Exclusive interview with Jutta Heix

Our Head of International Affairs is featured in Nordic Life Science Magazine.

Read about how we are accelerating the development of new cancer treatments and diagnostics, while connecting and helping innovators, and putting Norwegian oncology on the global map. In an exclusive interview, Jutta Heix, Head of International Affairs in Oslo Cancer Cluster, talks about her efforts to advance an oncology innovation ecosystem.

In collaboration with Nordic Life Science Magazine, we are pleased to offer this issue to our readers for free.

Read here: https://www.e-magin.se/paper/sptrqx7k/paper/30

 

Håvard Danielsen

AI researcher gets cancer award

Professor Håvard Danielsen has received a cancer research award for the use of artificial intelligence (AI) to improve cancer prognosis.

King Olav Vs Cancer Research Award of 2022 has been granted to Professor Håvard Danielsen at the Institute for Cancer Genetics and Informatics (ICGI) at Oslo University Hospital.

“This is a huge recognition and an inspiration. I am proud to join the 29 cancer researchers that have received the prize before me,” Danielsen commented.

The prestigious prize is awarded annually by the Norwegian Cancer Society, and it is the highest honour for Norwegian cancer researchers.

The description states: “Danielsen is a pioneer and a world-leading expert in digital pathology and the development of new methods for the application of artificial intelligence”.

Ground-breaking AI research

Simply explained, Danielsen and his research team at ICGI have trained computers to recognise cancer tumours, their characteristics and the patient’s prognosis, by feeding the computer with millions of images of samples from tumours of cancer patients.

“We have used machine learning to automate cancer diagnostics and prognosis. We have developed new methods to give a more objective diagnosis,” said Danielsen.

There are three reasons for this.

  1. Cancer diagnoses are made by pathologists, and the number of pathologists is declining while the number of cancer cases rise.
  2. It is difficult for pathologists to determine the disease progression of the patient. This leads to many patients getting too much treatment or too little treatment, which is both expensive for society and damaging to the individual.
  3. Tumours are very heterogeneous, more efficient methods to investigate more samples from each tumour are needed.

Artifical intelligence may drastically change the field of cancer pathology by offering new and objective methods that can easily be distributed as a supplement to the current practise.

Results from histotyping projected onto the histological slide being analysed.

This is a heatmap showing the result of the computer analysis in each part of the cancer sample. Photo: ICGI.

The research has mainly focused on colorectal cancer. However, the exact same technology and design can be applied to other cancer types too. The research group has already had positive results for prostate cancer and are now working on lung cancer.

“Instead of spending many years training a pathologist, you can simply copy the algorithm from one computer to another. A computer can work 24 hours a day, doesn’t make mistakes and doesn’t get tired. This is not a replacement of the pathologist, but a tool to help the pathologist,” said Danielsen.

From research to commercial product

The research is part of the DoMore project, a five-year project that was awarded NOK 60 million by the Norwegian Research Council as a trailblazer for connecting IT technologies in health.

“There were huge anticipations. We were expected to break new ground, act as an inspiration, and create new jobs for Norway. This was an opportunity you don’t get every day,” Danielsen said.

The partners in the DoMore project were Oslo Cancer Cluster, the Vestfold Hospital Trust, the University of Oxford, the University College London, DIPS, the Department of Informatics at Oslo University Hospital, and the Institute for Cancer Genetics and Informatics at Oslo University Hospital. Around 50 people have worked with DoMore so far.

“This is truly a team effort across Norwegian and international institutions, and with many people involved. I feel privileged to have led this project,” Danielsen commented.

After five years of intense research, DoMore published their results in the academic journal The Lancet two years ago. At the same time, the company DoMore Diagnostics was established, and they are now a member of Oslo Cancer Cluster.

The video below was produced by ICGI when the company was set up.

“Oslo Cancer Cluster, OCC, has played a central role in the project, from start to finish.” Danielsen said.

