20 Jul 2012, Karin Rancuret, BioSpectrum
Cancer is one of the serious diseases riding high on the healthcare list today, with an estimated 12.7 million cancer cases emerging around the world every year. Despite improved diagnostics and treatment in recent years, the number of people dying from cancer is expected to rise to 26 million by 2030. The World Cancer Research Fund ranks the Netherlands as having the 12th highest rate in the world in terms of registered cancer cases.
These alarming numbers translate to an increased pressure on healthcare systems to come up with novel and innovative approaches.
On the basis of scientific breakthroughs in recent years, the explosion of knowledge in cancer research is set to deliver a continuous stream of new applications, and the Dutch are well on their way. Crucial developments in the treatment of different types of cancers such as colon, renal, brain and asbestos-related cancer have been achieved by harnessing the strong capabilities of the Dutch life sciences' landscape that includes a strong foundation in R&D and collaborative efforts between the public and the private sector.
Currently, there are 55,000 life science employees in the Netherlands with about 20 percent of the workforce comprising research staff, because of its knowledge intensive nature. Approximately 935 companies are active in the heath-related life sciences industry whilst another 150 companies follow R&D-focused business models.
The Netherlands' dense network of world-class universities and research institutes, private sector companies and clinical research organisations have contributed a great deal in the treatment of some cancers.
Cancer research in the Netherlands
Asbestos-related cancer: In June 2010, the Erasmus Medical Centre (MC) in the Netherlands introduced a treatment method which they hoped would beat a deadly cancer that was linked to asbestos. Researchers tested the vaccine, which infuses a patient's own dendritic cells with antigen from the patient's tumor, on 10 patients and found that it induced an immune T-cell response against mesothelioma tumors.
This is the first time dendritic cell-based immunotherapy has been tested in patients with mesothelioma, which typically occurs in the lungs but can arise at other body sites. Asbestos has been banned in developed countries for decades, but the incidence of mesothelioma is expected to continue to increase until 2020. The median survival after mesothelioma diagnosis is about 12 months. Standard chemotherapy treatment improves survival by about three months.
The major problem in mesothelioma is that the immunosuppressive environment caused by the tumor will negatively influence the therapy. The researchers are now working on a method to lower this immunosuppressive environment. The aim is to increase survival in patients with mesothelioma and eventually vaccinate persons who have been in contact with asbestos to prevent them from getting asbestos-related diseases.
Brain tumor: Dr Tom Wurdinger of the Neuro-oncology Research Group (NRG) of VUmc Cancer Center in Amsterdam discovered a certain type of enzyme that is responsible for the return of malign brain tumor after surgery and radiation. According to Dr Wurdinger, if this specific enzyme is slowed down by a chemical substance and becomes "inactive" this can confuse the cancer cell. The cell would not be able to find its way and will split up without repairing the damaged DNA. This way the cell basically blows itself up. This potentially could be an effective supplementary treatment method for treating this very aggressive and deadly type of cancer.
The most common and aggressive type of brain tumor is glioblastoma multiforme (GBM). The standard treatment for GBM is generally surgery, followed by a combination of radiation and chemotherapy, causing the DNA of the remaining cancer cells to be damaged. The DNA of the cancer cell determines what the cell should do, for example, double in size causing the tumor to grow. Since the cancer cells have the capacity of repairing the damaged DNA, for now the treatment is only partially effective, and eventually the tumor will always keep growing.
At present, the healing percentage of the most aggressive brain tumor, GBM, is basically zero percent. Treatments are palliative: they aim at stretching a patient's life and controlling and reducing symptoms as much as possible.
Colon cancer: The exceptional work of Dr Jeroen Meijerink and his doctoral student Martijn van der Pas at the Department of Surgery in VU University, Amsterdam is testament to the importance of innovation in R&D. Their breakthrough could help some 12,000 people, who are diagnosed with colon cancer each year in the Netherlands.
The spread of colon cancer cells from the primary site to distant locations in the body has been difficult to treat. Locating the source of the malignant cells is made more complicated as the sentinel lymph node, the first lymph node to which cancer cells are likely to spread to, is embedded in a layer of fatty tissue. This is especially the case in overweight people, who have more fat surrounding their organs.
