, strategic adviser for the Norwegian Cancer Society.

A Norwegian Cancer Mission Hub has already been set up in Norway by several stakeholders, including Cancer Society, Oslo Cancer Cluster, The Research Council, The Norwegian Health Directorate, the Cancer Registry of Norway, and more.

“Norway is a part of the Mission on Cancer and this is important both for the ministry and from political leadership. EU has seen that we have to work together in the area of health. It is important that Norway is a part of this, because it also gives us possibilities.

“We have a great health service and fantastic health data, which we need to take better advantage of. We have a high degree of knowledge and fabulous research environments, as well as a population with a high degree of trust. Many positive things are happening, but we need to attract the big companies and their competence,” said Cathrine Lofthus, Secretary General of the Ministry of Health and Care Services.

Successful industry collaborations

Idar Kreutzer, director of The Confederation of Norwegian Enterprise (NHO), gave several historic examples of how Norway has built industries based on public-private collaboration, such as water power and the oil industry.

“We were impressed when we saw the power of the development of vaccines during the pandemic, which was a real collaboration between authorities, researchers and industry – with impressive results! The health industry is already exporting for more than NOK 20 billion per year, but the potential is even larger and Norway has perfect conditions to grow a health industry,” said Kreutzer.

One example of a current collaboration between academia and industry is the Oslo Cancer Cluster Innovation Park, which is expanding and has recently signed a lease agreement with the global company Thermo Fisher Scientific.

“We are doing many of the right things in Norway from basic research to patient treatment, but we need to look at the whole ecosystem. We built this ecosystem in miniature around the Radium Hospital, because this is where most of the cancer patients come through and most cancer research is done. It has been a difficult journey, but we have a very exciting pipeline with several up-and-coming companies and promising treatments,” said Jónas Einarsson, CEO of Radforsk Investment Fund and founder of Oslo Cancer Cluster.

Is there political will?

There seemed to be broad political consensus around the Cancer Mission among the politicians at the meeting.

“Missions and the EU’s work in this area is a part of our new cancer strategy and we have to collaborate on this, as well as collaborate with the EU. The mission concept is nothing new. It is first and foremost about achieving collaboration between the health service and the industry. Our cancer strategy will lay the basis for this: to gather all resources around a common goal,” said Even Røed, the Labour Party (Norway).

“We need to replace the income from oil and gas with new industries, which need to have large potentials. All Nordic countries have managed to make their health industries grow. Now we have the opportunity in Norway. The health service, academic milieus and industry are already gathering momentum, but there is a lack of political will. Norway has joined the Mission on Cancer, but how will it be implemented in Norway? There needs to be political will to build the health industry,” said Alfred Bjørlo, the Liberal Party (Norway).

“This is a really exciting method, to involve civil society, industry and academic milieus. I am most concerned about this being politically anchored. Will we see it when the new Cancer Strategy is presented? Will we see the Minister of Health together with the Minister of Industry and a representative from the European Union? Will we be connected to the Europen Union, or will this be a Norwegian hobby project, where we don’t take advantage of the big advantages we have?” asked Kristoffer Robin Haug, Green Party (Norway).

 

The meeting was organised by Oslo Cancer Cluster, the Norwegian Cancer Society, Legemiddelindustrien LMI, MSD Norway, Janssen Norway and AstraZeneca Norway. Thank you to our collaboration partners!

 

The post Arendalsuka: – We need to attract the big companies first appeared on Oslo Cancer Cluster.

Arendalsuka 2023

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Møt oss i Arendal! Vi skal sette kreftinnovasjon på den politiske dagsorden!

Våre arrangementer streames direkte via vår YouTube-kanal @OsloCancerCluster. 

 

Fremtidens kreftbehandling

Tirsdag 15. august, kl. 08.00-09.00, Clarion Hotel Tyholmen Sal A

Velkommen til frokostseminar om samfunnsoppdraget kreft.

