Sowing the seeds of change for breast cancer

26 July 2017 | Physical Sciences/Engineering

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Detecting the spread of breast cancer is a critically important step in the diagnosis, treatment decisions and long-term outcomes for a patient suffering from the disease. One of the conventional procedures utilised to detect any spread uses radioactive tracer administered by a nuclear medicine team, with all the inherent restrictive, time-sensitive and safe handling issues this can create. But this procedure is undergoing a quiet revolution thanks to an innovation that started life at UCL in 2003.

Improving detection rates bring its own issues

According to the charity Breast Cancer Care, the disease impacts nearly 62,000 people in the UK each year, with another being diagnosed every 10 minutes. In fact, one in eight women in the UK will develop the disease in their lifetime, making it the gender’s most common cancer. And although the incidence rate varies country to country, Cancer Research UK estimated in 2012 that nearly 1.7m women are diagnosed annually with breast cancer worldwide.

Over the last two decades survival rates for breast cancer have greatly improved. This is down to a variety of factors, from improved education and self-examination to ongoing screening programmes and medical advances. However, when clinicians attempt to determine a breast cancer’s spread they check the patient’s lymph nodes (often referred to as ‘sentinel’ lymph nodes) located under the armpit, as these are usually the first place in the body cancerous cells drain to. But those early detection rates sometimes mean that any resultant lumps in the lymph nodes are small and can be difficult to feel during routine physical examination.

In those cases, a surgical procedure called a sentinel lymph node biopsy is required. This is when the radioactive tracers mentioned above are injected into the patient. As part of the body’s defence mechanism, these tiny injected particles drain to the lymph nodes within the body and can be located using a radiation sensor called a gamma probe which enables the clinician to remove the node for biopsy.

Back to the future – 2003

Professor Quentin Pankhurst from the London Centre for Nanotechnology at UCL formed a collaboration with Professor Audrius Brazdeikis, a Research Associate Professor of Physics at the University of Houston which over a four year period led to the design, development and early clinical testing of a magnetics-based medical device which could better guide clinicians during breast cancer related surgical procedures.

“This new solution has resulted in a more flexible, practical and potentially more patient-acceptable alternative to the conventional radioactive tracer technique.”

Tiny particles, huge benefits – the power of magnetic fields

So promising was this leading-edge technology that the academic team and Dr Steven Schooling from UCL Business decided that a new spinout company, Endomagnetics Ltd (now Endomag) shoud be established to commercialise the innovation, with initial investment being provided by UCL Business, two London based seed investment funds and the Technology Strategy Board (now Innovate UK).

Endomagnetics initial commercial application was in ‘sentinel’ lymph node location, a key step in the breast cancer staging protocol. However rather than using nuclear medicine, Endomagnetics approach was to inject a proprietary fluid – Sienna+® – containing minute superparamagnetic iron oxide nanoparticles into the patient before surgery. Just like the breast cancer cells in a spreading cancer and in a similar manner to the nuclear medicine technique, these also accumulate in the sentinel lymph nodes.

A Sentimag®magentic sensing probe is then used in a similar manner to a gamma probe to identify the minute magnetic signature given off by Sienna+® fluid, helping clinicians locate, excise and analyse those nodes.

Sentimag® and Sienna+® change the game

Endomagnetics innovative new solution has resulted in a more flexible, practical and potentially more patient-acceptable alternative to the conventional radioactive tracer technique. For example, the timing of a radioactive tracer injection has to be carefully matched to the half-life of the radioisotope and the surgeon’s schedule. By contrast, just 20 minutes after the injection of the Sienna+® nanoparticles, they’ve migrated to the sentinel lymph nodes and the surgeon can operate.

Sienna+® also provides a procedure that could be more widely leveraged because it has a three-year shelf-life not the six-hour half-life of a radioactive tracer. So clinics far from nuclear medicine facilities – in developing countries, for example – can undertake sentinel lymph node biopsies.

Eric Mayes, Endomag CEO, commented, ‘Since its first sales in 2012, we’ve seen triple-digit growth in demand for Sentimag® and Sienna+® by hospitals and clinics worldwide. This technology has already treated over 20,000 breast cancer patients across Europe, the Middle East and Australia.’

Building on Endomag’s success in breast cancer staging

Endomag’s many clinical champions around the world asked the company to enhance its magnetic sensing technology so that it could be used to mark early stage breast cancer tumours. This led in 2016 Endomag to launch Magseed®.

Clinicians removing breast cancer tumours seek to minimise procedural time and the amount of healthy tissue removal. This makes accurately pinpointing tumours vital. Radiologists currently mark the tumour by inserting a guide wire but these can cause discomfort and anxiety for the patient and are also restrictive for the surgeon.

Magseed® marks breast cancer tumours with a magnetic seed that is the size of a grain of rice. Guided by ultrasound or mammography a radiologist places the seed into the site of a tumour up to 30 days in advance of surgery, which assists the surgeon’s operation scheduling as well as their ability to locate of the tumour. Importantly the seed is visible to X-rays and ultrasound and is also designed to integrate into the tumour’s structure so it doesn’t move.

Eric added, ‘Endomag is also developing advanced laparoscopic and endoscopic probes to guide surgeons in melanoma, prostate, thyroid, colon and cervical cancers, so the Endomag story really is really evolving.’

Throughout the Endomag journey, UCL Business has strongly supported the development of the company, both through Endomag board representation and also substantial investment support alongside co-investors Sussex Place Ventures and New Wave Ventures.