{"id":"devices-roadmap","name":"Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants","route":"/roadmaps/devices-roadmap/","eras":[{"era":"1900s-1990s","title":"Radium, heat and light","description":"Brachytherapy placed radioactive sources inside tumours within a decade of radium's discovery and remains standard in cervical and prostate cancer. Hyperthermia, heating tumours to 40-43 degrees to sensitise them to radiation and chemotherapy, showed benefit in randomised trials for cervical cancer and sarcoma but never became routine. Photodynamic therapy, a light-activated drug for skin and superficial tumours, was approved in the 1990s. Each worked in a niche; none had the trial machinery to grow beyond it.","status":"historic","refs":[{"id":"brachytherapy","kind":"technology","name":"Brachytherapy","route":"/technologies/brachytherapy/","status":"standard-of-care","tldr":"Brachytherapy places a radioactive source directly inside or next to the tumour."},{"id":"hyperthermia","kind":"technology","name":"Hyperthermia","route":"/technologies/hyperthermia/","status":"established","tldr":"Hyperthermia heats tumours to 40-43 °C to make radiation and chemotherapy work better."},{"id":"photoimmunotherapy","kind":"technology","name":"Photoimmunotherapy & photodynamic therapy","route":"/technologies/photoimmunotherapy/","status":"approved","tldr":"An antibody carries a light-sensitive dye to the tumour; shining near-infrared light then bursts the cells."},{"id":"aminolevulinic-acid","kind":"drug","name":"Aminolevulinic acid (topical, for photodynamic therapy)","route":"/drugs/aminolevulinic-acid/","status":"approved","tldr":"Aminolevulinic acid is painted on sun-damaged skin and then activated with a lamp, destroying actinic keratoses before they can become skin cancer; in Europe the gel is also approved for superficial basal cell carcinoma."},{"id":"biofrontera","kind":"company","name":"Biofrontera","route":"/companies/biofrontera/","tldr":"Biofrontera is a German dermatology company whose photodynamic therapy product Ameluz (aminolevulinic acid gel) with its RhodoLED lamp treats actinic keratosis and, in Europe, superficial basal cell carcinoma."},{"id":"biolitec","kind":"company","name":"biolitec","route":"/companies/biolitec/","tldr":"biolitec is a German medical laser company that holds the EU authorisation for temoporfin (Foscan), a photosensitiser for palliative photodynamic therapy of advanced head and neck cancer."}],"trials":[],"papers":[]},{"era":"1990s-2015","title":"Ablation through a needle","description":"Radiofrequency, then microwave and cryoablation, destroyed small liver, kidney and lung tumours through a needle under imaging guidance and became guideline alternatives to surgery for patients who could not have an operation. Irreversible electroporation used high-voltage pulses to kill cells without heat, sparing vessels and ducts near the pancreas. Laser interstitial thermal therapy reached deep brain tumours through a small skull hole. High-intensity focused ultrasound treated prostate cancer from outside the body.","status":"historic","refs":[{"id":"thermal-ablation","kind":"technology","name":"Thermal ablation (RFA, microwave, cryo)","route":"/technologies/thermal-ablation/","status":"standard-of-care","tldr":"Thermal ablation kills a tumour with heat or cold delivered through a needle, with no incision required."},{"id":"irreversible-electroporation","kind":"technology","name":"Irreversible electroporation (NanoKnife)","route":"/technologies/irreversible-electroporation/","status":"established","tldr":"Irreversible electroporation uses short high-voltage pulses that punch permanent holes in tumour cells while sparing nearby vessels and ducts."},{"id":"litt","kind":"technology","name":"Laser interstitial thermal therapy (LITT)","route":"/technologies/litt/","status":"established","tldr":"Laser interstitial thermal therapy guides a laser fibre through a small skull hole, monitored by real-time MRI, to heat and destroy deep brain tumours a surgeon could not safely reach."