How Photonics Innovation Is Countering Cancer’s Cortisol Complications

Hypocortisolism – known as Addison’s Disease – is a major complication arising from immunotherapy-based cancer treatments. Early detection is critical to ensuring better patient outcomes. Working with leading oncologists at the world-renowned NKI (The Netherlands Cancer Institute), expert academics from Wageningen University, and as part of the PhotonDelta ecosystem, the photonics specialists at Surfix created a photonics-based point-of-care testing (POCT) platform that’s helping save lives: today. 

Challenge

Neoadjuvant immunotherapy continues to yield significant improvements in combating certain early-stage cancers – including melanoma, triple-negative breast cancer, lung cancer, as well as head and neck cancer. It’s used prior to surgery to shrink tumour sizes in some cases, but especially to boost the patient’s immune system; often forgoing the need for extensive surgery or mitigating its invasiveness. 

However, although neoadjuvant immunotherapy increases patient survival rates considerably, long-term side effects can seriously impair their quality of life and lead to serious health consequences.

A significant group of patients receiving immunotherapy experience attacks on the steering hormone that regulates the adrenal gland. This leads to hypocortisolism and a condition known as Addison’s Disease, which can be fatal if undetected and unmanaged.
“With immunotherapy, there is always the danger that there could be lasting damage to a patient’s hormone-producing glands,” says Dr Christian Blank, a leading oncologist physician. “This can lead to problems with cortisol production and adrenal insufficiency.”
Dr Blank and his team have been leading the charge on neoadjuvant immunotherapy at the Netherlands Cancer Institute (NKI) for the last 10 years. In that time, they’ve identified that one of the major obstacles to early detection is that the only way to determine if a patient has Addison’s is through blood tests, which take time and need to be conducted in a clinical setting: typically every few weeks.

“Current methods are often too late to prevent irreversible damage. Early detection by daily monitoring, just one to two weeks earlier than current methods, could significantly improve patient outcomes and potentially even make the condition reversible, rather than a lifelong chronic disease.” Dr Christian Blank, Oncology, NKI


For Dr Blank, there was an urgent need to develop a point-of-care testing (POCT) system; in order to detect subtle drops in cortisol levels that serve as early warning signals. It was also clear that any solution needed to be simple and effective enough for patients to use in their own homes – similar to the way in which insulin levels can be monitored.
But such a platform didn’t exist… yet.

Solution

Dr Blank sought a partner to develop a point-of-care analysis device, leading to a global search for a technology company able to collaborate with the NKI team. However, when evaluating several best-in-class solutions, the team discovered Surfix – another Netherlands-based organisation – specialised in using integrated photonics for diagnostics.

Surfix began life as a spin-off from Wageningen University. Initially specialising in surface modification technologies using organic chemistry, the team has incrementally added complementary expertise – including biosensing, microfluidics, and systems engineering – and is now part of the PhotonDelta ecosystem.

Alongside NKI, Surfix also kept collaborating with Wageningen University & Research to develop its integrated photonics-based diagnostics platform that delivers exceptional sensitivity, accuracy, and a broad dynamic range for the detection of low-abundance biomarkers. 

Underpinning the platform itself is an integrated photonics biochip with six sensors, enhanced by Surfix’s patented nanocoating, which optimises flow, boosts sensor sensitivity, and minimises unwanted biomolecule binding. Designed to measure cortisol and interleukin-6 (IL-6) levels in saliva samples, this cutting‑edge technology consists of a photonic chip integrated in a microfluidic test cartridge and a small read-out instrument.

The cartridge contains a number of fluidic channels, where samples – in this case, saliva – are collected and can flow over the sensors. The sensors then leverage optical changes to accurately quantify biomarkers with high sensitivity and precision. Surfix’s coatings help immobilise the receptor molecules that are needed to detect biomarkers. This not only enables diagnosis with optimum precision, but it also provides quantitative results in 15 minutes. 

Using high-precision wafer-scale production and assembly methods similar to those used in electronics, photonics allows for significant miniaturisation and scalability at a low cost. Because Surfix’s solution is designed for portability, it doesn’t need to be made significantly smaller. While interactions of the machine will make future models smaller over time. However, patient-friendly handling remains more important than extreme miniaturisation in this particular instance.


“Our tech stood out for its sensitivity, precision, and ability to multiplex relatively easily. It’s fast and it’s a low-cost point of care system that’s ideally suited for patient monitoring where minor changes in biomarker concentrations can have a significant impact.”  Luc Scheres, Surfix, CTO


While the long-term goal is for patients to use the device at home regularly, similar to insulin measurement devices, the current focus is on identifying high-risk patients during neoadjuvant therapy for daily home monitoring.

“Surfix’s platform stood out due to its sensitivity, precision, multiplexing capabilities, speed, and low cost, making it suitable for both hospital and home use under specialist guidance,” said Dr Blank. 

Results 

Over the last two years, since the collaboration began, blind studies on the detection of IL‑6 have shown that Surfix’s platform is, in fact, at least as sensitive as current gold standard laboratory tests.

But, perhaps more importantly, hundreds of cancer patients will benefit from the technology in the near future. They will be able to address Addison’s symptoms much sooner, helping prevent them from developing the condition – and with significantly more understanding about their personal treatment needs than was possible before. 
This will mean fewer emergency hospitalisations, easier symptom management, and a future where patients can monitor their conditions safely and easily.

Surfix aims to continuously enhance the platform, further exploring photonics’ capabilities to refine ease of use and enhance already accurate biomarker detection. In fact, the team is now able to use the platform to detect a variety of different conditions, meaning it has an even broader set of applications across oncology, neurology, and infectious diseases. They remain committed to their mission to advance global health by delivering accurate, accessible, and affordable diagnostic solutions. 

At NKI, Dr Blank and his group continue to focus on testing different novel neoadjuvant combination immunetherapies, pioneering personalised neoadjuvant immunotherapy. Their overall goal is to offer every patient a customised therapy with the best risk-benefit ratio, and Surfix’s work in photonics is a crucial part of realising those ambitions.

“It’s clear that with further clinical studies, Surfix’s photonics-based platform has the potential to be a market-leading solution – significantly improving patient health outcomes by preventing or minimising chronic conditions. Early and accessible detection can fundamentally change the way we manage immune‑related side effects of cancer treatment. I cannot stress the importance of being able to do this enough.” Dr Christian Blank, Oncology, NKI