A lot of progress has been made in recent years in treating cancer using immunotherapy. This treatment strengthens the immune response by the immune system so that the tumour disappears. This is an expensive form of treatment, which can cause serious side-effects and is also not effective in all patients. Doctors therefore want to be able to determine in advance whether immunotherapy will be effective for particular patients. 

Screening the tumour genes

‘We know that this therapy works best on tumours that have many mutations in their DNA,' says Dr De Miranda, who works at the LUMC. ‘Ideally, we would determine the complete genetic code of each tumour, then you know just how many mutations there are. But that's much too expensive and takes far too long.' The solution is not to screen all 20,000 genes, but a selection that is representative for the whole DNA. There are already a number of commercial tests available that can do this. 'But, in these tests, genes are selected that you wouldn't necessarily expect, based on our current knowledge of the genetics of cancer.'  

‘Ideally, we would determine the complete genetic code of each tumour, then you know how many mutations there are.'

Dr De Miranda wanted to explore whether he could make a representative selection of genes, and so develop a better test. He applied to the LUF for a project subsidy and in 2018 was awarded a grant from the Nypels-Van der Zee Fund.

Representative selection

‘We're now fairly well advanced with the project,' De Miranda says. Based on computer data, he makes a selection of genes that should give a good indication of the number of mutations in the tumour. 'We have already carried out the first lab tests using material from tumours from previous patients. These show that our selection is so representative that even using a much smaller number of genes than the commercial test can give us a better picture of the number of mutations.'

The subsidy from the LUF made a big difference for Dr De Miranda. ‘Because it's mainly commercial parties that are involved in this type of research, it is difficult to get funding for independent research.' De Miranda is now in discussion with different companies regarding whether they want to improve their tests on the basis of his research results. These commercial tests could be better, faster and cheaper. 'And that would allow doctors to apply immunotherapy more effectively, in those patients for whom it would have the greatest impact.'