Hvert år får 3,5 millioner europeere diagnosen kreft. Om utviklingen fortsetter, vil tallet være 4,3 millioner i 2035. Kreft er i dag den vanligste dødsårsaken i Norge og i flere europeiske land. Utfordringen på kreftområdet er med andre ord formidabel – og økende. Nettopp derfor har EU definert kreft som en av fem store samfunnsutfordringer, som har fått sine tilsvarende målrettede samfunnsoppdrag, såkalte missions. Disse oppdragene skal føre til løsningsforslag på vår tids største utfordringer innen miljø, klima og kreft.

Hvordan kan vi best lykkes med et samfunnsoppdrag på kreft i Norge? Hva har helsenæring og eksport med et samfunnsoppdrag på kreft å gjøre? Og er det ønskelig fra politisk hold å bruke missions som metode? Dette er sentrale spørsmål vi vil debattere med politikere og samfunnsaktører under dette frokostseminaret i møteserien Fremtidens kreftbehandling.

Arrangører: Oslo Cancer Cluster, Kreftforeningen, Legemiddelindustrien, Janssen Norge, MSD Norge, AstraZeneca Norge

Medisinsk innovasjon etter Inflation Reduction Act

Tirsdag 15. august, kl. 14.30-15.30, Clarion Hotel Tyholmen Sal A

Hvordan vil USAs enorme støttepakke til egen industri påvirke medisinsk innovasjon i Europa og Norge?  

Amerikanerne har lansert en støttepakke til egen industri, kalt Inflation Reduction Act. Denne vil påvirke investeringer i forskning og innovasjon i USA, og få ringvirkninger for Europa og Norge.

Inflation Reduction Act, som ble vedtatt i amerikansk lov i fjor, skal få fart på det grønne skiftet og redusere inflasjonen i USA. Men kommentatorer peker på at det vel så mye er en gigantisk pakke for å hente industri og arbeidsplasser hjem, blant annet gjennom subsidier. I pakken kommer også en rekke tiltak som påvirker utvikling av legemidler. Blant annet har flere legemiddelselskaper uttrykt bekymring for en betydelig usikkerhet knyttet til investeringer i forskning og utvikling, og at flere fremtidige kliniske studier kan bli satt på pause.

Hvordan skal Europa og Norge svare på dette?

Historisk har Europa vært ledende på medisinsk innovasjon, men de siste tjue årene har vi falt etter USA. I 2002 var forskjellen mellom investeringer i forskning og utvikling i helseteknologi mellom USA og Europa på 2 milliarder euro, og i dag har denne forskjellen blitt 25 milliarder euro. På tross av dette er Europa i en unik situasjon til å ta over lederrollen innen medisinsk innovasjon, med et helsevesen i verdensklasse, og en lang historie innen forskning og utvikling. Når USA nå satser tungt på egen industri, er det en mulighet for Europa til å intensivere sin egen innovasjonskraft innen helse.

Medisinsk innovasjon er avhengig av et levende økosystem mellom private aktører, helsetjenester og akademia. Derfor vil vi invitere aktører fra det norske økosystemet for å diskutere hvordan Europa, inkludert Norge, skal svare på den globale utviklingen som USA nå dytter framover med sin nasjonale støttepakke.

Arrangører: Oslo Cancer Cluster, Abbvie, Photocure

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The Future of Digital Health in Norway: Leading the Way

Onsdag 16. august, kl. 13.30-14.30, Rygerelektra

Digital solutions offer significant potential to enhance healthcare delivery and innovation for Norwegian businesses. Despite a multitude of available apps, global downloads, and opportunities, many healthcare systems struggle with effective utilization due to trust issues and market complexity. This event highlights successful European cases, aiming to inspire Norway to become a pioneer in secure and impactful digital healthcare solutions.

Agenda:

13:30 – Introduction and Moderation Presented by Stephen McAdam from DNV

13:35 – Norges strategi for implementering av digitale helse teknologier Presented by Lucie Aunan, Divisjonsdirektør at Direktoratet for eHelse (Presentation in Norwegian)

13:40 – The Importance of Certification for Norwegian Municipalities Presented by Terje Wistner, Director ehealth at KS

13:45 – Sleepio: Experience from the UK and Other Countries (Video)

13:48 – A European Perspective: What’s Working and What’s Not Presented by Liz Ashall Payne, CEO and Founder of Orcha

14:00 – Challenges of Implementing Digital Solutions in Norway Presented by Solvor Øverlien Magi, CEO of Lifeness

14:07 – Round Table Discussion Participants: KS, Lifeness, Orcha, CEO of Norwegian Smart Care Cluster Arild Kristensen representing Norwegian Health clusters

14:25 – Summarizing Comments Presented by Stephen McAdam

14:30 – Closing Remarks

Arrangører: Oslo Cancer Cluster, Norway Health Tech, Norwegian Smart Care Cluster, The Life Science Cluster, DNV

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Kan persontilpasset medisin bidra til å løse ressurskrisen i helsetjenesten?