},{"id":"hifu-histotripsy","kind":"technology","name":"Focused ultrasound & histotripsy","route":"/technologies/hifu-histotripsy/","status":"established","tldr":"Destroying tumours from outside the body with tightly focused sound waves, using either heat or microscopic bubbles."},{"id":"partial-nephrectomy-active-surveillance","kind":"technology","name":"Partial nephrectomy, ablation & active surveillance of small renal masses","route":"/technologies/partial-nephrectomy-active-surveillance/","status":"standard-of-care","tldr":"Most small kidney tumours found on scans grow slowly. Options range from watching them, to freezing or heating them, to removing just the tumour and keeping the kidney."}],"trials":[],"papers":[]},{"era":"2011-2026","title":"Electric fields become a treatment","description":"Tumour treating fields, delivered through electrodes worn on the skin for most of the day, disrupt the mitotic spindle in dividing cells. EF-14 showed that adding the device to temozolomide extends survival in newly diagnosed glioblastoma; STELLAR supported approval in mesothelioma; and in 2026 PANOVA-3 made the device the first ever approved for pancreatic cancer, extending survival when added to chemotherapy. The mechanism is unusual enough that the field spent years arguing about it; the randomised data settled the practical question.","status":"current","refs":[{"id":"ttfields","kind":"technology","name":"Tumour treating fields (TTFields)","route":"/technologies/ttfields/","status":"approved","tldr":"Wearable electrodes that deliver alternating electric fields disrupting cancer cell division."},{"id":"optune","kind":"drug","name":"Optune / Optune Pax (TTFields)","route":"/drugs/optune/","status":"approved","tldr":"Optune is a wearable device delivering electric fields that disrupt cell division. It is approved for glioblastoma and, in 2026, pancreatic cancer."},{"id":"ef-14","kind":"trial","name":"EF-14","route":"/trials/ef-14/","status":"positive","tldr":"The trial that made a wearable electric-field device part of glioblastoma care, extending median survival by about five months."},{"id":"stellar","kind":"trial","name":"STELLAR","route":"/trials/stellar/","status":"positive","tldr":"STELLAR is the small single-arm study behind the device approval of tumour treating fields in mesothelioma."},{"id":"panova-3","kind":"trial","name":"PANOVA-3","route":"/trials/panova-3/","status":"positive","tldr":"PANOVA-3 is the trial behind the 2026 approval of a wearable electric-field device for pancreatic cancer, the first new approval in locally advanced disease in decades."},{"id":"novocure","kind":"company","name":"Novocure","route":"/companies/novocure/","tldr":"Novocure makes Optune tumour treating fields, approved in glioblastoma, lung, mesothelioma, and (2026) pancreatic cancer."}],"trials":[{"id":"ef-14","name":"EF-14","route":"/trials/ef-14/","outcomes":[{"endpoint":"Progression-free survival","primary":true,"unit":"months","arms":[{"name":"TTFields + temozolomide","n":466,"value":6.7},{"name":"Temozolomide","n":229,"value":4}],"hr":0.63,"ci":[0.52,0.76],"p":"<0.001","source":"https://jamanetwork.com/journals/jama/fullarticle/2666504"},{"endpoint":"Overall survival","unit":"months","arms":[{"name":"TTFields + temozolomide","value":20.9},{"name":"Temozolomide","value":16}],"hr":0.63,"ci":[0.53,0.76],"source":"https://jamanetwork.com/journals/jama/fullarticle/2666504"}],"setting":"Newly diagnosed glioblastoma after chemoradiation: TTFields + maintenance temozolomide vs temozolomide alone","enrolled":695,"enrolledBasis":"registry"},{"id":"stellar","name":"STELLAR","route":"/trials/stellar/","outcomes":[{"endpoint":"Overall survival (single arm vs historical)","unit":"months","arms":[{"name":"TTFields + chemotherapy","n":80,"value":18.2},{"name":"Historical chemotherapy control","value":12.1}],"source":"https://doi.org/10.1016/S1470-2045(19)30532-7"}],"setting":"Unresectable pleural mesothelioma, first line: TTFields (150 kHz) + platinum-pemetrexed, single arm","enrolled":82,"enrolledBasis":"registry"},{"id":"panova-3","name":"PANOVA-3","route":"/trials/panova-3/","outcomes":[{"endpoint":"Overall