Health:

Science may not have a cure for can­cer – yet – but the like­li­hood of one be­ing dis­cov­ered may be just around the cor­ner. In­grid Pyne gives a run­down of the lat­est sci­en­tific break­throughs chang­ing and saving lives.

Australian Women’s Weekly NZ - - CONTENTS -

med­i­cal ad­vances that may save your life

Ground­break­ing med­i­cal in­no­va­tions this year will change our lives – and hope­fully even save them. Some of the an­tic­i­pated break­throughs seem to take us beyond the realm of science and into science fic­tion ter­ri­tory (think 3D-printed pills or gene edit­ing), while oth­ers have less of a “wow” fac­tor, but will still of­fer much-needed re­lief to suf­fer­ers.

Yet med­i­cal in­no­va­tion is a risky busi­ness. For every suc­cess story – such as last year’s stun­ning launch of a new hepati­tis C cure – there is a giant scrap-pile of shat­tered hopes.

Late last year, for ex­am­ple, phar­ma­ceu­ti­cal giant Eli Lilly had to aban­don a promis­ing new Alzheimer’s disease treat­ment at the 11th hour, when it failed to mean­ing­fully beat a placebo in late-stage clin­i­cal tri­als, so dash­ing the hopes of 50,000 New Zealan­ders who have the disease.

Com­pil­ing a de­fin­i­tive list of fu­ture med­i­cal game-chang­ers is, there­fore, im­pos­si­ble. So The Aus­tralian Women’s Weekly spoke to sci­en­tists, pol­icy mak­ers and phar­ma­ceu­ti­cal in­dus­try in­sid­ers to bring you some of the break­throughs just over the hori­zon that may have a pro­found im­pact on your health in the year ahead.

Im­munother­apy for can­cer

Sci­en­tists at the Gar­van In­sti­tute of Med­i­cal Re­search in Aus­tralia pre­dict im­munother­apy – a rev­o­lu­tion­ary treat­ment which uses the body’s own im­mune sys­tem to help fight can­cer – will be the med­i­cal story of 2017.

Ini­tially, im­munother­apy was used to tackle me­lanoma, then a type of lung can­cer. Now, it is be­ing used (or tested in clin­i­cal tri­als) to treat a broad range of ma­lig­nan­cies, such as bowel, pan­cre­atic and blad­der can­cers. Sci­en­tists hope that im­munother­a­pies may one day prove to be a “cure-all” for can­cer, in much the same way that peni­cillin is the panacea for in­fec­tions. This year, the US Food and Drug Ad­min­is­tra­tion (FDA) is ex­pected to ap­prove the drug for the treat­ment of acute lym­phoblas­tic leukaemia, trig­ger­ing a wave of approvals for the treat­ment of other blood can­cers and lym­phomas. Aus­tralia’s Therapeutics Goods Ad­min­is­tra­tion (TGA) tends to fol­low the FDA’s lead.

Sci­en­tists have long viewed im­munother­apy as the holy grail of can­cer treat­ments, but it’s proved in­cred­i­bly dif­fi­cult to make it work. Now, many on­col­o­gists be­lieve we may have cracked it. While still used in con­junc­tion with chemo­ther­apy, it’s hoped it will sup­plant chemo, along with its hor­rific side ef­fects.

Tai­lor-made medicine

Four years ago, An­gelina Jolie an­nounced to the world she’d had a dou­ble mas­tec­tomy to pre­vent the scourge of her fam­ily’s breast can­cer. In that coura­geous move, the film star splashed the sub­ject of ge­netic test­ing for disease preven­tion across the front pages.

Sin­gle gene tests for disease risk – such as the BRCA1 gene that An­gelina car­ries – have been around for some years. Yet, in­creas­ingly, it is be­com­ing pos­si­ble to es­ti­mate peo­ple’s in­di­vid­ual risk of a whole range of diseases by look­ing at pat­terns across their genome se­quence (the six bil­lion base pairs of DNA they carry in every cell). Call it what you will – per­son­alised, ge­nomic or pre­ci­sion medicine – this ap­proach is aimed at both pre­vent­ing disease and tai­lor­ing treat­ments.

