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Cleveland Clinic names top 10 breakthrough technologies for 2018
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Cleveland Clinic named the top 10 list of medical breakthrough technologies for the coming year at the Medical Innovation Summit.
“These are to be the top 10 disruptors in health care in 2018,” moderator Michael Roizen, MD, chief wellness officer at Cleveland Clinic, said during the presentation. “They are the clinic physicians’ choices for those things that will have a magnitude effect next year. So, the two major criteria are: it is innovative and it will change care in a major way in 2018.”
The breakthrough technologies ranged across a variety of diseases including breast cancer, heart and vascular disease, infectious diseases, retinal disease sleep apnea and diabetes.
Approximately 150 to 200 physicians, as well as 20 to 30 venture capitalists and members of the media, are interviewed regarding their opinion on the top technology for the coming year. After those selections are thinned out, 40 physicians vote for the top 10.
The top 10 breakthrough technologies included:
1. Hybrid closed-loop insulin delivery system;
2. Neuromodulation to treat obstructive sleep apnea;
3. Gene therapy for inherited retinal disease;
4. The unprecedented reduction of low-density lipoprotein cholesterol;
5. The emergence of distance health;
6. Next-generation vaccine platforms;
7. Arsenal of targeted breast cancer therapies;
8. Enhanced recovery after surgery;
9. Centralized monitoring of hospital patients; and
10. Scalp cooling for reducing chemotherapy-induced hair loss.
Targeted breast cancer therapies
The advancement of targeted therapy for women with BRCA1- or BRCA2-positive breast cancer offers promise to oncologists caring for these patients.
In particular, studies designed to evaluate treatment with olaparib (Lynparza; AstraZeneca, Merck) a PARP inhibitor approved for use in women with BRCA-related ovarian cancer have shown promising safety and efficacy results.
“It is very exciting from a cancer genetics point-of-view because we have always had these surveillance patterns,” Pauline Funchain, MD, from the Taussig Cancer Institute at Cleveland Clinic, said. “But, we have not had drugs or classes of drugs that were made for that subset of patients.”
This particular innovation targets the molecular underpinning of a subset of breast cancer, Funchain said.
“This is what we define as precision oncology defining the tumor not by where it came from, but by a particular molecular change that can be targeted,” she added. “When you identify a subset of patients for whom you found essentially the driver, you can target your therapies for that and improve outcomes — in this case double the response rate and actually decrease side effects.”
Similarly, targeted therapies are having an increasing benefit among women with HER-2-positive breast cancer, especially when combined with additional therapies and chemotherapy.
As a result, experts believe study results are pointing to an increasing survival rate and, perhaps, the eventual end of chemotherapy for a significant population of patients with breast cancer.
“As we move forward with immunotherapy, precision therapy, the combinations and timing them correctly, choosing the right patient at the right time with the right type of therapy, we are actually looking at an end [to chemotherapy],” Funchain said.
Scalp cooling device
Scalp cooling — achieved by wearing a cooling cap that circulates refrigerated liquid — is designed to reduce the temperature of the scalp by a few degrees immediately before, during and after the administration of chemotherapy.
The device is intended to reduce the amount of chemotherapy that reaches the hair follicles, reduce drug diffusion through the cell membrane, decrease cell division, reduce active transport mechanisms and generally reduce metabolic activity.
Julie Nangia , MD, assistant professor of medicine at Lester and Sue Smith Breast Center of Baylor College of Medicine, and colleagues randomly assigned 182 women (mean age, 52.1 years; 83% white) to scalp cooling or a control arm.
In total, 95 women in the scalp-cooling arm and 47 in the control arm completed the first chemotherapy cycle and were evaluable for alopecia (n = 142). Sixty-four percent (n = 91) received taxane-based chemotherapy and 36% (n = 51) received anthracycline-based chemotherapy.
Researchers observed successful hair preservation in 48 women who received scalp cooling (50.5%, 95% CI, 40.7-60.4) compared with no women in the control group (0%, 95% CI, 0-7.6; success rate difference, 50.5%; 95% CI, 40.5-60.6). The 1-tailed P value from the Fisher exact test was less than .001, which crossed the superiority boundary of .0061. Thus, the data and safety monitoring board recommended the study be closed early.
Sixteen percent (95% CI, 4-46) of women in the scalp-cooling arm who received anthracycline-based chemotherapy reported hair preservation compared with 59% (95% CI, 27-84) of women treated with taxanes.
In April, the FDA approved the DigniCap Cooling System (Dignitana Inc) to reduce the frequency and severity of alopecia in women undergoing alopecia-inducing chemotherapy for breast cancer.
In July, the clearance was expanded to include all patients with solid tumors.
“A lot of technologies in oncology are focused on targeted therapies, but I think this is innovative and transformational because, from a patient perspective, it is very meaningful to not lose their hair,” Alberto Montero, MD, from the Taussig Cancer Institute at Cleveland Clinic. “I am a breast cancer specialist, and in a lot of my patients that is potentially a big issue.” - by Kristie L. Kahl