survival","primary":true,"unit":"months","arms":[{"name":"TTFields + gemcitabine/nab-paclitaxel","n":284,"value":16.2},{"name":"Gemcitabine/nab-paclitaxel","n":287,"value":14.2}],"hr":0.82,"ci":[0.68,0.99],"p":"0.039","source":"https://ascopubs.org/doi/10.1200/JCO.25.00361"},{"endpoint":"Pain-free survival","unit":"months","arms":[{"name":"TTFields + gemcitabine/nab-paclitaxel","value":15.2,"note":"95% CI 10.3 to 22.8"},{"name":"Gemcitabine/nab-paclitaxel","value":9.1,"note":"95% CI 7.4 to 12.7"}],"hr":0.74,"ci":[0.56,0.97],"p":"0.027","source":"https://doi.org/10.1200/JCO-25-00746"}],"setting":"Unresectable locally advanced PDAC: TTFields + gemcitabine/nab-paclitaxel vs chemotherapy alone","enrolled":571,"enrolledBasis":"registry"}],"papers":[]},{"era":"2020-2026","title":"Light-activated drugs and drug-releasing implants","description":"Cetuximab sarotalocan, an EGFR antibody carrying a dye that bursts cells when near-infrared light is shone on them, is approved in Japan for recurrent head and neck cancer and is being paired with PD-1 blockade to turn the burst tumour into a vaccine. In the bladder, the TAR-200 pretzel implant releases gemcitabine for weeks and cleared carcinoma in situ in most patients in SunRISe-1; nadofaragene firadenovec became the first bladder gene therapy. Electrochemotherapy and IL-12 gene electrotransfer use electric pulses to get drugs or genes into a tumour directly.","status":"current","refs":[{"id":"cetuximab-sarotalocan","kind":"drug","name":"Cetuximab sarotalocan","route":"/drugs/cetuximab-sarotalocan/","status":"approved","tldr":"Cetuximab sarotalocan is an EGFR antibody carrying a light-activated dye: after infusion, a red laser is shone on the tumour and the cells burst. It has been approved in Japan since 2020."},{"id":"photoimmunotherapy","kind":"technology","name":"Photoimmunotherapy & photodynamic therapy","route":"/technologies/photoimmunotherapy/","status":"approved","tldr":"An antibody carries a light-sensitive dye to the tumour; shining near-infrared light then bursts the cells."},{"id":"idea-photoimmunotherapy-plus-pd1","kind":"idea","name":"Photoimmunotherapy as an in situ vaccine with PD-1 blockade","route":"/ideas/idea-photoimmunotherapy-plus-pd1/","tldr":"Bursting tumour cells with light releases their contents to the immune system; adding immunotherapy might turn a local treatment into a body-wide one."},{"id":"tar-200","kind":"drug","name":"Gemcitabine intravesical system (TAR-200)","route":"/drugs/tar-200/","status":"approved","tldr":"TAR-200 is a small pretzel-shaped device placed in the bladder that releases gemcitabine for three weeks at a time. It was approved in 2025 for early bladder cancer that no longer responds to BCG."},{"id":"sunrise-1","kind":"trial","name":"SunRISe-1","route":"/trials/sunrise-1/","status":"positive","tldr":"A tiny pretzel-shaped device that slowly releases chemotherapy inside the bladder cleared carcinoma in situ in over 80% of patients whose BCG had failed."},{"id":"bcg-and-intravesical-therapy","kind":"technology","name":"Intravesical therapy (BCG, chemotherapy, devices, gene and viral therapy)","route":"/technologies/bcg-and-intravesical-therapy/","status":"standard-of-care","tldr":"Treating early bladder cancer by putting the drug straight into the bladder through a catheter, so the whole body is spared."},{"id":"nadofaragene-firadenovec","kind":"drug","name":"Nadofaragene firadenovec","route":"/drugs/nadofaragene-firadenovec/","status":"approved","tldr":"Nadofaragene firadenovec is the first gene therapy for bladder cancer: a virus that makes bladder cells produce interferon for weeks, given once every three months."},{"id":"electrochemotherapy","kind":"technology","name":"Electrochemotherapy","route":"/technologies/electrochemotherapy/","status":"established","tldr":"Brief electric pulses applied to a tumour open pores in cell membranes so that a tiny dose of bleomycin or cisplatin floods in; used for skin metastases and, increasingly, for deep tumours."