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Dr. Philippe Bedard is often surprised by the strength and selflessness of his patients.
Despite the grueling physical and emotional toll of cancer, many patients are willing to give of themselves to support the research efforts of clinicians and scientists to improve treatments and outcomes for all of those battling the disease.
"I'm amazed every day to see what patients are willing to do to contribute to research and how well supported they are by their families and friends," says Dr. Bedard, a medical oncologist at Princess Margaret Cancer Centre.
"It's a big ask to be part of a clinical trial. But so many patients do it with the hope that even if it doesn't directly benefit them it will contribute to helping us as a research community."
And that commitment to research has been rewarded. Access to the number of drugs and the ability to transfer knowledge from the lab to the clinic have grown considerably in recent years – within individual cancer centres such as the Princess Margaret, across the province and country, and around the world.
Research collaborations, the development of new technologies, and patient participation in clinical trials have made a significant contribution to understanding what drives an individual patient's cancer.
It's this spirit of collaboration that is at the heart of the 'We can. I can.' theme for this year's World Cancer Day on Feb. 4. With worldwide cases of cancer predicted to reach nearly 22 million by 2030, 'We can. I can.' is about how everyone – as a collective or as individuals – can do their part to reduce the global burden of cancer.
"At the Princess Margaret, we collaborate widely with our academic partners around the world, but we also try to engage our community of other cancer providers, other cancer centres, and make sure that we can deploy the advances in cancer treatment as quickly as we can," says Dr. Mary Gospodarowicz, Medical Director.
"We do that through engaging our partners in clinical trials, and specifically rolling out molecular profiling of tumours, and being able to give precision targeted therapy, or immunotherapy, to as many patients in our community as we can – hoping that together we can accelerate the progress in understanding and treating cancer."
Cancer Genomics Program
The Cancer Genomics Program is one example at the Princess Margaret where individual clinical and research expertise is brought together to improve treatment for patients and advance precision medicine.
Through a variety of studies, the program offers comprehensive molecular profiling to cancer centre patients. Genomic or molecular profiling is the process of testing for mutations in cancer cells.
"All cancers have mutations, or errors in their DNA, that drive them to become cancerous – drive them to become responsive or resistant to treatment," says Dr. Bedard, who is also the Clinical Director of the Cancer Genomics Program.
"And genomic profiling is about trying to get a snapshot of how each patient's cancer is unique."
By looking at the molecular profile of many tumour samples from many different patients, it allows clinicians and researchers to understand what makes one cancer different from another. This is important because it will help explain why two patients with the same type of cancer may respond very differently to the same treatment.
"We've come a long way – a decade ago we were at the point where we could test for a single mutation in a single gene," Dr. Bedard recalls. "Now we're able to test hundreds of genes at the same time and get a real understanding of what drives an individual patient's cancer."
IMPACT, COMPACT, OCTANE
Starting in 2012, medical oncologists at the Princess Margaret enrolled more than 3,000 patients in a clinical research study that used molecular profiling to analyze individual mutations in cancer tissue from patients with advanced solid tumours.
It was the first time clinical researchers in the cancer program used a panel of 50 genes versus traditional single gene testing to examine mutations.
The initial study, known as IMPACT – Integrated Molecular Profiling in Advanced Cancers Trial, – involved patients from across UHN. A parallel study was expanded to include other Greater Toronto Area hospitals and was called COMPACT – Community Molecular Profiling in Advanced Cancers Trial.
The trials involved collaboration by oncologists, laboratory physicians and clinical geneticists to generate complex molecular profiling data. This information could help physicians make a treatment decision to put a patient on an already approved drug, or suggest a clinical trial, to see if it would have an impact on their care.
The infrastructure from these projects led to a study called OCTANE – Ontario-wide Targeted Nucleic Acid Evaluation. The study is currently open to patients being treated at the Princess Margaret, the London Regional Cancer Program, Kingston General Hospital, the Ottawa Hospital, and the Juravinski Cancer Centre in Hamilton.
"It's an exciting time because over the last six months the other centres across the province have come on-board and we're approaching 1,000 patients enrolled," says Dr. Bedard.
"It's been a success in terms of getting all the pieces in place for a complex study that involves tissue and blood samples being exchanged across a number of different institutions to undergo genomic testing, making results available in a common portal for researchers across the province, and collecting information on patient outcomes."
To understand how a cancer grows, spreads, and kills, researchers need to examine a lot of data from a large number of patients.
Sharing anonymized patient data, like the kind collected in the IMPACT and COMPACT studies, across a number of centres, allows clinicians and researchers to analyze patterns and trends with the goal of providing treatments that are more precise.
"Research is not something that is done in a silo," says Dr. Bedard. "Even in large cancer centres like ours, we rely upon external collaborations with other cancer hospitals and industry, to innovate and deliver the best care for our patients."
The important partnerships among clinicians, researchers and institutions is critical to pushing towards better and more precise treatments, but the work could not be done without the generosity of patients.
"Engaging patients as partners in creating progress in cancer is very important," says Dr. Gospodarowicz. "When patients engage in clinical trials they do not necessarily achieve any personal benefit immediately, but they benefit the future generation of patients.
"There's no doubt that there's a degree of commitment and giving among our patients who are willing to have more appointments, come more frequently, have more testing, in order for us to be able to make more progress in cancer care."
While progress takes time, Dr. Bedard says he has seen significant improvements and is enthusiastic about the types of new drugs and the scientific progress being translated into clinical care.
Dr. Gospodarowicz adds that World Cancer Day provides an opportunity to not only reflect on the progress made, but also advocate for what still needs to be done in global cancer control.
"Cancer is a growing problem everywhere in the world," says Dr. Gospodarowicz.
"In addition to doing research, pushing forward with precision medicine, with molecular profiling, with better therapeutics, we need to all be engaged in advocacy so that we can bring the know-how that we have, the treatments that we have, and the knowledge to every patient, not only in our own institution, but in our province and in the world."