Results from the T-DM1 study were published in the prestigious New England Journal of Medicine in November 2012. “Women who received T-DM1 lived much longer, had fewer side effects and enjoyed a better quality of life compared to those who received standard chemotherapy,” says Dr. Verma. “These findings create the framework for a new direction for the treatment of cancers, and potentially for earlier stages of disease, by improving the way chemotherapies can now be combined with targeted therapies.”
Delaney feels fortunate to have been included in the trial. She’s also pleased to have taken part in research that recently resulted in the widespread approval of the drug for women with HER2-positive breast cancer. “It’s humbling to think I had a role in helping to bring this drug to women across Canada,” she says.
LESS CAN BE MORE
On the opposite end of the cancer research spectrum, Dr. Kerbel is partnering with Israel’s Dr. Yuval Shaked on preclinical studies to get a better understanding of why “less can be more” when it comes to chemotherapy.
Dr. Kerbel has spent nearly half of his 30-year career as a cancer biologist pioneering a treatment known as metronomic chemotherapy. Unlike traditional chemo – characterized by high doses of toxic anti-cancer drugs usually given every few weeks for up to five months – metronomic chemotherapy uses lower and less toxic doses that are delivered more frequently, even daily, over one or more years.
“Traditional chemotherapy remains one of the main treatment methods for cancer, yet it has considerable side effects,” explains Dr. Kerbel, a senior scientist at Sunnybrook Research Institute (SRI) and the Canada Research Chair in Tumour Biology, Angiogenesis and Antiangiogenic Therapy. “For people with cancers that spread aggressively, standard chemo usually doesn’t extend life expectancy very much. In preclinical research, my laboratory has developed quite effective metronomic chemotherapy treatments for aggressive metastatic cancers – used either on their own or in combination with drugs called angiogenesis inhibitors, which cut off the blood supply that feeds tumours.”
Dr. Shaked, who worked in Dr. Kerbel’s SRI lab as a postdoctoral fellow, is now an assistant professor with the Rappaport Faculty of Medicine at Technion (Israel Institute of Technology). He notes that metronomic chemo remains a niche treatment concept that needs further investigation to bring it into the mainstream. In particular, the medical oncology world needs a better understanding of the biological mechanisms the treatment uses to attack cancer cells.
Drs. Kerbel and Shaked will get these answers with their international research collaboration. Through a generous donation from Rena and Michael Buckstein, Sunnybrook Foundation and Israel Cancer Research Fund are partnering to fund this innovative Canadian-Israeli research project.
“We will study several aspects of how metronomic chemotherapy acts against cancer cells,” says Dr. Shaked. “This includes whether this method can target the reactive host response usually found after conventional chemotherapy, thereby delaying tumour relapse, in addition to the ability of metronomic chemo to act against tumour cells that are usually resistant to conventional therapy.”
Their research will bolster recent and ongoing human clinical trials of metronomic chemo. A large study in the Netherlands among colon cancer patients has provided the first clinical evidence of the treatment’s promise, and there are several other large trials underway among metastatic breast cancer patients around the world.
STAND AND DELIVER
For the Odette Cancer Program, innovation in drug treatment extends beyond testing the newest drugs and developing leading-edge therapies. Improving the delivery of treatment is equally vital.
“In recent years, we’ve made important changes that have led to notable improvements in the scheduling of therapy and the patient experience,” says Philomena Sousa, process specialist and manager at the Odette Cancer Centre.
One change was the development and implementation of the Chemotherapy Appointment Reservation Manager
(CHARM), software that has helped reduce the average treatment wait time. It has also cut the number of phone calls between chemotherapy unit and pharmacy staff by 80 per cent, thanks to CHARM’s automated communication approval of patient drug therapy regimens.