},{"id":"il12-electroporation","kind":"technology","name":"Intratumoural gene electrotransfer (IL-12 plasmid)","route":"/technologies/il12-electroporation/","status":"phase-2","tldr":"Intratumoural gene electrotransfer injects a plasmid carrying the interleukin-12 gene into a tumour and pushes it into cells with electric pulses, so this T-cell-activating cytokine is made locally instead of at the toxic doses intravenous IL-12 needed. It produced responses with pembrolizumab in anti-PD-1-resistant melanoma, but the sponsor's programmes have stalled."}],"trials":[{"id":"sunrise-1","name":"SunRISe-1","route":"/trials/sunrise-1/","outcomes":[{"endpoint":"Complete response rate (CIS)","primary":true,"unit":"%","arms":[{"name":"TAR-200 monotherapy","n":85,"value":82}]},{"endpoint":"Duration of CR ≥12 months","unit":"%","arms":[{"name":"TAR-200 monotherapy","value":51}]}],"setting":"BCG-unresponsive high-risk NMIBC with carcinoma in situ: TAR-200 (gemcitabine intravesical system) ± cetrelimab, single-arm cohorts","enrolledBasis":"registry"}],"papers":[]},{"era":"2024-2028","title":"Focused sound: destroy, prime, open","description":"Histotripsy destroys tissue with cavitation bubbles rather than heat, without incision or radiation; it is approved for liver tumours, its inventor was acquired for over two billion dollars, and trials are asking whether the debris it leaves primes an immune response that other ablations do not. Focused ultrasound with microbubbles briefly opens the blood-brain barrier so that chemotherapy or antibodies can reach brain tumours, in trials at Sunnybrook and elsewhere. Sonodynamic therapy activates a drug only where ultrasound hits it, in glioblastoma trials.","status":"emerging","refs":[{"id":"hifu-histotripsy","kind":"technology","name":"Focused ultrasound & histotripsy","route":"/technologies/hifu-histotripsy/","status":"established","tldr":"Destroying tumours from outside the body with tightly focused sound waves, using either heat or microscopic bubbles."},{"id":"histosonics","kind":"company","name":"HistoSonics","route":"/companies/histosonics/","tldr":"Inventor of histotripsy, non-invasive tumour destruction with focused ultrasound bubbles; acquired for $2.25B in 2025."},{"id":"histotripsy-immune-priming","kind":"technology","name":"Histotripsy as an immune primer","route":"/technologies/histotripsy-immune-priming/","status":"phase-1","tldr":"Destroying a tumour mechanically with sound, rather than heat, leaves the debris intact enough for the immune system to learn from it."},{"id":"bbb-focused-ultrasound","kind":"technology","name":"Focused-ultrasound blood-brain barrier opening","route":"/technologies/bbb-focused-ultrasound/","status":"phase-2","tldr":"Sound waves plus microbubbles briefly open the brain's protective barrier so chemotherapy or antibodies can get to the tumour."},{"id":"insightec","kind":"company","name":"Insightec","route":"/companies/insightec/","tldr":"MR-guided focused ultrasound company, with oncology use in blood-brain-barrier opening for brain tumours."},{"id":"sunnybrook-odette","kind":"institution","name":"Sunnybrook Odette Cancer Centre","route":"/institutions/sunnybrook-odette/","tldr":"One of Canada's largest cancer centres, where focused ultrasound first opened the blood-brain barrier in a patient and Canada's first MR-linac was installed."},{"id":"sonodynamic-therapy","kind":"technology","name":"Sonodynamic therapy","route":"/technologies/sonodynamic-therapy/","status":"phase-2","tldr":"A drug that does nothing until ultrasound hits it, then kills the cells that took it up. Being tested in brain tumours because sound reaches where light cannot."},{"id":"sonalasense","kind":"company","name":"SonALAsense","route":"/companies/sonalasense/","tldr":"SonALAsense is testing sonodynamic therapy, in which patients receive a drug that cancer cells turn into a light-sensitive chemical and then focused ultrasound is beamed through the skull to activate it, killing brain tumour cells without surgery."