Netherlands Cancer Institute (NKI)
The Netherlands Cancer Institute (NKI) has been at the forefront of cancer research and treatment in the Netherlands for more than 100 years. We spoke to Emile Voest, a medical oncologist who at the time was the NKI’s Medical Director.
100 years of medical excellence
Alongside its partner hospital, the Antoni van Leeuwenhoek Hospital, the NKI forms a cornerstone of the Dutch life sciences and health community. The 2 institutions, now also known as NKI-AVL, emerged from a cancer hospital and research centre founded in 1913 as the Antoni van Leeuwenhoek-Huis. Located on the Keizersgracht, it had space for 17 patients and 10 scientists. Today, the NKI accommodates around 650 scientists and support staff; the AVL has 185 medical specialists, 180 hospital beds and an outpatient clinic.
Personalised treatment can make therapy more effective
In his research, Voest focuses on immunotherapy – getting a patient’s immune system to fight cancer cells – and personalised, or precision, medicine. This specialisation is a result of, as he puts it, “the frustration of having a patient in front of me and not being able to say which treatment is going to work. It’s continuously getting better, but cancer treatment is still a numbers game.”
In personalised medicine, a number of factors are examined to determine which therapy is right for a particular patient at a particular time. Biomarkers, for example, can predict how well a treatment can work for a patient. “We create a treatment that is tailor-made for the patient’s needs,” explains Voest.
Expanding the uses of medication
Another aspect of personalised medicine for cancer patients is using drugs “off-label”, says Voest. This involves using drugs that have been approved for a certain type of tumour to treat another type if both types share specific genetic properties. Using drugs that have only been approved for a different kind of cancer is not normally possible due to the prohibitive cost involved – they would not be covered by healthcare, explains Voest. But the so-called DRUP study, which used Next-Gen DNA sequencing to determine these shared genetic properties of tumours, is changing that.
Joining forces for scientific advances
Voest is the principal investigator of the DRUP trial, having worked on it alongside colleagues from LUMC (Hans Gelderblom) and AUMC (Henk Verheul). The trial was carried out on behalf of the Center for Personalized Cancer Treatment (CPCT), which is a cooperation between numerous Dutch hospitals and the Hartwig Medical Foundation. It’s a great example for the way separate institutions within the Dutch life sciences and health community in the Netherlands join forces to further research advances, facilitated by the spirit of cooperation and concentration of the industry’s organisations in the Netherlands.
Voest says the Netherlands’ life sciences and health sector is thriving. “Science is at a high level here. There is a reason why the NKI is rated by other international hospitals in the top 5 cancer hospitals. I would say the Dutch have a good knack for doing science. We are very innovative; it’s in the culture that we have, to be smart with limited resources, that’s our creativity.” He does raise concerns about funding for research. Cancer, he says, “is a societal problem that is huge and there are great opportunities for improving it. But we need to make sure we have the resources and retain that competitive edge.”
Building a solid base for ground-breaking results
The current ground-breaking discoveries and new treatments in immunotherapy are a good example. “I think progress in cancer research is coming in waves of new findings. Right now, we have the immunotherapy wave. But, this is based on decades of research. It’s basic research that is feeding how we can help with cancer – or any type of disease. In immunotherapy, we are reaping the fruits of that basic research now. And that is why we need to continue doing research, because otherwise, where are we in 20 years?”
The future of cancer treatment
Well – if everything goes well, where will we bein 20 years? What does the future of cancer treatment look like? Voest laughs. “If I knew that, I’d put all my money on it now.” But there are promising trajectories. At the NKI, “we’re looking at how to improve immunotherapy by individualising it. We take blood from the patient to get T cells and grow a piece of the patient’s tumour outside the body, in a petri dish.” The cells are trained to kill the tumour cells. “For now, it’s a research platform. But it is something that could support personalised immunotherapy in the future.”
“Cell-based therapies are going to be very important. You take cells, manipulate them to recognise and kill the cancer and put them back in. Tumour cells are almost identical to other cells, they just have one little thing that’s different, and if we get immune cells to recognise that thing, we have a route to treatment.”
Another important topic for cancer research, says Voest, is AI. “Images of tumours in response to treatment, sections of tumours under the microscope, blood samples with biomarkers – these are all areas where AI can play an important role. And if you have a database that is really big and combine that with machine learning – it’s early days but I am convinced that this can make a significant impact in the coming years. Combine all the information we have in data sets, and we can take huge steps forward.”
Of course, the use of patients’ data must happen on a voluntary basis, and Voest concedes that “privacy is an important topic. But I’ll be honest, if we have a patient and we ask if we can use their data for research, almost no one says no. All patients want to help their fellow citizens.”
Life after cancer
The NKI’s work doesn’t stop with research and active treatment. “Another important area we work on is survivorship,” says Voest. “More and more patients are surviving cancer now. 60% of patients now survive until 10 years beyond their diagnosis. So that’s good, but we also see that people are struggling physically and emotionally with the impact of cancer, which is why we do research into issues relating to this.
Let’s just say that there is no scientific basis for many of the things being advocated on the internet. One of the few proven tips is that proper physical exercise, anything from half an hour a day, helps patients deal with chemo better and live longer.”
The aim, then, is to consider advice that may work and substantiate it with research. “We want to provide good solid data proving things that do work.”