The Gar­van In­sti­tute pre­dicts that, this year, we are likely to see clin­i­cal proof-of-prin­ci­ple stud­ies that show how “ge­nomic risk” can be used for early de­tec­tion and preven­tion

“This ap­proach is aimed at both pre­vent­ing disease and tai­lor­ing treat­ments.”

pro­grammes, such as in can­cer. Beyond 2017, it will be­come more com­mon for doc­tors to use ge­nomic in­for­ma­tion as a first-line ap­proach to the di­ag­no­sis of diseases.

Doc­tors should then be able to de­ter­mine how best to treat pa­tients. By read­ing the clues in in­di­vid­ual genome se­quences, they will be able to ad­vise which drugs pa­tients are most likely to re­spond to.

Big Data per­spec­tives

The past decade has seen huge ad­vances in the amount of data we rou­tinely gen­er­ate, as well as our abil­ity to in­te­grate, cu­rate, an­a­lyse, un­der­stand, store and share it. The in­ter­sec­tion of these trends is what we call

“Big Data” and the health­care sec­tor (and so all of us) will be one of its main ben­e­fi­cia­ries.

Un­til re­cently, the huge amount of data col­lected by the med­i­cal in­dus­try has been siloed in archives con­trolled by dif­fer­ent hos­pi­tals, surg­eries, clin­ics and uni­ver­si­ties. Now, us­ing ad­vanced com­put­ing tech­niques, doc­tors can share all types of data – from symp­toms and med­i­ca­tions to test re­sults and re­sponses to medicine – to im­prove care.

Big Data ap­proaches, such as com­puter algorithms, can also de­tect pat­terns and trends to pre­dict epi­demics, im­prove qual­ity of life, avoid pre­ventable deaths and even cure disease. Data-shar­ing ar­range­ments be­tween the phar­ma­ceu­ti­cal giants, for ex­am­ple, led to the dis­cov­ery that a lit­tle used an­tide­pres­sant might be able to cure some types of lung can­cer. By us­ing algorithms to an­a­lyse ex­tremely large ge­netic and bi­o­log­i­cal data­bases in this way, we should be able to find fresh uses for known drugs, ac­cel­er­at­ing the de­vel­op­ment of new treat­ments.

Ex­perts say it usu­ally takes a decade and about $1.3 bil­lion to turn a lab­o­ra­tory find­ing into a suc­cess­ful drug treat­ment – Big Data break­throughs could cut this to two years and about $130,000.

Blood tests for can­cer

Ex­perts say it’s only a mat­ter of time be­fore di­ag­nos­ing and treat­ing can­cer will be as rou­tine as an an­nual check-up, thanks to so-called “liq­uid biop­sies”. These sim­ple blood tests look for cell-free cir­cu­lat­ing tu­mour DNA (ctDNA), which is shed from a tu­mour into the blood­stream and is more than 100 times more abun­dant in the blood than tu­mour cells.

Stud­ies are still be­ing con­ducted, but this tech­nol­ogy may do away with in­va­sive tis­sue biop­sies. Sev­eral med­i­cal com­pa­nies are de­vel­op­ing test kits to hit the mar­ket next year and an­a­lysts ex­pect huge de­mand, tip­ping an­nual sales of more than $13 bil­lion.

Hope for de­pres­sion

More than half a mil­lion Ki­wis have been di­ag­nosed with de­pres­sion at some time in their lives. And for some, tra­di­tional an­tide­pres­sants don’t re­ally work. Their only op­tion is in­ten­sive treat­ments, such as elec­tro­con­vul­sive ther­apy.

