Cervical cancer is under attack from multiple modalities – including AI
January 17, 2019 | Disease
Computer algorithms have joined the battle against cervical cancer. Scientists at Israeli digital health company MobileODT have developed technology that can detect pre-cancerous lesions better than trained humans or conventional pap smear tests. The artificial intelligence (AI)-based approach needs only a single image to do its detective work, generating results in seconds rather than the days required by regular screening.
MobileODT’s Automated Visual Evaluation (AVE) machine learning algorithm, validated by the National Cancer Institute and FDA-approved, is already in use across 29 countries. The technology could turn cervical cancer into a thing of the past, including in low- and middle-income countries where the disease’s impact is deadliest. Vaccines against the human papilloma virus (HPV) responsible for most cases have been around for over a decade, but aren’t widely available in poorer nations.
There is good news, too, for many with the disease – the fourth most frequent cancer among women, according to the World Health Organisation. More treatments may soon arrive, after a relative drought in approvals over the last few decades.
Merck’s checkpoint inhibitor Keytruda (pembrolizumab) became the latest new option, in mid-2018, for women with recurrent or metastatic disease whose tumors express PD-L1. Roche’s bevacizumab (sometimes called Avastin) was approved in 2014 and is now part of standard therapy, but offers limited improved survival.
Regeneron’s checkpoint inhibitor, Libtayo (cemiplimab), already approved for some kinds of skin cancer, in late 2017 begun a Phase III for cervical cancer with Sanofi, after promising results in a small Phase I study. Cervical cancers tend to have quite high numbers of gene mutations, which may enhance their sensitivity to the wide range of immuno-oncology (I-O) approaches progressing across the broader cancer field.
They include, for cervical cancer, Princeton, NJ-based Advaxis’ Phase III therapeutic vaccine axalimogene filolisbac. This involves re-programming a live strain of listeria bacteria with a particular antigen to generate cancer-targeting T-cells, and to knock out tumors’ in-built immune-protection mechanisms. The drug candidate showed promising results in Phase II (12-month survival rates over 50% higher than predicted, given patient characteristics) and has Fast Track designation as an adjuvant therapy for women with locally advanced disease.
Iovance’s adoptive cell therapy approach involves extracting and multiplying patients’ own tumor-infiltrating lymphocytes (TIL). TILs are naturally-occurring immune cells that can penetrate and kill tumors, but which are typically out-gunned by cancer’s own immune-cloaking mechanisms. Iovance, based in San Carlos, California, is currently recruiting a Phase II trial of LN-145 among women with recurrent, metastatic or persistent cervical cancer.
Further combination trials are underway, many involving checkpoint inhibitors with bevacizumab, chemotherapy and radiotherapy. There are also non-I-O studies underway, such as Genmab/Seattle Genetics’ antibody-drug conjugate tisotumab vedotin. The conjugate targets and inhibits a protein involved in tumor signalling and angiogenesis (tumor blood vessel growth), and includes a cytotoxic drug.
AstraZeneca and Roche have the highest number of cervical cancer clinical trials, according to Datamonitor analysts. Industry’s increasingly busy pipeline, alongside improved screening offered by AI, will hopefully soon improve the prognosis for women suffering with the disease, estimated to total almost 600,000 worldwide.
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