A universal test for cancer

One person in three will, at some point in their lives, have a brush with cancer. But very often cancers present at a late stage when they’re much harder to treat. If we could pick them up sooner, or spot when they return after treatment much earlier, the prognosis would be dramatically better. And that’s  Elypta are trying to do, they’ve discovered a unique fingerprint of chemical changes present in body fluids when a person has any kind of cancer, providing the possibility of an early warning system for the disease. Chris Smith spoke to Francesco Gatto and Karl Bergman from the Elypta team...

Francesco - It's about discovering the right biomarkers, essentially molecules that we can find in the blood, in the urine that indicate cancer might be present. And we identified a process in metabolism which is essentially how cells nourish themselves. And we know that cancer does it differently.

Chris - When you say you discovered a problem what, so, because of the physical presence of the cancer it churns out molecules or a different combination of molecules that are a different combination to normal. That's what you're saying you're detecting?

Francesco - That is correct.

Chris - And what molecules are you going after?

Francesco - It's complex sugars. They participate in the way the tumour grows in a certain tissue and we detect that kind of process directly in the blood or in the urine.

Chris - And what, because the cells are behaving abnormally, because they're cancerous they make these things which shouldn't normally be there? So that's a hallmark that there must be cancer somewhere?

Franceso -  Absolutely. The pattern is actually a bit more complex. That's why we have also software we're developing because it’s not about only creating something new because you have a cancer in place. It's also that cancer needs to modify what's normally available in the body and make it amenable for its own growth.

Chris -  And how are you applying this Karl? What's actually happening when you when you test things?

Karl - What we've done is that we've tested this in a wide range of cancers to understand what the potential is and what we find is that this is something that we can use across the cancer spectrum. So what we're doing now is that we're developing assay kits, basically the reagents that we need in order to measure these metabolites in the blood, to commercialise this as a diagnostic test.

Chris - So you would take a blood sample or say a urine sample, you can spot the presence of these abnormal molecules there, that tells you this person might have cancer somewhere but it doesn't tell you where though does it?

Karl - No that's true. It doesn't tell us conclusively where but that's why our first use of this is actually to help patients that have already been diagnosed with a certain cancer. So they've had surgery to remove the cancer and are more or less cured but then they need to come in for a follow-up for many years, and we know what cancer it is if it should come back. So it becomes less of a problem.

Chris - Is there any way, Francesco, to track down the source of these abnormal molecules in the body, so that having just detected them you could then also say well where are they coming from, because that will pinpoint where the tumors might be?

Francesco - The molecules that we're actually tracking and do not directly give information about the tissue where the cancer has started but we are discovering a lot because we're a bit at the forefront of this field. Cancer that come from different types might have slight changes between themselves and we can use this software to capture if you want subtle differences between cancer types, exactly for this purpose.

Chris - One of the crucial things about a screening test, Karl, is that you must not miss any cases. So how sensitive is this test, so that you can say to somebody if they have a negative test this rules out cancer in you?

Karl - So we've done studies in blood samples that we've collected from clinicians and identified that we have a sensitivity across cancer of around ninety-nine percent. So it's highly sensitive to detect early stage cancer.

Chris - So what's the next step then?

Francesco - Well we just received a European Union grant and that will allow us for the first time to roll out these in a very large patient population, across eight to eleven hospitals in the United States and Europe and primarily in kidney cancer, to prove that we can use our test to detect the coming back of cancer after surgery as early as possible, which of course has tremendous impact in the life of these people

Chris - And beyond kidney cancer, because you're looking for something which is a marker more generically of cancer rather than just one specific type of cancer, are you planning to then say, well let's start screening people for lots of different types of cancers? The reason I'm asking the question, Francesco, is that it may well be that some of these kidney cancer patients develop another kind of tumour in the meantime and you might get a signal and it's not because their kidney cancer's come back, it's because they've got lung cancer as well.

Francesco - Right. That's quite rare in the clinic but it may happen. And of course we will most likely detect it as an effect of the fact that our markers are precisely designed for that reason. Now from where we are today to the moment to which we can do screening, there will be a lot of research to be done. But of course Elypta has a quite extensive clinical program. We have already collaborations in prostate cancer and bladder cancer for example. And we did complete a very recent study in lung cancer that has indicated very promising results.

Chris - And is this going to end up being a countertop test in a general practice, as in you could as part of a well man or well woman middle aged health screen you could go and have one of these tests?

Karl - In the first setting, from the patient's perspective you won't notice the difference. You leave your blood but then the blood will be sent to a central laboratory where we collect all the blood samples and do the testing. And the reason for this is it’s quite complicated to do this analysis, it’s a novel method. But as time moves on we are likely to automate this and then bring it so that it becomes available in any clinic.