},{"id":"b-brain-delivery","kind":"bottleneck","name":"The brain: barrier and sanctuary","route":"/bottlenecks/b-brain-delivery/","tldr":"The blood-brain barrier's tight junctions and efflux pumps keep antibodies, antibody-drug conjugates and most kinase inhibitors out of the brain, so glioblastoma treatment has barely changed since 2005 and brain metastases, which develop in about a fifth of adults with cancer, are usually left to radiotherapy alone."}],"trials":[],"papers":[]},{"era":"2015-2028","title":"Devices that make treatment bearable and reachable","description":"Scalp cooling caps preserve hair through chemotherapy and are cleared and increasingly funded; a compression device aims to do the same more cheaply; low-level laser reduces the mouth ulcers of head and neck radiotherapy; a wearable ultrasound images the whole breast in minutes; and a portable freezing device lets a nurse treat cervical precancer in any clinic, which matters where colposcopy does not exist. Infusion pumps, ports and compounding robots are the devices every chemotherapy dose depends on.","status":"current","refs":[{"id":"scalp-cooling","kind":"technology","name":"Scalp cooling (cold caps: DigniCap, Paxman)","route":"/technologies/scalp-cooling/","status":"established","tldr":"A tightly fitted cap chilled to a few degrees above freezing, worn before, during and after each chemotherapy infusion, narrows the blood vessels of the scalp so less drug reaches the hair roots. In a randomised trial about half of women on taxane-based chemotherapy kept most of their hair, compared with none who went without."},{"id":"luminate-medical","kind":"company","name":"Luminate Medical","route":"/companies/luminate-medical/","tldr":"Luminate makes a wearable device that presses gently on the scalp during chemotherapy to stop the drug reaching the hair follicles, so patients keep their hair. It is in trials and no regulator has cleared it."},{"id":"photobiomodulation-mucositis","kind":"technology","name":"Photobiomodulation (low-level laser) for oral mucositis","route":"/technologies/photobiomodulation-mucositis/","status":"established","tldr":"Shining low-power red or near-infrared light on the inside of the mouth before and during treatment prevents severe mouth ulcers in people having head and neck radiotherapy or high-dose chemotherapy for transplant. Mucositis guidelines recommend it, though few centres yet have the equipment."},{"id":"isono-health","kind":"company","name":"iSono Health","route":"/companies/isono-health/","tldr":"iSono Health makes a wearable ultrasound scanner that images the whole breast automatically in about two minutes, with software to flag suspicious masses, for use outside specialist imaging centres."},{"id":"precancer-ablation","kind":"technology","name":"Thermal ablation and cryotherapy for cervical precancer","route":"/technologies/precancer-ablation/","status":"standard-of-care","tldr":"Destroying precancerous cervical cells with a heated or frozen probe in under a minute, the tool that makes screen-and-treat possible where there are no surgeons."},{"id":"ananya-health","kind":"company","name":"Ananya Health","route":"/companies/ananya-health/","tldr":"Ananya Health makes a portable freezing device that lets a nurse in any clinic treat abnormal cervical cells before they turn into cancer, at a tenth of the usual cost."},{"id":"idea-acc-hpv-self-sample-same-day-ablation","kind":"idea","name":"HPV self-testing with same-day treatment as the national cervical programme","route":"/ideas/idea-acc-hpv-self-sample-same-day-ablation/","tldr":"Women can collect their own sample for the virus that causes cervical cancer; those who test positive can be treated the same day with a simple heat device. Done nationally, this could eliminate a disease that still kills hundreds of thousands of women a year."},{"id":"infusion-devices-vascular-access","kind":"technology","name":"Infusion pumps, ports, and ambulatory chemotherapy devices","route":"/technologies/infusion-devices-vascular-access/","status":"standard-of-care","tldr":"Infusion devices are the implanted ports, smart pumps, and take-home pumps that deliver chemotherapy safely, including 46-hour infusions patients carry home."