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The East Hospital drives innovation in targeted and personalised cancer treatment through three pilot projects
Having successfully secured support by being selected from an initial pool of 124 submissions in an open competition held by the National Health Service’s (NHS) ‘Healthcare Service Model Development Laboratory’ under the EU Recovery and Resilience Facility Plan, three pilot projects launched by Riga East Clinical University Hospital (East Hospital) aim to introduce cutting-edge solutions in Latvia’s healthcare system, ensuring targeted and personalised high-precision services for the diagnosis and treatment of oncological diseases. Their implementation would not only yield significant benefits to patients by ensuring cancer treatment in line with international guidelines, but also reduce healthcare and human resource costs, while improving the accessibility and quality of services.
In an effort to introduce cutting-edge solutions and improve accessibility to services within the publicly funded healthcare system, the NHS is implementing the project ‘Healthcare Service Model Development Laboratory’, with financial backing from the EU Recovery and Resilience Facility. The project will enable the testing and evaluation of innovative or previously underdeveloped healthcare service models until 2026. Achieving effective results could allow for their inclusion in the publicly funded services programme.
Emphasizing the relevance of innovative projects from both the treatment perspective and the implementation of scientific activities within the university hospital, Professor Haralds Plaudis, a Board Member of the East Hospital, emphasizes their significance: ‘The East Hospital is rapidly progressing towards becoming the Hospital of the Future, which entails not only new, modern buildings and facilities that are welcoming to patients and staff, along with state-of-the-art technological equipment, but also active scientific research and innovation. University-level hospitals should serve as innovation centres where new treatment methods and technologies are implemented and approved, thereby ensuring most effective patient treatment. Through this project, we reaffirm our commitment to achieving excellence on a global scale.’
From the initial pool of 124 submissions, the NHS selected the top 33 pilot projects for public evaluation. In the final selection phase, three pilot projects from the East Hospital secured approval, all of which are related to cutting-edge and scientifically approved solutions for targeted and personalised diagnosis and treatment of oncological diseases: High-precision robotic percutaneous thermal ablation laboratory for inoperable malignant tumors; Introduction of new molecular genetic diagnostic methods for personalised treatment of breast cancer patients in Latvia; Implementation of new highly effective molecular pathology diagnostic methods and services for the development of precision medicine in oncology.
Aina Kratovska, Head of the Radiology Centre at the East Hospital and expert in invasive radiology, explains: ‘The high-precision robotic percutaneous thermal ablation laboratory for inoperable malignant tumors aims at providing an innovative platform for treatment of both primary and secondary tumors of the liver, kidney, bone, and other locations that cannot be resected through open surgery, utilising microwave, cryoablation, and other types of percutaneous ablation (PATA) techniques, supported by a high-precision cutting-edge robotic navigation system. PATA is a minimally invasive treatment method for malignant tumors that destroys the tumor through a small puncture in the skin, using a special needle, without the need for open surgery.
Up to 40–60% of primary diagnosed liver, kidney, and bone tumors have contraindications for open surgical treatment, and only palliative therapy is offered, which results in reduced patient survival. PATA has yet to be developed in Latvia, whereas this technique is leading the way in modern medical advancements in other European countries and the USA.
Physicians from the East Hospital’s Invasive Radiology Department, in collaboration with physicians from the Vilnius Cancer Institute and Vilnius University Hospital Santaros Clinic, have mastered microwave and cryoablation procedures for the development of the PATA technique at the East Hospital. As the project continues, four more specialists are to be trained in the application of these techniques.
The approval of this cutting-edge technique would allow to perform 50 PATA surgeries within the scope of the pilot project, including robot-assisted navigation-guided surgeries for patients unable to undergo open surgical tumor removal. Upon completing the pilot project, the adoption of the PATA technique in routine oncology care in Latvia will guarantee that certain patient groups receive treatment in accordance with current European guidelines through cutting-edge, patient-friendly, and minimally invasive methods. Integrating PATA into the publicly funded healthcare services would result in financial gains for the public budget, while minimising the length of hospital stays, the count of intensive care bed days, and the disability periods for economically active patients.
Introduction of new molecular genetic diagnostic methods for personalised treatment of breast cancer patients in Latvia aims at providing personalised, value-based therapy for breast cancer patients in Latvia by integrating the Oncotype DX genetic test into the clinical pathway for breast cancer patients. Approximately 1200 new cases of breast cancer are diagnosed in Latvia each year. Postoperative chemotherapy for patients with early HR+, HER2- breast cancer significantly reduces the risk of disease recurrence and mortality.
Alinta Hegmane, an oncologist-chemotherapist and associate professor at the East Hospital, explains: ‘Standard clinical and pathological characteristics do not allow for precise selection of those patients who would benefit from postoperative chemotherapy in addition to hormone therapy. Chemotherapy involves severe short-term and long-term side effects, making it essential to evaluate the benefits, options, and effectiveness for specific patient groups. The Oncotype DX genetic test enables the identification of patients who scientifically benefit from chemotherapy, while allowing at least 70% of patients to avoid unnecessary, toxic treatment that diminishes quality of life and increases long-term work incapacity and disability. This aligns with internationally recommended value-based approach to oncology patient care.’ The integration of this genetic test into clinical pathways of certain patient groups would also enhance service availability in the field of chemotherapy for other oncology patient groups, as it would result in a reduced number of chemotherapy procedures, which means approximately 900 fewer chemotherapy procedures per year.
