Dr. Daniel De Carvalho
Senior Scientist, Princess Margaret Cancer Centre
Photo courtesy of UHN’s StRIDe team
Ever since the 1950s, when Dr. Vera Peters demonstrated that patients with early Hodgkin’s disease could be cured with radiation therapy, Toronto’s Princess Margaret Cancer Centre has been a beacon of groundbreaking cancer research and care. Today, the pace of discovery at the Cancer Centre is only accelerating as new technologies allow researchers and clinicians to understand aspects of cancer that were previously unknown.
Senior scientist Dr. Daniel De Carvalho, orig-inally from Brazil, is one of many researchers at the Cancer Centre harnessing the latest technology to revolutionize our understanding of cancer and reshape the paradigm of cancer diagnosis and care.
“We’re in a moment of rapid transformation in our understanding of cancer,” says Dr. De Carvalho. “How we approach cancer research in the coming decades — increasing our knowledge about how to prevent it, how to detect it early, and how to intercept it before it becomes an advanced disease — will define the outcomes of cancer care for generations.”
Early cancer detection means better cancer outcomes
Dr. De Carvalho’s research is focused on early cancer detection. Novel cancer treatments are being developed every year, but the new therapies and the old almost universally share one thing in common: the earlier treatment begins, the better the outcome.
“For many cancer types, most patients are diagnosed at late stages,” says Dr. De Carvalho. “This gives time for the disease to spread and become more heterogeneous, allowing the cancer to become more difficult to treat. When the cancer is diagnosed at an early stage, the chance of a cure can be much higher.”
Using advanced tools like DNA sequencing and machine learning, Dr. De Carvalho’s team has developed a new liquid biopsy procedure that detects previously imperceptible epigenetic markers unique to cancer cells. Finding these markers in a conventional blood sample is a classic needle-in-a-haystack problem. By leveraging artificial intelligence, the team has been able to not only pick out the marked cells within the great wash of unmarked cells, but also identify the area of the body from which they originate.
“My research focus is on using an epigenetic mark called DNA methylation to identify if small pieces of DNA circulating in the blood come from normal cells or from tumour cells,” explains Dr. De Carvalho. “In my group at The Princess Margaret, we developed a technology to capture all the DNA molecules tagged with these epigenetic marks from a blood sample, so we can read these epigenetic tags using DNA sequencing technology. Then, we trained a computer program to learn these patterns and identify if each blood sample contains DNA from a tumour or not, and, if it gives a positive result, where the tumour is located.”
A blood test for cancer is revolutionary. And it’s just the tip of the iceberg
This innovation is a potential game-changer, allowing multiple types of cancer to be diagnosed and located through a simple blood test both earlier and more effectively than using existing diagnostic tools. Dr. De Carvalho’s liquid biopsy technology must undergo further testing and validation before it can be put into clinical use, but the results so far are extremely encouraging.
As Dr. De Carvalho’s research makes it through this phase of the bench-to-bedside pipeline, there are many other concurrent cancer research initiatives at The Princess Margaret at various stages, from basic research to clinical trial. Just as Dr. Peters’ discoveries changed the landscape of Hodgkin’s disease treatment 70 years ago, more recent research at Princess Margaret Cancer Centre has been transforming the standard of cancer care worldwide. In the last decade alone, The Princess Margaret’s scientists and clinicians have pioneered advancements in targeted anticancer drugs, radiotherapy, chemotherapy, stem cell science, and even mental health management for cancer patients.
We’re in a moment of rapid transformation in our understanding of cancer. Research in the coming decades will define cancer care for generations.Dr. Daniel De Carvalho
The road to a healthier Canada, and world, is paved with well-funded cancer research
Looking to the future, Princess Margaret Cancer Centre has a broad mandate for new science, with multiple promising areas of focus. Stem cell research, for example, promises a powerful new avenue of insight into how cancer operates and develops, as well as offering potential new therapies. Immuno-therapy — an area in which The Princess Margaret is a leader internationally — recruits the body’s own immune system as an ally in the fight against cancer. Genetics and epigenetics, as in Dr. De Carvalho’s research, are allowing us to understand cancer, in all its many forms, far better than ever before, leading to new diagnostic tools and more targeted treatments. And, as a final example, smart cancer care is about transforming the way we think about cancer care entirely, so we can allocate resources intelligently and provide the best care and quality of life for the most patients, nationwide.
For these and other important research initiatives to advance, a robust mix of public funding and private philanthropy is necessary to provide the foundation on which our nation’s advanced cancer research centres can build a healthier tomorrow. Philan-thropy has undoubtedly posi-tioned The Princess Margaret as one of the top 5 cancer research centres in the world.
Made-in-Canada cancer science, global cancer care
The return on investment for Canadians when sufficient resources are available to keep developing this science here at home is profound and multifaceted.
“Developing novel technology locally has multiple benefits to Canadians,” says Dr. De Carvalho. “First, it allows Canadians to have faster access to novel diagnostic tools and new therapies. Moreover, it allows the development to focus on Canadian needs, such as public health care versus private health care and accessibility to remote communities. Further, having Canadian and global scientists trained here developing their own technical and scientific expertise can create an invaluable innovation ecosystem that will help the Canadian economy to thrive, now and into the future.”
The very fact that Dr. De Carvalho — along with medical and research trainees from over 70 institutions from around the world — has chosen to conduct his science at The Princess Margaret makes the case for well-funded Canadian research institutions clear and tangible. By maintaining state-of-the-art research facilities within our borders, we’re able to attract top scientists and clinicians from around the world, and give our homegrown innovators a powerful incentive to stay. And the reach of these innovations is enriched through research partnerships with over 200 institutions worldwide, benefiting all global citizens and further cementing Canada’s role as an international leader in cancer research.
“Princess Margaret Cancer Centre is one of the top 5 cancer research centres in the world,” says Dr. De Carvalho. “It’s ahead of most other places, with world-leading science and high-profile scientists. We’re a comprehensive cancer centre, treating over 200 types of cancers, including the rarest ones, so we have clinicians who are interested in the science and scientists who are interested in the clinical questions and we talk to each other daily. In fact, roughly 17% of Princess Margaret patients are participating in clinical trials, versus an average of 5% at other major cancer centres in North America. This translates into rich learning that can affect the future standard of cancer care worldwide.”
When we help great research institutions like Princess Margaret Cancer Centre to thrive, we provide an unparalleled venue for the scientific collaboration and achievement that have been progressively improving Canadian and global cancer care for decades, and will continue to do so in the decades to come.
Key discoveries and innovations at The Princess Margaret
Dr. Vera Peters’ groundbreaking work shows that patients with early Hodgkin’s disease, then considered incurable, could be cured if given extended field radiotherapy.
Dr. James Till and Dr. Ernest McCulloch discover stem cells and how they function, which changes the course of cancer research.
The Princess Margaret bone marrow transplant unit performs the first allogeneic transplant — transplants between unrelated donors.
Dr. Norman Boyd identifies breast density as a major risk factor for breast cancer, and later demonstrates that it’s
Dr. Tak Mak identifies a new anticancer target called PLK4, which plays a crucial role in the process of cancer cell division. Health Canada and the U.S. FDA provide clearance to advance a first-in-class cancer drug to Phase I clinical trials.
Stem cell scientists, led by Dr. John Dick, identify a new view of how human blood is made. Different kinds of blood cells form quickly from the stem cell and not further downstream as traditionally thought.
Dr. Daniel De Carvalho discovers a mechanism to mimic a virus and potentially trigger an immune response to fight colorectal cancer stem cells like an infection.