Emerging Cancer Therapeutics

The presentation will focus on technologies that are transforming traditional cancer therapies for surgical and radiation oncology. The high cost today of proton radiotherapy systems is due to the use of large gantries to direct the beams. Robotic techniques and novel immobilization systems can allow the beam to be fixed and an upright patient directed into the beam, thereby reducing cost. It turns out that there is medical benefit for lung cancer patients who should be treated in this fashion due to less normal lung tissue in the field and less lung motion when upright. Fluorescent guidance of vascular surgery has for several years been shown to be useful for breast reconstructive surgery. Several fluorescent agents tagged onto cancer seeking agents are at various phases of feasibility or clinical trials. One agent 5-ALA has been approved for gliomas. These agents have the potential to revolutionize cancer surgery by reducing the chance that the surgical margin is clean or to better justify radiation therapy if resection is not possible. Immune checkpoint inhibitors (ICI) are ineffective when there are few antigens and infiltrating T-cells. Preclinical and clinical data demonstrate multiple immunogenic effects of radiation therapy. The same seeking agents used for fluorescent guided surgery may be instead radiolabeled providing sufficient radiation dose for increasing the number of anti-tumor T-cells and providing better response to ICIs leading to an “in situ vaccine”.