Onsdag 16. august, kl. 16.30-17.30, Clarion Hotel Tyholmen Sal A

Konsortiet CONNECT inviterer til diskusjon om persontilpasset medisin i lys av ressurskrisen i helsetjenestene.

Hva er de største ressursutfordringene helsetjenesten står overfor – og hvordan kan persontilpasset medisin bidra til å løse disse?

I løpet av denne timen tar vi på oss fremtidsbrillene. Vi ser på hva den nye strategien for persontilpasset medisin sier om utsiktene for mer presis behandling, og hvordan blant annet data fra norske kreftpasienter kan bidra til en mer effektiv bruk av helsepersonell og ressurser.

Både fagfolk og politikere deler sitt syn på hva som vil skape bedre ressursbruk i helsetjenesten i årene framover, og hvilken plass persontilpasset medisin bør få i helsetjenesten.

Arrangører: CONNECT

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Du finner mer informasjon om alle arrangementer i Arendal via Arendalsuka.no

The post Arendalsuka 2023 first appeared on Oslo Cancer Cluster.

Karsten Rydén-Eilertsen, Head of Proton Therapy Physics at Oslo University Hospital, is testing the new technology from Kongsberg Beam Technology in a clinical environment, and hopes to improve the precision of radiation therapy.

AI for more precise radiation therapy

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Artificial intelligence is changing the way radiation therapy is used to combat cancer.

A Norwegian technology, developed by the company Kongsberg Beam Technology to improve the precision of external beam radiation therapy, is being tested at Oslo University Hospital.

“There are almost half a million Norwegians living with cancer today. Many more cancer patients survive after radiation therapy, but that doesn’t necessarily mean the patients get well. What concerns us most today is to create treatment plans with less side effects,” said Karsten Rydén-Eilertsen, Head of Proton Therapy Physics at Oslo University Hospital and responsible for the test project.

Huge developments

Karsten Rydén-Eilertsen has worked with radiation therapy at Oslo University Hospital for 33 years. He remembers when the doctors had to make radiotherapy plans for cancer patients using only 2D X-ray images and palpating the tumour site with their hands. Medical physicists and radiotherapy technicians would calculate the dose using standardised charts.

“I have experienced an explosive development in the field of radiation therapy against cancer. We now only use three- and four-dimensional images that we transfer to a sophisticated treatment planning system, where we can outline the tumour and vital organs in detail. There are advanced algorithms for calculating the exact right doses for the individual patient,” Rydén-Eilertsen explained.

These developments are thanks to major advancements in imaging technology, computer power, programming and data handling.

“The big difference today is that the level of personalisation and precision is much higher. We can deposit a high dose of radiation that can destroy the tumour while sparing healthy tissue,” Rydén-Eilertsen commented.

Still many side-effects

With radiation therapy, doctors aim to eradicate the tumour, while minimizing the damage to healthy tissue and vital organs.

“It is a difficult balancing act, because sometimes the organs are so close to the tumour that you can’t avoid affecting them with radiation. Sometimes, you need to choose between destroying the tumour and keeping a vital organ,” Rydén-Eilertsen said.

This dilemma isn’t unique for radiation therapy, but is also true for other cancer treatments, such as surgery and chemotherapy.

“With radiation therapy, you will never have zero radiation dose to the surrounding tissue. There will always be some side-effects. My hope with proton therapy is that these side effects will be reduced,” added Rydén-Eilertsen.

Photons vs. protons

Traditional radiation therapy involves beaming millions of photons through the patient’s body to the tumour. The photons deposit radiation all along their way through the body before exiting. It is not possible to control the photons to only deposit radiation to cancer cells.

