Established by Bengt Sjöberg 2016
In addition to the Sjöberg Prize, where 9/10 of the prize money is reserved for research purposes, the Sjöberg Foundation has in 2022 made decisions on grants totaling approximately SEK 56 (63) million.
Can individualized treatments increase survival rates in pancreatic cancer?
A range of chemotherapies are available for treating pancreatic cancer, but there are no good decision-making tools for establishing which would have the best effect for a given individual. Researchers will now investigate whether treatments could be more effective if they are tailored to the tumor’s genetic fingerprint.
Pancreatic cancer is one of the deadliest forms of cancer but can, in some cases, be cured if the tumor can be removed and the patient receives chemotherapy that eliminates any remaining cancer cells. There are two main types of chemotherapy to choose from. Currently, physicians choose one based on the patient’s overall condition and whether they have other diseases.
However, researchers have discovered that the two different treatment protocols appear to have varying effects on different genetic subtypes of pancreatic cancer. A group of European physicians has therefore initiated a study, ESPAC-6, in which they will investigate whether it is better to adapt the cytostatic treatment to the type of tumor. Daniel Öhlund, assistant professor at Umeå University, will now receive 1.6 million Swedish kronor from the Sjöberg Foundation to run the Swedish part of the project, along with colleagues around the country.
ESPAC-6 will include 394 patients with pancreatic cancer. Half of them will be randomly selected for chemotherapy that is chosen in the traditional manner, while the other half will receive chemotherapy that is tailored to the genetic fingerprint of their tumor. The hope is that this optimized form of treatment will help more people survive the disease.
Designing an immunotherapy that can eradicate aggressive brain tumors
Magnus Essand has previously received a grant from the Sjöberg Foundation for constructing immune cells that can recognize and attack an aggressive form of brain tumor, glioblastoma. He will now receive an additional 4.5 million Swedish kronor to investigate a method that can help these immune cells move from circulating blood into the tumor.
Using advanced molecular biological methods, Magnus Essand, professor at Uppsala University, has succeeded in constructing special immune cells, CAR T cells, which attach to the surface of a glioblastoma and attack the tumor. To boost this assault from the immune system, they have also equipped the CAR T cells with a neutrophil-activating protein (NAP), that wakes up the immune cells in the tumor’s surroundings.
The specially constructed T cells, called CAR(NAP) T cells, have proven they can eradicate tumors in animal models, but the effect is not as good if the tumor is in the brain. This is because T cells find it difficult to enter the brain tumor; it is protected by the tumor’s blood vessels, which are dysfunctional and cannot recruit immune cells from the circulation.
However, Magnus Essand and Anna Dimberg, also a professor at Uppsala University, have a potential solution. They will equip the CAR(NAP) T cells with a molecule that allows them to attach to the inside of the tumor’s blood vessels. They will also modify the T cells, so they release a molecule that they know can change the tumor’s blood vessels and make them extremely efficient at recruiting immune cells. The aim is that the specially constructed T cells, and other immune cells, will then be able to cross the wall of the blood vessel and destroy the glioblastoma.
Will improve the treatment of a malignant lymphoma
Mantle cell lymphoma is a form of lymphoma that can be treated, but almost always recurs in the people it affects. Ingrid Glimelius will test a potentially more effective treatment for this disease. She will also map tissue samples from patients to find methods that may make individualized treatment possible.
Mantle cell lymphoma often occurs late in life; the median age is 70. Currently, most patients are treated with a combination of chemotherapy and an antibody called rituximab, which inhibits the growth of the cancer cells. This treatment usually causes the disease to go into complete remission but, after a few years, almost all patients experience a recurrence.
Ingrid Glimelius, professor at Uppsala University, has been granted 6 million Swedish kronor by the Sjöberg Foundation to improve the treatment of mantle cell lymphoma. She is responsible for the Swedish part of a Nordic study, ALTAMIRA, in which older patients are treated using a combination of rituximab and a new form of targeted drug, acalabrutinib. The patients are also monitored using a sensitive analysis method, minimal residual disease (MRD), which can detect a single cancer cell among 100,000 healthy white blood cells. When the cancer cells have been eradicated, the researchers can stop the treatment. If they find early indications of a recurrence, they can restart the treatment.