The Oncotype DX genetic test is recommended in international clinical guidelines and also included in the plan for improving healthcare services in oncology in Latvia for 2022–2024. Oncotype DX is covered by the majority of EU member states, including Estonia, while the implementation of the test is underway in Lithuania. Unfortunately, the administration of this test is not included in the list of publicly funded services in Latvia. As estimated by the East Hospital, Oncotype DX tests for 200 patients would spare the public budget more than EUR 680 000, as 70% of patients would not require unnecessary chemotherapy, support treatments during chemotherapy (such as additional medications), and treatment for complications arising from chemotherapy (like febrile neutropenia), while 70% of patients would not experience a six-month work disability related to chemotherapy, which is compensated by public budget resources.
Implementation of new highly effective molecular pathology diagnostic methods and services for the development of precision medicine in oncology aims at improving diagnostics for patients with hereditary cancer predisposition syndromes.
Colorectal cancer is among the most commonly diagnosed types of cancer, and currently, one-third of patients succumb to this disease. Lynch syndrome (LS) is the most prevalent hereditary cancer predisposition syndrome. Colorectal, gastric, oesophageal, small intestinal, and endometrial cancers can be triggered by mutations in genes responsible for DNA repair mechanisms, with LS being the most common type of hereditary cancer.
Professor Baiba Lāce, a medical geneticist at the East Hospital, highlights: ‘The most effective approach currently available for testing all colorectal and endometrial cancers is through microsatellite instability (MSI) testing and the immunohistochemical (IHC) analysis of specific proteins. So far, MSI testing has not been implemented in Latvia due to the lack of a technological solution that meets the in vitro diagnostic criteria. Launching the pilot project allowed the East Hospital to implement two new cutting-edge diagnostic methods enabling the identification, informing, and counselling of LS patients, The precision in diagnosis will allow the specialists to tailor treatment strategies for these patients. Additionally, the introduction of these new diagnostic methods will lead to the development of clinical algorithm solutions for patients with colorectal, gastric, oesophageal, small intestinal, and endometrial cancers.’
In Latvia, oncology is one of the priority areas of healthcare, and it is essential to ensure that oncology patients receive treatment in line with international clinical guidelines. The pilot project launched by the East Hospital aims at addressing this issue by introducing new diagnostic methods and adapting patient pathways to international guidelines. The long-term outcomes will involve early identification of cancer cases among high-risk groups, as well as identifying families with hereditary cancer syndrome (LS) and a heightened risk of cancer development, accompanied by evidence-based regular medical oversight.
The implementation of pilot projects at the East Hospital is set to begin in autumn 2024, and it is expected to continue by 31 March 2026, at which point the clinical and economic benefits will be assessed and a decision will be made about their inclusion in publicly funded healthcare programmes.
Photos of the pilot project leaders are available here.
The pilot projects are being implemented under the EU Recovery and Resilience Facility Plan’s reform 4.3.1.r, titled ‘Sustainability of healthcare, strengthening governance, efficient use of health resources, increase of the total public budget in the health sector’, as part of the National Health Service’s open pilot project selection for the ‘Healthcare Service Model Development Laboratory’. The approved funding for the project ‘Introduction of new molecular genetic diagnostic methods for personalised treatment of breast cancer patients in Latvia’ under the Recovery and Resilience Facility Plan amounts to EUR 853 725.18. The approved funding for the project ‘Implementation of new highly effective molecular pathology diagnostic methods and services for the development of precision medicine in oncology’ under the Recovery and Resilience Facility Plan amounts to EUR 774 951.42. The approved funding for the project ‘High-precision robotic percutaneous thermal ablation laboratory for inoperable malignant tumors’ under the Recovery and Resilience Facility Plan amounts to EUR 1 566 097.62.
About the East Hospital
Riga East Clinical University Hospital is the largest and strategically significant multi-profile hospital in the country. The hospital consists of five inpatient facilities – Gaiļezers, Latvian Oncology Centre, Biķernieki, Tuberculosis and Lung Disease Centre, and Latvian Infectious Diseases Centre, along with various specialised centres and clinics. The hospital provides highly specialised inpatient and secondary outpatient healthcare, offering multidisciplinary tertiary-level treatment and care in line with modern technology and medical knowledge. Approximately 80% of all cancer patients in Latvia are treated at the hospital. It serves as a practical training base for both Latvian educational institutions and foreign students, providing further education and knowledge transfer to healthcare specialists within and beyond the country. The hospital engages in scientific research and develops innovative methods for patient treatment. As the third-largest employer in the country, the hospital employs around 5000 staff members.
