By: Elizabeth Chorney-Booth
What is Syantra?
This Calgary-based company developed a new way to test blood in order to detect cancer at early stages. Its flagship product is the Syantra DX™ Breast Cancer test. This test measures gene expression markers in blood and the data is interpreted using proprietary software. International independent clinical study results show the test to be 98.5 per cent accurate in detecting breast cancer in patients under 50 years of age and 92.2 per cent accurate for its entire study cohort of women ages 25 to 80. The test gives a simple positive or negative result indicating if the breast cancer signal was detected.
“Breast cancer is not detected at early stages in many women, such as those with dense breast tissue,” says Syantra’s vice-president Carol Roesler. “The Syantra DX™ Breast Cancer test provides a new option, in particular for younger women and women with dense breast tissue.”
Patients across Canada can access the test via a requisition form signed by their doctors. Then, a phlebotomist collects a blood sample to be sent to Syantra’s lab. Results are typically sent back to the patient’s physician within five business days. The Syantra DX™ Breast Cancer test is available at $499, paid out of pocket. The test is not covered by provincial health-care plans, but can be reimbursed through health spending accounts via private insurance.
Who is behind the innovation?
Syantra grew out of Dr. Tina Rinker’s lab in biomedical engineering and the Arnie Charbonneau Cancer Institute at the University of Calgary. After collaborating with a laboratory medicine group out of Yonsei University in Korea, Rinker, Robert Shepherd and Ken Fuh worked together to develop what is now the Syantra DXTM Breast Cancer test. Syantra was formed in 2016 and soon after received an Alberta Small Business Research Innovation grant to support the clinical studies.
How will it improve cancer care in Alberta?
Breast cancer is typically detected later in women with dense or extremely dense breasts (which is 50 per cent of women) and women under age 50. The earlier cancer is detected, the better the outcomes, and the Syantra DXTM Breast Cancer test was developed to increase early stage detection of breast cancer.
Roesler explains that, “as a molecular blood test, the Syantra DX™ Breast Cancer test complements existing breast imaging for assessing the presence of breast cancer.”
She adds that, “the test is a convenient option for women who may otherwise not be screened due to anxiety, or geographical or cultural barriers preventing them from seeking a mammogram as frequently as recommended. The blood test can also detect cancer signals in higher-density breast tissue, which may camouflage tumours in mammogram imaging.”
What is MR-Linac?
Scientists often say that magnets and radiation are “allergic to each other.” That’s because magnetic resonance imaging (MRI) units and the Linac devices used to deliver radiation treatment typically need to be placed 10 metres apart, as the magnets can distort radiation beams.
However, a new hybrid MR-Linac developed in Edmonton allows radiation and MRI technology to co-exist, delivering more precise radiation via a single machine once it becomes widely available (pending clinical trials). Without this groundbreaking innovation, doctors can’t observe the small shifts that organs and tumours may make when a patient breathes or moves with real-time imaging. But now they’ll be able to see everything as they precisely administer radiation.
Who is behind the innovation?
Dr. Gino Fallone, professor and director of medical physics at the Cross Cancer Institute and University of Alberta, dedicated 15 years of his career to the development of the MR-Linac technology. The first version of the machine was constructed in the basement of the Cross by Fallone and his team and installed in 2013.
How will it improve cancer care in Alberta?
Research on the MR-Linac continues with the Northern LIGHTS trial; it’s a five-phase trial, one of which has been completed so far. One hundred patients are enrolled for trial treatment this year at the Cross and it’s expected the technology will improve outcomes through its improved precision. Being able to target tumours with extreme accuracy means oncologists can get as much of the tumour as possible while avoiding adjacent organs. This allows for a stronger dose of radiation without the worry of damaging non-cancerous tissue. The hope is for fewer, yet more effective radiation sessions. The machines are expected to become available in the Arthur J.E. Child Comprehensive Cancer Centre, as well as the Cross.
