Supporting technological initiatives in low and middle income countries

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Published: 25 Apr 2018
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Dr Paul Pearlman - National Cancer Institute, Rockville, USA

Dr Pearlman speaks with ecancer at AACR 2018 about the work of the SBIR at the NCI.

He discusses the supporting role of technological innovation projects in covering low and middle-income countries,  contributing to practical and timely interventions.

For more on the work of the SBIR, watch our interview with Michael Weingarten here.

Later this afternoon I’m going to be at the NCI Meet the Experts session talking about a portfolio that we’ve been able to support for the last five years in global health technology. Specifically these are technologies looking at detection, diagnosis and treatment of cancer really at the point of need in low and middle income country settings.

Can you give me some examples of these projects?

Certainly. When you think about the cancers that we want to focus on in this initiative we’re really looking at very practical health systems interventions. That is to say we’re looking at cancers that we can actually really address in some of these low resource settings and within the context of health systems realities in these countries. As a result, cervical cancer plays a very big role in our portfolio, it’s something that we can really do something about.

I’ll highlight really a few technologies along that pipeline. The first, I would say, is that we have a series of HPV assays. Certainly HPV diagnostics can play a clear role in any sort of algorithm that we put together when we want to think about addressing cervical cancer. As these tests really get more and more towards a true point of care test we’re really going to be able to integrate those into see and treat strategies. Moreover, as the cost comes down this is going to become more and more of a tool that can be used in these settings.

Moving a little bit further we also need to think about confirmatory diagnoses and really that’s where we can start talking about supporting devices like Rebecca Richards-Kortum’s high resolution microendoscope. She has been able to really do high resolution imaging of the transformational zone of the cervix which gives us an ability to really get pathology quality diagnostics at the point of need in real time, combining that with AI systems to simplify those diagnostics.

When we start getting into treatment, then we’re supporting a number of devices and really we’re talking about treatment of pre-invasive disease initially. We’re supporting two cryotherapy tools right now that are really trying to get around to the fact that while we’ve told ourselves a story that availability of compressed gases for cryotherapy is readily available worldwide because of the Coke and Pepsi supply chains, in practical scenarios we have found that not to be true. So we’re really looking at devices that can really get at trying to provide cryotherapy without needing those supply chains. Additionally we’ve been supporting some formative studies around thermocoagulation, or cold coagulation as some people call it, looking at trying to really go at other ablative targets.

Later on in the treatment paradigm we’re also supporting two radiotherapy projects that are really looking at trying to simplify the delivery of effective radiotherapy in low resource settings and reducing, really, workload. One of the underpinning messages for all of these projects across all the cancer sites and across the cancer control continuum is that we’re really looking at taking existing or emerging platforms. This isn’t high risk research, this is very practical on the ground translational work trying to address real health system challenges

How is this funded?

These are grants, they are funded by the National Cancer Institute, they are cooperative agreements. The reason for the cooperative agreement really is that given the international nature of these projects and the populations involved, it’s often very helpful for NCI staff to get involved and work through our embassies to really make sure that all of the approvals are in place and that we can really be of service to the grantees. But, like any other grant, they’re competitive in nature, the funding levels were competed across the same kind of level of difficulty we see across the NCI. I think we fund it at about 9% so it’s very competitive research and we’re really happy to be able to provide an avenue of support for this kind of novel work.

How do you see this progressing over the next 5 years?

We have to look at a couple of avenues. Certainly these trials are getting at important clinical validation questions and we need to build on those. So I would like to see larger trials going forward, I’d like to see more industry partnerships certainly because these are devices and we need to talk about going to scale. It would be really helpful to see industry get involved, especially some of those big holding companies that really know how to take on some of that risk and bring these devices to scale. Because the market reality for a lot of technology, it’s a really challenging space. So we need to have to consider that the final purchaser is often Ministries of Health, NGOs, non-profits and that we have to think about what scale looks like in a domain where your end buyer is often charity.

To that end we really are focussed on affordability, we’re focussed on really getting to a practical solution that is cost-effective. The next steps from the NCI point of view really have to be continuing these clinical validation studies but also looking at other mechanisms, like SBIR, STTR, to think about commercialisation and to think about bringing some of the right partners to bear for that next stage in business development which really goes beyond the doors of the NIH.

Is there anything you’d like to add?

What I’d like to say is I’d like to really reinforce the fact that what we’re looking at here is not high risk, high reward research. We’re looking at really borrowing from some of the lessons learned in the infectious diseases community, looking at taking some of these really incredible platforms that have come out to get at the ability to perform meaningful assays at the point of need, to make imaging tools portable, to bring ablative low-cost therapies to bear. And really looking at practical translational research to move these into a domain where they can be accessed by patients in low resource settings. I would also add that when we look at some of the settings globally where we’re doing this work there are some obvious parallels we can draw to low resource settings in the US and other high income countries. For some of these technologies, certainly not all, it’s really health system dependent, we may be able to bring some of the lessons we’ve learned home, in fact I expect we’ll be able to bring many of them home and start to think about algorithms in which we can address cancers among cancer health disparities populations in high income settings as well.