“Ketil Widerberg, general manager of OCC, has been one of the leaders of DoMore. His responsibility has been to ensure that we develop solutions that can be commercialised. He has participated in all discussions and nudged us in the right direction. The company DoMore Diagnostics is a direct result of OCC’s involvement in the project,” Danielsen continued.

Danielsen also believes having Oslo Cancer Cluster as a partner from the start helped convince the Norwegian Research Council to back the project, which made everything possible.

Danielsen and his research group are still working hard to invent new solutions for better, more accurate cancer prognosis, which the company DoMore Diagnostics aim to take to market.

OUS team

Norwegian cancer initiatives receive international attention

Norway is pioneering precision medicine in cancer with three nation-wide initiatives.

Norway is breaking new ground for precision cancer medicine implementation with three national initiatives that are highlighted in the latest issue of the academic journal Nature Medicine. The article shows the broad stakeholder involvement in the initiatives with 116 contributors with 80 different affiliations.

Kjetil Taskén, Head and Director of Institute of Cancer Research at Oslo University Hospital (OUS). Photo: OUS

Kjetil Taskén, Head and Director of Institute of Cancer Research at Oslo University Hospital (OUS). Photo: OUS

“These initiatives represent a triple-win effect,” said Kjetil Taskén, Head and Director of Institute of Cancer Research at Oslo University Hospital and Professor at University of Oslo. “The patients gain access to modern treatments; the researchers can investigate the effect of different medicines on new indications; and the industry can expand the application of their drugs.”

The three initiatives

  • InPreD is a service for precision diagnostics organised as a national infrastructure within the specialist health service. 
  • IMPRESS-Norway is a nation-wide clinical trial evaluating the efficacy of anti-cancer drugs on new indications. 
  • CONNECT is a consortium of public and private stakeholders driving the implementation of precision cancer medicine in Norway. 

Precision diagnostics for patients

Recent developments in precision medicine offer new medical opportunities for cancer patients, which has ignited a debate in Norway about access to more modern treatments. Though equal access is ensured through Norway’s universal health coverage, the medical possibilities challenge public budgets and has led to delayed access for some patient groups.

“There is a growing, worrying split in the health service, where some patients feel compelled to buy diagnostics and treatments at private clinics, when the opportunity does not exist in the public sector,” said Ingrid Stenstadvold Ross, General Secretary of the Norwegian Cancer Society. “These initiatives are spearheading new solutions for seriously ill cancer patients, wherever they live in Norway, and demonstrate what is possible to accomplish with public-private collaboration.”

Norway is one of the first countries in Europe to have a reimbursement scheme, with additional financial support from the regional health authorities to hospitals, for the gene panel test via InPreD. The infrastructure is being set up at all university hospitals in Norway and patients from all Norwegian hospitals can be referred to InPreD. It is currently only available to patients with no other treatment options. The results from the test are discussed in a weekly molecular tumour board that refers patients to clinical follow-up, IMPRESS or other clinical trials.

Åslaug Helland

Åslaug Helland from Oslo University Hospital presented IMPRESS-Norway at Nordic Precision Medicine Forum 2022 in Stockholm. Photo: Åsmund Flobak

InPreD has screened more than 359 patients, of which 67 patients have been included into treatment cohorts in IMPRESS, as of April 2022. An additional 10-15 per cent of screened patients have been assigned to another clinical trial or drugs through compassionate use programmes. This means about 40 per cent of screened patients have received a new treatment option.

“This is about leaving no stone unturned, about finding drugs for patients who wouldn’t have gotten it otherwise. We want to serve the needs that the patients have in terms of modern treatments in the public healthcare system,” said Taskén.

Clinical trial offers new hope

There are currently 16 drugs available in IMPRESS and the goal is to include 23 drugs by the end of 2022. The first pharmaceutical company to join was Roche, providing eight drugs in January 2021. Novartis entered IMPRESS as second partner in 2021, now contributing four cancer medicines.  

“These initiatives offer patients who have exhausted available treatments, a chance for new treatment options and hope,” said Eli Bergli, Medical Head Oncology, Novartis Norway. “Novartis is proud to be part of the implementation of precision diagnostics, so patients can receive a tailor-made treatment for their disease. These innovative partnerships, where public sector, academia and private industry collaborate in finding the best solutions for the future of healthcare, are ground-breaking and offer patients early access to new innovative treatments.”

