UAE residents have an 11.3 per cent chance of developing cancer before the age of 75, research from the Global Cancer Observatory shows. The online database from the International Agency for Research on Cancer, the specialised cancer agency of the World Health Organisation, tracks the disease’s incidence across 185 countries. A total of 4,807 new cancer cases were recorded in 2020, the last year for which data is available.
Breast cancer accounts for the most commonly occurring cancer at 21.4 per cent of all reported cases, followed by colorectal (10.6 per cent), thyroid (8.4 per cent), leukaemia (5.7 per cent) and prostate (5.6 per cent) cancers. Cancer also accounts for 12 per cent of all deaths in the UAE, according to the WHO.
Now, new breakthroughs in cancer research and treatment are changing oncology care in the UAE and the wider Middle East. On World Cancer Day, GN Focus looks at some new developments over the past year.
A new drug for lung cancer
In 2021, the UAE became the second country in the world to approve the registration and use of lung cancer drug Lumakras (sotorasib) after the US Food and Drug Administration (FDA). Early access to the new formulation, helps speed up treatment for specific types of lung cancer while improving patients’ quality of life.
The prescription drug targets a specific mutation, G12C, in the KRAS protein that is responsible for various forms of cancer. For now, treatment has been approved for patients with non-small cell lung cancer (NSCLC), whose tumours have a specific type of genetic mutation called KRAS G12C and who have received at least one prior systemic therapy. The KRAS mutation accounts for about 25 per cent of mutations in non-small cell lung cancers, according to the FDA, and this is the first approved targeted therapy for this kind of tumor. KRAS G12C mutations comprise about 13 per cent of mutations in non-small cell lung cancers.
It is one of the first drugs to be registered under the UAE Ministry of Health and Prevention’s fast-track approval mechanism for breakthrough drugs.
Lung cancer comprises about 7.8 per cent of cancers among men in the UAE.
Immunotherapy research for blood cancers
In September, the Abu Dhabi Stem Cells Centre (ADSCC) began the first experiment of its kind in the region to study the safety and effectiveness of CAR T-cell therapy in treating haematologic cancers, such as myeloma, lymphoma, and some types of leukaemia.
Haematologic cancers — also called blood cancer — arise in blood-forming tissue, such as the cells of the immune system or in bone marrow. Lymphomas are cancers that begin in cells of the lymphatic system. These cancers are most commonly treated by chemotherapy, surgery (such as bone marrow transplants) or radiation therapy.
But the treatment being researched in Abu Dhabi represents a new form of immunotherapy that harnesses the body’s defense system by reprogramming T-Cells, the white blood cells that are a crucial component in the body’s anti-tumour response, WAM reported. CAR (Chimeric antigen receptor) T-Cells are reprogrammed T-Cells that mobilise through the body, continually tapping the immune system to attack disease, serving as a sort of living drug.
The treatment, developed in partnership with biomedical research firm Miltenyi Biotec, involves a minimally invasive blood donation process that separates blood components for analysis and treatment. The T-Cells are
then genetically modified using viral vectors so that they only attack tumour cells. Viral vectors were most recently used to produce certain Covid-19 vaccines.
Dr Rupert Handgretinger, Head of Adoptive Cells Transfer Section and Head of Paediatric Service, Abu Dhabi Bone Marrow Transplant Programme, said, “We want to ensure that the immune cells we modify effectively target the tumor cells in each patient so we can help guide them on the path to remission. This is where the role of viral vectors and the partnership with Miltenyi Biotec is key. By combining the best manufacturing practices with cutting-edge research expertise at Abu Dhabi Stem Cells Centre, we are confident in achieving successful clinical trials and, ultimately, building a robust CAR T-Cell treatment programme in Abu Dhabi.”
A vaccine for breast cancer
Late last year, Cleveland Clinic launched trials to produce a vaccine that could prevent millions of women from developing the most aggressive form of breast cancer. Research should be completed by September.
The phase 1 trial aims to determine if the highest dose of the vaccine works for patients with early-stage triple-negative breast cancer. This type of breast cancer accounts for just 12-15 per cent of all breast cancers but accounts for a disproportionately higher percentage of deaths and recurs more often.
“This vaccine approach represents a potential new way to control breast cancer,” said Vincent Tuohy, the primary inventor of the vaccine and staff immunologist at Cleveland Clinic’s Lerner Research Institute. “The long-term objective of this research is to determine if this vaccine can prevent breast cancer before it occurs, particularly the more aggressive forms of this disease that predominate in high-risk women.”
The FDA recently approved an investigational new drug application for the vaccine. The approval permitted Cleveland Clinic, which has a large hospital branch in Abu Dhabi, and its partner Anixa Biosciences to launch the study. The vaccine under investigation targets a breast-specific lactation protein, α-lactalbumin. The protein is not usually found post-lactation in normal, aging tissues but is present in the majority of triple-negative breast cancers.
The study includes 18 to 24 patients who have completed treatment for early-stage triple-negative breast cancer within the past three years and are currently tumor-free but at high risk for recurrence. Over the course of the study, participants will receive three vaccinations, each two weeks apart and will be closely monitored for side effects and immune response. The study is estimated to be completed in September 2022.
Over the long term, the clinic hopes the vaccine could be administered to healthy women to prevent them from developing triple-negative breast cancer, the clinic said.
The vaccine strategy could be applied to other tumour types such as ovarian and endometrial cancers, Dr Tuohy said. “If successful, these vaccines have the potential to transform the way we control adult-onset cancers and enhance life expectancy in a manner similar to the impact that the childhood vaccination program has had.”
Doctors speak
GN Focus asked doctors in the region to talk about current approaches to the treatment of cancer in the UAE and the region.
Robotic radiosurgery is used to destroy malignant and benign tumors, says Mohammad Aggag, MD, Alterna General Manager and Chief Medical Informatics Officer. He is also paediatric radiologist at the Children’s Cancer Hospital, Egypt, in Cairo — also called Hospital 57357 — where robotic radiosurgery has just been introduced.
“The CyberKnife Robotic Radiosurgery System is the world’s first and only robotic radiosurgery system designed to treat tumours throughout the body,” he says. “CyberKnife is a completely safe, non-invasive alternative to surgery, in many situations, for the treatment of both cancerous and non-cancerous tumours anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney by attacking the tumour only without attacking the healthy cells making it very precise and safe, and instead of receiving 38-42 radiation sessions this number drops to five sessions maximum due to its preciseness.
“It can be an alternative to surgery for patients who have inoperable or surgically complex tumours, and of course with no pain. The CyberKnife System has more than two decades of clinical proof and has helped thousands of cancer patients.”
Invidiualised care is essential to the treatment of cancer, says Dr Ibrahim Husni Abu-Gheida, Head of Department — Radiation Oncology at Burjeel Medical City (BMC). “We are proud to offer world-class, individualised, and comprehensive cancer care, with all treatment modalities under one roof. Our patients get complete care — from cancer screening, diagnosis, staging, treatment and follow up. We start treatment at our comprehensive diagnostic radiology and pathology departments that include a fully established nuclear medicine department — after which we provide individualised case discussion in our comprehensive, multi-disciplinary tumour boards, where sub-speciality experts contribute to the treatment plan of each patient. Our medical, surgical and radiation oncologists follow the most modern and up-to-date protocols for all sites, including the most common cancers, such as breast and colorectal cancers.
“BMC is also proud to have a comprehensive bone marrow transplant unit, along with a state-of-the-art Novalis-recognised radiotherapy facility, having two matched linear accelerators, a robotic six-degree couch, for a comprehensive stereotactic radiotherapy/ radiosurgery programme.”