Dr Meijerink developed an innovative treatment solution for colon cancer. With the help of a fluorescent dye solution and minimally-invasive infrared ray laparoscopy surgery with a special camera, the sentinel lymph node can be almost effortlessly located. An ICG solution, salt and albumin protein is injected into the patient at the site of the primary tumor. The solution then travels to the sentinel lymph node. The camera and surgical instruments enter the gland. The camera has a special filter that detects the fluorescence in the lymph node, which is removed to test for further cancerous cells.
With Dr Meijerink's work, doctors hope that the fluorescence will be used in diagnosing and treating other forms of cancer such as cervical and stomach cancer in the near future.
Breast cancer: X-ray mammography is an important diagnostic tool in the fight against breast cancer, but it has certain drawbacks that limits its effectiveness. It can give false positive and negative results and also exposes women to low doses of ionizing radiation, which while accepted as safe, still carries some risk. Earlier this year, researchers from Netherlands' University of Twente and Medisch Spectrum Twente Hospital in Oldenzaal used photoacoustics (light-induced sound) rather than ionizing radiation to detect and visualize breast tumors. The team's preliminary results conducted on 12 patients with diagnosed malignancies provided proof-of-concept support that the technology could distinguish malignant tissue by providing high-contrast images of tumors. While this is still early days, the technology shows promise and could possibly lead to the development of a safe, comfortable, and accurate alternative or adjunct to conventional techniques for detecting breast tumors.
Another breakthrough this year was that scientists were able to map the genetic code of hereditary breast cancer for the first time, raising hopes for better diagnosis and treatment for the killer disease. This is the result of a collective effort that included research from the Institut Curie in France, the University Medical Centre Utrecht in the Netherlands, the Cancer Research Institute in London.
The team was able to sequence the DNA of two breast cancers caused by a faulty BRCA1 gene, responsible for aggressive and highly drug-resistant tumors that do not benefit from targeted drugs such as tamoxifen and herceptin. With this development, it would be easier to determine the best treatment strategies to save more lives of hereditary breast cancer patients.
Novel ideas save lives
Life sciences companies in the Netherlands strive to develop and produce innovative medicines and medical devices that enable people to live a long and happy life. From world-class companies developing modern technologies in the fields of genomics and medical technology to start-ups developing solutions for applications such as vaccines, therapeutics and diagnostics, their goals are all similar. Their objective is to drive exciting innovations for better and more sustainable healthcare solutions.
The best way to transfer knowledge is to work together in order to translate it into practical applications. The Dutch never shy away from any opportunity to collaborate. Cooperation is in our DNA and we believe that partnerships reinforce the organizational strength of the sector, resulting in an optimal sharing of resources and knowledge. Owing to the cordial business environment being provided by the Netherlands, several Asian firms have come here and formed collaborations with the Dutch. The Netherlands, she adds is focused on international markets. More than 60 percent of the country's health and life science companies work with foreign businesses and knowledge centers abroad. Asian companies are also moving to the Netherlands to tap on their expertise through joint ventures and collaborations.
It comes as no surprise that the Netherlands is actively a part of one of Europe's largest efforts in the global fight against cancer.
In January 2011, leading oncology organizations across the region including the Netherlands Cancer Institute, Erasmus Medical Center and European Cancer Patient Coalition joined forces in an EU-led initiative titled EurocanPlatform. The project is a network of Europe's 28 most research-intensive institutions in the field of cancer research. The European Union has pledged a generous funding of €12 million. In addition, resources will be put towards finding more effective ways to ensure the prevention, early discovery and treatment of different forms of cancer. EurocanPlatform aims to streamline cross border research. Researchers from the Netherlands, Sweden, Denmark, Norway, France, Spain, Italy, Germany, Hungary, Belgium, and Britain are involved in various parts of the project.
A world leader in scientific research and education, the Netherlands with its R&D capabilities, combined with excellent logistics, infrastructure and the ability to meet the commercial and technological demands of today's economy are just some factors that have shaped the country to become one-of-the-most productive life sciences breeding grounds worldwide.
Thanks to continued support from the Dutch government, industry-players and academia, the Netherlands remains at the forefront of life science innovations. A wealth of public-private partnerships acts as an encouraging platform for collaborators from anywhere in the world.