“InPreD, IMPRESS and CONNECT are core initiatives for the implementation of precision medicine in Norway, and Roche is a proud partner,” agreed Kristin Krogsrud, Healthcare System Partner, in Roche Norway. “In addition to the important goals of establishing genetic testing in clinical practice and generation of scientific data, we see the work around development and piloting novel reimbursement methods as key to be able to improve patient’s access to personalized treatment.”

The four Norwegian regional health authorities recently decided to reimburse drugs in Stage 3 cohorts in the IMPRESS trial. The pharmaceutical industry pays for the first 16 weeks and, if the patient achieves a response after 16 weeks in the trial, the treatments can be reimbursed permanently from the public healthcare system. This is the first mechanism for a pay-for-performance model in precision cancer medicine in Norway ever.

Jan Frich, Deputy Chief Executive Officer at South-Eastern Norway Regional Health Authority.

Jan Frich, Deputy Chief Executive Officer at South-Eastern Norway Regional Health Authority.

“We have had a great and close collaboration with the hospitals in the establishment of a national infrastructure in the Specialist Health Service for precision diagnostics in the cancer field (InPreD),” said Jan Frich, Deputy Chief Executive Officer at South-Eastern Norway Regional Health Authority. “The high inclusion numbers in the IMPRESS-study after referral from InPreD confirm that we are on the way to succeeding in establishing the necessary ecosystem for advanced diagnostics and clinical studies in the Specialist Health Service. This is something we are very proud of.”

Connecting public with private

The third initiative is CONNECT, a public-private consortium consisting of 28 partners, with Oslo Cancer Cluster being the project coordinator. The common goal is to drive the implementation of precision cancer medicine in Norway.

“Oslo Cancer Cluster is a neutral facilitator and an intermediator between public and private. They have been with us since we started working on these national initiatives. Among other things, Oslo Cancer Cluster has been a great supporter in bringing in the pharmaceutical companies in IMPRESS,” said Taskén.

The Norwegian Health Directorate is one of the observers in CONNECT and a coordinator for the National Strategy for Precision Medicine. 

“We follow the work in CONNECT with great interest as it investigates new ways of implementing precision medicine,” said Grethe Foss, Project Leader for Precision Medicine at the Norwegian Health Directorate. 

Taskén stresses one reason for the success of these initiatives is that they are not about profiling individual institutions or people but about coming together with shared objectives. 

“There has been trust and we have been able to act together. The fact that these initiatives now receive international attention can hopefully lead to an expansion of our efforts, that more companies and institutions join, so that more cancer patients gain access to the cancer treatments of the future.”

 

Learn more

Fremtidens kreftbehandling frokostmøte 2022

Challenged politicians about cancer

Where are the Norwegian political ambitions for cancer treatment? We need more public-private collaboration on cancer.

Breakfast and political conversations on cancer are the hallmark for our meeting series Fremtidens kreftbehandling. On 21 April 2022, health officials, politicians, patient spokespeople and industry representatives met to discuss the future of cancer treatments. They all agreed: we need more public-private collaboration on cancer.

As introduction, Ketil Widerberg, general manager of Oslo Cancer Cluster, presented the results from a recent survey by Kantar of the Norwegian population’s views on health policy. The survey showed a majority want more modern cancer treatments with less side effects at public hospitals. They want the same treatment options as in other Nordic countries. They also think the public health service should pay for cancer treatments that work.

“We believe cancer can go from being a deadly disease to a disease people live well with, but we can’t get new treatments to the patients if the public and private sector don’t work together,” Widerberg said. “When we build roads, we assess the economy on a broader scale than when we assess new treatments. Is this really the kind of politics we want?”

