3 Questions with Dr. Adam Wax of Oncoscope Inc. and Duke University

Laura Marshall, Managing Editor, laura.marshall@photonics.com

Dr. Adam Wax is changing the way we look at cancer. Literally. His research at Duke University, where he is a professor in the biomedical engineering department and on the faculty of the medical physics graduate program, has focused on improving optical spectroscopy for early cancer detection as well as microscopy and interferometry techniques for biomedical applications. He has published more than 150 papers and holds seven patents.

Wax also is the chairman of Oncoscope Inc., which he and colleagues founded in 2006 to explore clinical translation of Wax’s technology, known as angle-resolved low coherence interferometry (a/LCI). The company’s noninvasive, scattered-light platform guides physicians toward sampling cells with enlarged nuclei, the primary early marker for cancer. This allows physicians to examine more tissue – and to do so more quickly, taking fewer samples for microscopic evaluation and leaving healthy tissue intact.

BioPhotonics caught up with Wax this summer.

Q: What is your company working on right now?

Wax: Oncoscope is focused on gaining FDA approval to market our a/LCI device for detecting precancerous lesions of the esophagus. The original a/LCI system was validated in a clinical study (Terry et al, Gastroenterology 2011) that used a prototype instrument developed in my laboratory at Duke University. This system was robust enough for the 50-patient feasibility study, but in order to translate the system for clinical use, we had to redesign several aspects of the system. For example, the Duke system required installation of the fiber optic probe by our Ph.D. scientists, while the new Oncoscope probe features an easily exchanged probe that can be attached by a technician.

Another important aspect is minimizing the time required for instrument preparation between patients. While the original Duke prototype required a 20-minute Cidex bath for disinfection between patients, the Oncoscope system uses a disposable sheath as a barrier. Not only does this protect the probe and maintain disinfection, but the sheath can be exchanged easily and quickly, allowing for fast turnaround between patients. In addition to these and other hardware changes designed to make the instrument more robust and durable, we have also created a new software interface which improves ease of use by the physician. With these design changes nearing completion, we are eager to begin our pivotal clinical study in the near future.

Q: What are the implications of this project/work?

Wax: Upon FDA approval, the a/LCI device from Oncoscope will provide a new way for monitoring patients with Barrett’s esophagus (BE), a metaplastic tissue transformation of the esophagus. BE patients have an increased chance for developing esophageal adenocarcinoma, an awful disease with a dismal 15 percent five-year survival rate. Because of this increased risk, BE patients undergo periodic endoscopic surveillance procedures to search for precancerous lesions.

Unfortunately, there is currently no way for the physician to identify precancerous cells without taking a biopsy. However, it is not feasible to take biopsies from more than a few selected points in the tissue. The Oncoscope a/LCI device will enable a physician to examine many more points in the tissue and guide their biopsies to suspicious regions for more effective surveillance.

Q: What’s the next step?

Wax: Preliminary data from the BIOS lab at Duke have shown that the approach is also feasible for detecting precancerous lesions in the colon and cervix. We are preparing for an in vivo study, under support from the Coulter translational partnership, to use a/LCI for detecting precancerous tissues in patients who suffer from inflammatory bowel diseases, such as Crohn’s disease and colitis. This is a similar situation as BE patients where the tissue condition can cause an increased risk of cancer so that periodic surveillance is warranted. However, the colon is a larger organ than the esophagus and thus even more biopsies are required to assess tissue health. The a/LCI device could help with this clinical task by en-abling more tissue sites to be evaluated in less time.

Application to cervical epithelial tissues is also a compelling target, where an advanced optical technique like a/LCI can offer advantages for surveillance of at-risk patients, such as those with a positive Papanicolaou smear or human papillomavirus (HPV) DNA test, but may also impact screening of the general population.

For more on Wax’s work at Duke, visit http://bios.bme.duke.edu.