Using a range of molecular biology methods, Ingrid Glimelius and her colleagues will also map tissue samples from previous patients. The aim is to develop even better methods for tracking the development of the disease and individualizing the treatment.
How can people who have had cancer become more physically active?
People who have cancer feel better and improve their quality of life if they are physically active. Karin Nordin is therefore investigating how to help people exercise more, during and after treatment for cancer. Among other things, she is evaluating digital support for encouraging individual behavioral changes.
People with cancer who train or walk regularly feel better, physically and mentally, and some studies indicate that they cope better with treatment; they also have a reduced risk of the cancer recurring. However, many of them find it difficult to get started, and only 9–20 percent of people who have survived cancer achieve the recommended level of physical activity.
Karin Nordin, professor at Uppsala University, will now receive three million Swedish kronor from the Sjöberg Foundation. She and her colleagues will evaluate how people who have had cancer can be guided towards more physical activity, using the Phys-Can project, in which 577 people with cancer have exercised during their treatment. They will be examining how these efforts have affected the participants’ physical activity in the long term and the effect on their health, as well as other factors.
The researchers will also evaluate how digital support can be used to help people who have survived cancer to become more physically active. This evaluation is being carried out in cooperation with the users and considers individual needs.
Can radiation make immunotherapy more effective against malignant melanoma?
For around half the patients who receive immunotherapy for metastatic melanoma, the treatment does not have an adequate effect. Hildur Helgadottir will now investigate whether more people could be helped if the tumor is irradiated during immunotherapy. The hope is that the radiation-induced damage in the tumor will kick-start the immune system.
Immunotherapies have revolutionized the treatment of malignant melanoma. In some cases, even patients with metastatic melanoma can be cured, which was previously impossible. However, the treatment does not have an adequate effect in around half the melanoma patients who receive immunotherapy, and then the prognosis is poor.
Hildur Helgadottir, researcher at Karolinska Institutet, will now receive a grant of 6 million Swedish kronor from the Sjöberg Foundation. This will be used for a clinical study in which she will investigate whether immunotherapy would work better if it were combined with radiotherapy. The hypothesis is that the damage and inflammation that occur in the irradiated tumor will kick-start the immune system. Hopefully, the immune system will then attack the tumor, as well as other tumors in the patient.
The study, which is called PROMMEL (Precision Radiation of Immune Checkpoint Therapy Resistant Melanoma Metastases), will include 27 patients. The researchers will analyze blood and tumor samples from every patient to see how immune cells and cancer cells react to the combined treatment. The project is expected to conclude in 2025.
Why does immunotherapy only help some patients with tumors in the esophagus and stomach?
Immunotherapy is very beneficial for a minority of people who have cancer where the esophagus joins the stomach, gastroesophageal adenocarcinoma. Andrea Ponzetta will now investigate why this is not the case for everyone. How does the tumor protect itself from the immune system and can these defenses be overcome?
Cases of gastroesophageal adenocarcinoma have increased tenfold over the past 40 years. The disease is often discovered too late, so the prognosis is poor. However, studies show that combining chemotherapy, which is the standard treatment, with immunotherapy extends life expectancy in a subgroup of all patients.
The question is why it doesn’t help everyone. Andrea Ponzetta, researcher at Karolinska Institutet, will now receive 4.5 million Swedish kronor from the Sjöberg Foundation to help find the answer. Working with other researchers, he will map biopsies from several hundred patients with gastroesophageal adenocarcinoma. One hypothesis held by the researchers is that the tumors lack specific immune cells, unconventional lymphocytes, which are otherwise known to attract other immune cells and alert the immune system.
By studying the tumor tissue in detail, researchers also hope to find biomarkers that can help physicians predict which patients with gastroesophageal junction adenocarcinoma could be helped by immune therapies, so patients can avoid undergoing demanding and unnecessary treatments.
RNA vaccine will help the immune system attack liver tumors
In some cases, immunotherapies can cure cancer that has spread, but only in a minority of patients. Anna Pasetto, researcher at Karolinska Institutet, is therefore developing new forms of immunotherapy for liver cancer. One aim is to develop RNA vaccines that can trigger the immune system into attacking the tumors.