“This technology was truly viewed as being scientifically impossible before Dr. Fallone’s invention,” says Lindsay Gilbert, director of philanthropy at the Alberta Cancer Foundation. “We’re so lucky somebody right here at the Cross Cancer Institute overcame that.”
Loyal donors have supported this discovery for more than 10 years, and, most recently, donations from the We Cross Cancer campaign help fund the Northern LIGHTS clinical trial.
Practicing oncologists are always looking to improve patient outcomes and the current standard of care, often through ongoing research into new drugs and therapies. Much of this research is done through clinical trials, something Alberta’s oncologists have embraced wholeheartedly. In addition to participating in global drug trials to help test the efficacy of emerging cancer drugs, a number of local oncologists are creating made-in-Alberta solutions through investigator-initiated trials (IITs).
What is an IIT?
Many of the big drug trials that local cancer patients find themselves participating in are connected to large commercial pharmaceutical companies that are working to get a particular medication or therapy to market. These are known as industry-sponsored trials. An investigator-initiated trial (IIT) involves an individual investigator (usually an academic or a practicing oncologist) pursuing an area of personal interest, be it the use of an already-approved therapy in a new application or a trend noticed during clinical practice. The investigator organizes and conducts a clinical trial, which can lead to outcomes or findings that alter the way the rest of the world practises cancer care.
Both types of clinical trials are immensely important to cancer care in the province, but Alberta has been a particularly fertile ground for homegrown IITs. Part of this is thanks to Alberta Cancer Foundation funding — every year, the Foundation grants a total of $1.5 million to successful applicants, typically funding an average of six to seven different trials.
“We have developed a program over the last 10 years in investigator-initiated clinical trials, and almost all are Alberta-born,” says Dr. Randeep Sangha, director of the Clinical Trials Unit at the Cross Cancer Institute. “The program has led to 60 key protocols answering critical questions to improve cancer care. Alberta investigators are leading the charge to improve outcomes for our patients.”
Directly benefiting Albertans
While IITs and other clinical trials are academically satisfying for the researchers, they also have real-world benefits for patients in Alberta. By definition, a clinical trial needs willing patients to participate, and nearly 1,000 Albertans are involved in oncology trials at a given time. Naturally, not all of those patients will experience benefits that go beyond the typical standard of care, but the potential for improved outcomes is always a possibility.
Some of Alberta’s locally grown clinical trials are making waves around the world. Dr. Quincy Chu, a medical oncologist at the Cross Cancer Institute and the lead investigator on a trial sponsored by the Canadian Cancer Trials Group, presented the results of his research at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago earlier this year, showcasing this Alberta-born research to top international doctors and researchers. His research combined the immunotherapy drug Pembrolizumab (sold commercially as Keytruda) with chemotherapy to treat patients with mesothelioma, a cancer most commonly affecting the lining of the lungs, with only a five-year survival rate of seven per cent in Canada.
“The combination of chemotherapy and Pembrolizumab makes patients live longer. At the three-year mark, 25 per cent of patients were still alive as compared to 17 per cent [not receiving this combined treatment],” Chu says. “Patients treated with the combination were more likely to have their mesothelioma reduced in size. This combination may become a treatment option for patients diagnosed with mesothelioma if approval is granted to health authorities throughout the world.”
Creating a culture of clinical trials
Chu’s mesothelioma trial is just one of many encouraging Alberta-based clinical trials that are making a difference.
“I want to change the perception about clinical trials — I don’t want it to be just an afterthought,” says Dr. Jose Monzon, medical lead of the Clinical Research Unit at the Tom Baker Cancer Centre. “Clinical trials, especially in incurable cancer settings, are absolutely a necessary part of care. Our job is to have a clinical trial for every patient so that we not only offer the standard of care, but also a clinical trial as an option. They provide patients hope for another line of treatment, where one might not have existed before.”
By the Numbers
More than 60 IITs have been funded by the Alberta Cancer Foundation over the last decade
More than 500 patients in Alberta are enrolled in new clinical trials every year
There are currently about 250 open clinical trials running in the province