},{"id":"pharmacy-automation","kind":"technology","name":"Oncology pharmacy automation and compounding robots","route":"/technologies/pharmacy-automation/","status":"established","tldr":"Robots and closed systems that prepare chemotherapy doses safely, protecting pharmacists from hazardous drugs and patients from errors."}],"trials":[],"papers":[]},{"era":"2030+","title":"Nanoparticles, alpha seeds and machines made of DNA","description":"Iron-oxide nanoparticles heated by an alternating magnetic field, gold nanoshells heated by light, and nanoparticles that amplify radiotherapy inside the tumour all have first-in-human data and no randomised proof. Radioactive seeds that emit short-range alpha particles from inside a tumour are in trials. DNA origami nanorobots that open only on contact with a tumour are mouse data. Each has a specific, known failure mode (delivery, clearance, toxicity) rather than a vague one, which is what keeps them on the map.","status":"speculative","refs":[{"id":"magnetic-nanoparticle-hyperthermia","kind":"technology","name":"Magnetic nanoparticle hyperthermia","route":"/technologies/magnetic-nanoparticle-hyperthermia/","status":"phase-2","tldr":"Magnetic nanoparticle hyperthermia injects iron-oxide nanoparticles into a tumour and heats them from outside with an alternating magnetic field."},{"id":"photothermal-nanoparticles","kind":"technology","name":"Photothermal (plasmonic) nanoparticle ablation","route":"/technologies/photothermal-nanoparticles/","status":"phase-2","tldr":"Gold nanoshells that accumulate in a tumour and cook it when a near-infrared laser is shone on them."},{"id":"radiodynamic-therapy","kind":"technology","name":"Radiodynamic therapy and radiosensitising nanoparticles","route":"/technologies/radiodynamic-therapy/","status":"phase-2","tldr":"Nanoparticles that turn ordinary radiotherapy X-rays into a much bigger dose exactly where they sit."},{"id":"alpha-tau-medical","kind":"company","name":"Alpha Tau Medical","route":"/companies/alpha-tau-medical/","tldr":"Alpha Tau Medical places tiny radioactive seeds directly inside tumours so that short-range alpha radiation destroys the cancer from within. It is testing the approach in pancreatic, skin, head and neck, brain and prostate cancers."},{"id":"dna-origami-nanorobots","kind":"technology","name":"DNA origami nanorobots","route":"/technologies/dna-origami-nanorobots/","status":"preclinical","tldr":"Folded DNA machines that open only when they touch a tumour, releasing a payload or clotting the tumour's blood supply."},{"id":"frontier-2035","kind":"roadmap","name":"Radical oncology: what could change the war by 2035","route":"/roadmaps/frontier-2035/","tldr":"Radical oncology is a horizon map of the wilder ideas in cancer, sorted by how close they are to mattering, with the reason each one might never arrive."}],"trials":[],"papers":[]},{"era":"What sets the pace","title":"Trials nobody owns, evidence nobody blinds","description":"Devices are approved on less evidence than drugs, then struggle for guideline adoption and payment because the trials were small or unblinded. No pharma company funds a device trial, and device companies are small. Sham-controlled designs, standing platform trials for local therapies, and reimbursement tied to registries are the fixes; access outside specialist centres, and outside rich countries, is the larger gap.","status":"current","refs":[{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/","tldr":"Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment."},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/","tldr":"A phase 3 trial takes years and hundreds of millions of dollars, and often answers a question that has already moved on."},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/","tldr":"New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt."},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/","tldr":"Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce."}],"trials":[],"papers":[]}],"watch":[]}