In 2013, a study to see if ke­tamine – which is com­monly used for anaes­the­sia and, less com­monly, as a party drug – could alle­vi­ate treat­ment-re­sis­tant de­pres­sion (TRD) pro­duced over­whelm­ingly pos­i­tive re­sults: 70 per cent of TRD pa­tients re­ported im­proved symp­toms within 24 hours of be­ing in­jected with a low dose of ke­tamine. As a re­sult, the FDA ex­pe­dited the de­vel­op­ment of new med­i­ca­tions based on the ke­tamine pro­file and some, such as es­ke­tamine, are ex­pected to be avail­able to US pa­tients shortly. There were 579 deaths by sui­cide in New Zealand in the 2016 fi­nan­cial year – more than 11 per week – so the need for an ef­fec­tive treat­ment for se­vere de­pres­sion is im­per­a­tive.

Self-ad­min­is­tered HPV test

In New Zealand, as in other de­vel­oped coun­tries, there have been huge strides in the treat­ment and preven­tion of the hu­man pa­pil­lo­mavirus (or HPV), the main cause of cer­vi­cal can­cer.

Women here are urged to see their doc­tor for reg­u­lar Pap tests, while the free na­tional HPV vaccination pro­gramme has been in place since 2008 for school­girls and be­gan this year for school­boys. But the big­gest preven­tion ef­fort to date is about to take

There will be a to­tal shift in the line-up of drugs for di­a­betes.

shape, through the de­ploy­ment of self­ad­min­is­tered HPV tests in Aus­tralia.

These tests – which in­clude a test tube, a swab and a mail-in box – would al­low you to ad­min­is­ter the test and process the re­sults at home, rather than a doc­tor’s surgery. The tests could be later in­tro­duced in New Zealand.

Bioab­sorbable stents

More than 170,000 New Zealan­ders are liv­ing with di­ag­nosed coro­nary heart disease. And many of those have metal stents in­serted into their chests to treat coro­nary artery block­age. More of­ten than not, the stent re­mains there for ever, long af­ter its mis­sion has been ac­com­plished. The stents can make some scans and fu­ture surg­eries tricky and lead to blood clots.

Yet what if they could just van­ish? The first bioab­sorbable stent was ap­proved in the US last July. Made of a nat­u­rally dis­solv­ing poly­mer, it widens the clogged artery for two years be­fore it’s ab­sorbed into the body in a man­ner sim­i­lar to dis­solv­able stitches. Ex­perts as­sem­bled by the Cleve­land Clinic are hail­ing these stents as one of the top med­i­cal break­throughs of 2017.

Mini pace­maker

It took Earl Bakken, founder of US med­i­cal de­vices com­pany Medtronic, just four weeks in 1957 to craft the first bat­tery-pow­ered pace­maker. His de­sign barely changed for 50 years, but last year, Medtronic’s new model, the Mi­cra, which is one-tenth the size and so small it can rest in­side the heart it­self, be­came the first of the next gen­er­a­tion of pace­mak­ers to be ap­proved by the FDA. Un­like tra­di­tional pace­mak­ers, which are im­planted un­der the skin us­ing an in­va­sive pro­ce­dure, the Mi­cra is slipped through the femoral artery via the groin us­ing a catheter and docked in­side the heart’s right ven­tri­cle. It op­er­ates with­out elec­tri­cal wires that can break or get in­fected.

No more swal­low­ing pills

Many peo­ple need to take med­i­ca­tion every day, but find it dif­fi­cult to swal­low. Soon, this could be a thing of the past. In 2015, the FDA ap­proved a new type of pill that is 3D-printed and dis­solves into liq­uid as soon as you take a sip of wa­ter. The pill, epilepsy drug Spri­tam, hit the US mar­ket last March. Its cre­ators are look­ing at other disease ar­eas, so more rapidly dis­in­te­grat­ing drugs could be com­ing to a 3D printer near you in 2017.

The Mi­cra is so small it can rest in­side the heart.

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