The coronavirus pandemic was the first time that RNA vaccines were tested in the real world, when they saved many lives. However, RNA vaccines were initially developed to promote an immune response to cancer tumors. Anna Pasetto will now receive 4.5 million Swedish kronor from the Sjöberg Foundation to develop RNA vaccines that can treat liver cancer.
The first stage in her project has been to identify molecular structures that can help the immune system recognize diseased tumor tissue. These structures form a target for the immune system called tumor antigens. Therefore, in 2020, she and her colleagues began mapping the DNA from 30 liver tumors from 16 patients. By analyzing the mutations in the tumors, they succeeded in finding several potential tumor antigens.
In the next stage, they investigated which of these tumor antigens caused the patients’ immune cells, T cells, to react. This allowed them to identify several working antigens, and the researchers will now create RNA vaccines that make the body produce large amounts of these antigens. They hope that if a patient with liver tumors receives this type of vaccine, the immune system will launch such a powerful response that it destroys the tumors.
Can a cytostatic agent called Lomustine better treat aggressive brain tumors?
Glioblastoma is the most aggressive brain tumor, giving a life expectancy of around one year. Researchers will now investigate whether people with a specific form of glioblastoma, mMGMT glioblastoma, can live longer if they receive a cytostatic agent called Lomustine in addition to the standard treatment.
People with glioblastoma that has a particular genetic variant, a methylated MGMT promoter (mMGMT), are more sensitive to alkylating chemotherapy. The standard treatment for this disease therefore includes a cytostatic called Temozolomide. Annika Malmström, associate professor at Linköping University, will now receive 6 million Swedish kronor from the Sjöberg Foundation to lead a clinical study that investigates whether patients can live longer if they receive an additional alkylating agent, Lomustine.
A small study indicates that adding Lomustine may extend life expectancy by a year, although this study has several limitations. The study that Annika Malmström will lead will include 200 patients from Sweden, Norway, Denmark, the UK, Austria, and Israel, who will be randomly assigned to a combination treatment with Lomustine and temozolomide or only the standard treatment.
Participants in the project will also be offered a form of treatment called tumor treating fields, in which the tumor is exposed to alternating electric fields. Studies show that this can extend life by five months. The primary aim of the project is to find out how combining these treatments impacts length of life, quality of life and the risk of side effects.
Chalmers University of Technology
Will develop AI-based methods for image analysis when evaluating lung cancer
More people will survive lung cancer if the disease can be discovered sooner. Researchers are now developing AI-based methods for image analysis, which can find emerging tumors in computed tomography scans of lungs. The computers will also learn to provide a prognosis for the disease and to identify early signs of a recurrence.
Lung cancer is often discovered too late, so many countries are developing screening programs in which the lungs are examined using computed tomography scans. However, the images are difficult to interpret; the human eye is not always able to differentiate between benign collections of cells and malignant tumors, which means that patients may be worried unnecessarily.
Ida Häggström, associate professor at Chalmers University of Technology, will now receive 5.25 million Swedish kronor from the Sjöberg Foundation to lead an interdisciplinary research project, which aims to improve the precision of image analysis. The researchers will get computers to interpret images from different stages of lung cancer; because the computers can use all the details in an image, the hope is that they can discover the disease at an early stage and be better at differentiating between benign and malignant tumors.
Researchers will also investigate whether AI-based image analysis can be used to better predict the progression of the disease, find early indications of any recurrence, and take more individualized decision about treatment.
How often do treatments for head and neck cancers cause lymphedema?
Treatments for head and neck cancers also damage healthy tissue. In many people, this leads to lymphedema and swelling in the area around the head and neck. Eva Ekvall Hansson will investigate a method that can discover problems at an earlier stage, because long-term problems with lymphedema can be counteracted if a patient gets help quickly.
Around nine out of ten people who are treated for head and neck cancers develop lymphedema, where lymphatic fluid collects in the tissues, which then swell up. The appearance of affected people changes, which can impact their self-image and self-confidence, with many people experiencing reduced quality of life.