A cancer revolution underway

The people’s wishes are clear, but how can doctors offer more modern treatments to their patients? In the first panel discussion, Anne Karin Rime, president of the Norwegian Medical Association, Jan Frich, deputy CEO of the South-Eastern Regional Health Authority, and Ingrid Stenstadvold Ross, general secretary of the Norwegian Cancer Society discussed how patients can gain access to precision medicine, which means the right treatment to the right patient at the right time.

“We are living in a kind of cancer revolution. There are many extremely promising treatments on the way, especially in precision medicine,” Stenstadvold Ross said. “The current system assesses the cost and effect of a treatment by looking at an average patient group. For lung cancer, it will typically be 60-plus men with a history of smoking, but if I developed lung cancer, my characteristics wouldn’t fit this description.”

Rime argued that these new, revolutionary medicines have made the doctor’s job more complicated.

“The role of the doctor has changed from deciding the best treatment for the patient. Now the doctor also needs to think about society as a whole: what can we afford to treat? It is extremely difficult for a doctor to know there are treatments or diagnostics that may help the patient, which they can’t offer,” said Rime. “Diagnostics become more important now and offering genetic tests to all patients to identify which treatment will work.”

Frich agreed that more precise diagnostics is the solution.

“The key to personalised treatment is good diagnostics,” Frich commented. “The last two-three years, much has happened in personalised medicine. We have created a national plan for advanced diagnostics and set aside resources for this. An infrastructure for precision diagnostics is being built. The CONNECT collaboration with the pharmaceutical industry work on a large clinical study called IMPRESS, which is supported with NOK 60 million from the regional health authorities.”

Make your voice heard

The system needs to change so that patients can take part in the cancer revolution. Gloria Traina is a PhD and advisor at the Specialist Health Section in the Norwegian Ministry of Health and Care Services. They are working on a Strategy for Personalised Medicine to be launched before 2023.

“There has been some success getting precision medicine to Norway and there are many new initiatives, including InPred, IMPRESS and CONNECT. We now see there is a need for a revised strategy,” Traina explained.

More public-private collaboration

While the new strategy materialises, patients are still waiting for access to better treatments. In the debate, politicians were challenged to declare their ambitions for Norway.

”I want to see more political vision. The European Union has launched a Cancer Mission, the goal is to improve the lives of 3 million people by 2030. What are Norway’s ambitions?” Stenstadvold Ross asked.

“We need to look at how we rig the decision-making systems, for example by involving clinicians and patients, how we attract clinical studies and how we implement personalised medicine,” Karl Kristian Bekeng from the Labour Party (Arbeiderpartiet) said. “When it comes to collaboration on new technologies and new medicines, there should be a lot more public-private collaboration. This should not be a replacement of the public health service, but an improvement of the public health service.”

Sylvi Listhaug from the Progress Party Association (Fremskrittspartiet) criticised the decision-making system.

“I think many patients – and the population as a whole – question why Norway is so late in implementing new medicines that can save lives and give better quality of life. I also think there are many desperate doctors, who see there are medicines that can give their patients a better life, which they can’t offer. The way we do this in Norway is completely out-dated. It doesn’t work. We are putting forward a new bill to Parliament now to change the whole system,” Listhaug announced.

Hege Edvardsen, senior adviser in LMI, represented the pharmaceutical industry in the debate and challenged the politicians to become more hands-on.

“We see that political decisions do not agree with what is actually delivered in the health service,” said Edvardsen, “It is important to strengthen the public-private collaboration. We have done a lot in oncology, but we are still struggling to get access to new treatments and we are lagging behind other Nordic countries. We need to consider the entire ecosystem when we talk about these things. If we wish to increase the number of clinical studies and attract research investments to Norway, we must also become better at solving the access part.”

The meeting also included mingling between the participants and the audience, which sparked further conversations and reflections. The debate will continue in our communication channels and at our next meeting during Arendalsuka at Clarion Hotel Tyholmen on 18 August 2022 (08:00-09:30). We hope to see you there!

Watch the meeting here (in Norwegian):

 


 

This meeting was a collaboration between Oslo Cancer Cluster, Norwegian Cancer Society, LMI, AstraZeneca, Janssen and MSD.