“Proton therapy is different. Protons are heavy particles that loose most of their energy the moment they stop. By adjusting their initial speed, you can direct them to deposit most of the radiation dose at the site of the tumour. This means that you don’t affect tissue ‘behind’ the tumour and there is minimal damage ‘in front’ of it. This opens for the possibility to greatly reduce side-effects,” explained Rydén-Eilertsen.

The challenge with protons however is that they are very sensitive to which type of tissue they pass through. The energy loss will be different in bone versus in fat.

“In proton therapy, changes in the patient’s body during treatment are critical. The anatomy of the patient may change from when we take the first CT scan for treatment planning to the day of treatment. A treatment course may take several weeks and involve 30-40 treatment sessions. The anatomy may change both between and during a session. Ideally, one may think that a new plan should be created for every session, but today we don’t have the resources for this. That is why we introduce margins to ensure that the tumour gets properly irradiated every time. Sometimes these margins need to be so large that the patient may still get side-effects,” said Rydén-Eilertsen.

First of its kind

This is where the MAMA-K technology developed by Kongsberg Beam Technology comes in. It can build a digital twin of the patient representing their anatomy as accurately as possible. The twin is created by using advanced mathematical models that allow for all image data sets to be combined into a longitudinal, virtual representation of the patient’s anatomy.

“With this mathematical modelling, we can visualize and quantify how the patient’s body, tumour and vital organs change over time, as well as, make an accurate scoring of the accumulated doses to the tumour and organs at risk,” said Rydén-Eilertsen.

This system will generate knowledge about how different cancer patients’ bodies, tumours and vital organs change while undergoing radiation therapy and the impact this may have on the delivered dose. This will be valuable when starting up proton therapy centres in Norway.

“The mathematical models may make it possible to even predict anatomical changes and the related consequences for the dosage. Artificial intelligence can tell us how the patient might look in 24 hours, so we can create a treatment plan accordingly. The next day, we can take a new CT image and compare if the AI’s prediction is correct. We can then introduce smaller margins, which will also reduce side-effects,” explained Rydén-Eilertsen.

There are 16 treatment machines that generate 3-dimensional data and 2 000 patient appointments every week at the Radium Hospital, generating a large volume of potential test data, which could map changes in cancer patients receiving radiation therapy.

“These data will be extremely valuable when we enter the era of proton therapy because they will tell us more about how patients’ bodies change. Then we can become better at adapting treatment plans and hitting the tumour directly,” explained Rydén-Eilertsen.

AI to identify organs

The next step will be to adjust the treatment plan while the patient is on the table by using real-time images. To accomplish this, the shape and location of the tumour and organs at risk must be extracted from the images. The use of AI will be crucial to realize the speed needed. AI models to identify different parts of the anatomy must be trained and tested – something Kongsberg Beam Technology hopes to have in place soon.

“One of the biggest workloads in radiation treatment today is that doctors must manually outline the tumour and organs at risk in the CT images. We have already tested AI methods to identify anatomic parts of the body, especially vital organs, and the models are very good at this. To find tumours is a different story. We have tested some models that can find breast tissue, and they work well. I think it is only a matter of technological development. A lot will happen in this area,” said Rydén-Eilertsen.

Norwegian proton therapy centres

There are two proton therapy centres being built in Norway and Rydén-Eilertsen believes the MAMA-K technology will be very useful in these centres.

“The exciting part about the establishment of proton therapy is that the number of patients eligible for treatment is quite small, perhaps between 100-200 patients every year, while the capacity of the centres is around 800 patients a year. About 70-80 per cent of patients will be recruited via clinical studies, which have the goal to document that side effects are less with protons than with photons. In this setting, it is super important to know what the patient looks like, and MAMA-K will be a useful tool to achieve this. I don’t know about anyone else that is developing this kind of technology. It is truly unique,” said Rydén-Eilertsen.

 

Kongsberg Beam Technology is a member of Oslo Cancer Cluster and participating in the Accelerator Programme at Oslo Cancer Cluster Incubator. Read more about the company at their website https://www.kongsbergbeamtech.com/

 

The post AI for more precise radiation therapy first appeared on Oslo Cancer Cluster.