Eva Ekvall Hansson, professor at Lund University, will now receive 800,000 Swedish kronor from the Sjöberg Foundation, so that she and her colleagues can map the amount of fluid in the tissues of people who received different treatments for head and neck cancers. They will measure the tissue dielectric constant (TDC), which shows how much fluid has collected in an area.
One aim is to gather better data about how many people actually develop lymphedema and whether some cancer treatments increase the risk more than others. Researchers will also investigate which areas of the head and neck collect the most fluid, and map how the problems influence the patients’ quality of life. The knowledge they obtain will be the foundation of an intervention study to evaluate the effect of early diagnosis and treatment for lymphedema.
Innovative imaging method can reveal skin tumors’ size and character
As one of the first research groups in the world, Malin Malmsjö and her colleagues are investigating whether a new imaging method – photoacoustic imaging – can be used to diagnose skin tumors. They hope to be able to map tumors in an entirely new way by combining lasers with ultrasound.
Currently, surgeons must remove a tumor and examine it with a microscope to determine the extent of a skin tumor. If the analysis shows that the tumor has grown deep into the surrounding tissue and that parts of the tumor are probably still in the skin, the patient must undergo another operation in which a larger area around the tumor is removed.
To prevent patients undergoing multiple operations, Malin Malmsjö, professor at Lund University, is now investigating if the tumor can be delineated using a new imaging method, which can provide high-resolution, three-dimensional images of tissue. In this method, called photoacoustic imaging, the tissue is illuminated using an intensive laser light. The laser affects the molecules in the tissue and, in simple terms, this creates ultrasound waves that can be detected. These soundwaves have special signatures that are different for different types of tissue.
Animal models show that this method can be used to create a much better image of the size and character of a tumor. Malin Malmsjö and her colleagues will now receive three million Swedish kronor from the Sjöberg Foundation to investigate whether the method will work equally well in clinical practice.
What effect does long-term treatment for acute leukemia have on children?
Tough treatments are necessary if a child is to survive acute lymphatic leukemia (ALL), which may lead to long-term side-effects. Researchers will now offer follow-ups to children who have been treated for ALL. The aim is to map how children’s health and wellbeing change over time, and hopefully to find ways of avoiding long-term complications.
Nine of ten children now survive ALL, but making all the cancer cells disappear requires treatment that often causes difficult and acute side effects. For example, the child’s immune system suffers, and many children have some degree of kidney damage. Both the disease and the treatment also affect the children’s mental health.
The treatment is so intensive that it often causes long-term complications. However, physicians’ knowledge of which acute side-effects may cause problems for children in the future is poor. Kees-Jan Pronk, associate professor at Lund University, will now receive 4.5 million Swedish kronor from the Sjöberg Foundation for a project that includes all the pediatric oncology clinics in Sweden, and where all children in the Nordics who were treated for ALL 2008–2019 will be offered a follow-up.
The children will answer a questionnaire about their health and undergo a thorough medical examination. The researchers will map how the child’s immune system and kidneys have recovered, and how they feel physically and mentally. Their long-term complications will be considered in relation to the acute side-effects they had during treatment. The hope is that researchers will find a way to modify treatment for ALL so the risk of long-term damage can be reduced.
Women with breast cancer will avoid lymph node surgery
Lymph nodes in the armpits are removed from patients to determine whether breast cancer has spread. Lisa Rydén is developing an AI-based diagnostic method that will help women with a low risk of metastasis avoid this, allowing them to keep their lymph nodes.
When surgeons operate for breast cancer, they remove lymph nodes from patients’ armpits. Then they check whether they contain any cancer cells, which is important in assessing whether the cancer has spread.
However, only a minority of breast cancer patients actually have cancer cells in the lymph nodes, so many people undergo unnecessary surgery. At the same time, some people have long-term side effects after the operation, including arm lymphedema. Lisa Rydén, professor at Lund University, will now receive three million Swedish kronor from the Sjöberg Foundation to validate an AI-based method she and her colleagues developed, so these women will not need this surgery.
Computers have been fed with ten known parameters for the women and the tumors and machine learning has then been used to calculate what determines whether a tumor has spread. This AI method will be further developed in this project, so that it is based on the information available before the woman is operated on. If the AI-based diagnostics show a very low probability that the woman has lymph node metastases, she can avoid undergoing that surgery.
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