The researchers changing lives at the Cross Cancer Institute are able to succeed not just because they’re asking the right questions, but because they have what they need to find the right answers. This is possible because the Cross Cancer Institute, with your help, is creating an environment rich with the spirit of collaboration necessary to move an idea from the bench to the bedside. The research underway in Edmonton—at the University of Alberta and the Cross Cancer Institute—is becoming the standard of treatment worldwide. And, it’s saving lives.
What are clinical trials and why are they important?
Cancer treatment and care has come a long way over the years, and it continues to improve quickly thanks to research and clinical trials. Clinical trials are research studies performed with real patients to find out if a new treatment, like a new drug or device, is safe and effective to use on people as standard-of-care. Clinical trials can provide an alternative treatment option for patients when all other treatment options have been exhausted, and provide valuable insight and hope for people facing cancer in the future. Because Alberta is home to some of the top researchers in Canada and in the world, more clinical trials at the Cross Cancer Institute also means more homegrown answers to changing the way we treat cancer. Here are just a few of the innovations that your donation will help support.
CAR T-cell therapy
CAR T-cell therapy is a type of immunotherapy where some of a patient’s own infection-fighting T-cells are enhanced using a “good virus” to enable the cells to detect and attack cancer. Modifying T-cells is a complicated but groundbreaking process in treating cancer.
T-cells are considered the workhorse of the immune system for their ability to find and kill cells infected with a pathogen. CAR T-cell therapy involves collecting those cells from a patient, genetically modifying and infusing hundreds of millions of them back into the patient. If successful, the CAR T-cells will naturally multiply in the patient’s body, where they are programmed by their newly engineered receptors to identify a unique protein that exists on the cancer cell’s surface and then kill it—and only it— leaving healthy cells intact.
The cost of this treatment is typically half-a-million dollars US per patient. As more common types of cancer start using these approaches, Canada could see what Dr. Michael Chu, medical oncologist at Cancer Care Alberta and University of Alberta researcher, calls “a crisis of access.”
To ensure that doesn’t happen, Chu is running a trial to treat 57 adult and pediatric patients with relapsed leukemia and lymphoma using “point-of-care” CAR T-cell manufacturing. Rather than outsource the entire process, he is using two manufacturing sites in Edmonton and Calgary to create the “living treatment” for each patient in the study. This point-of-care manufacturing will reduce the cost of CAR T-cell treatment by approximately 90 per cent per patient.
In addition to a more sustainable cost, the point-of-care model will likely have numerous clinical benefits. Unlike the pharmaceutical model, point-of-care-made CAR T-cells do not need to be frozen because, as the name suggests, the freshly created treatment can literally be walked from the lab to the treatment sites and given to patients, increasing the likelihood of success.
“I think of it like buying groceries at the supermarket,” Chu says. “We think the fresh cells actually work better than the frozen, so that’s a major plus.”
Alberta’s Northern LIGHTs program involves using the world’s most advanced radiation therapy. It merges the abilities of MRI with the treatment capabilities of a linear accelerator, meaning clinicians can more precisely locate tumours, tailor the shape of radiation beams in real time, and deliver more accurate radiation.
The made-in-Alberta Linac-MR, developed by medical physicist Dr. Gino Fallone and his research team, combines the imaging capabilities of an MRI with the radiation abilities of a linear accelerator (Linac) to accurately target tumours (previously these two machines were considered “allergic” to each other). Blending these two technologies has multiple benefits: the Linac-MR offers real-time imaging during radiation treatments and has the capability to shorten treatment time and negate damage to healthy organs.
For decades, doctors have used CT-based technology to see inside the body to better target tumours with radiation. But CT can’t see all of the organs or tumours clearly. Also, some tumours are prone to movement during radiation, such as lungs, prostates and stomachs. Magnetic resonance (MR) can both visualize some organs and tumours more clearly and provide a live visual of the cancer so even if there is movement, accuracy won’t be lost.
“It’s like going from black and white pictures to colour pictures, where you are able to appreciate some details more clearly with MR,” says Dr. Nawaid Usmani, program lead for the Northern LIGHTs program, which launched a clinical trial at the Cross Cancer Institute in September 2021 to study and confirm the safety and effectiveness of the Linac-MR.
“The exciting thing with this technology is not only that we can see things better than before, but we can actually watch the tumours during treatment,” Usmani says. “This way, if the tumour moves out of the way of radiation through breathing or some other natural process, we can correct or stop the treatment temporarily until it comes back to the right place. By doing that, we will hopefully have fewer side effects and less risk of long-term damage to normal tissues.”
PET-MRI introduces short-lived, radioactive atoms attached to prostate cancer—seeking biomarkers which can highlight cancerous cells via PET imaging. These radio tracers act as spies, identifying and tracking prostate cancer cells, so clinicians can monitor tumour growth and progression, and assess best treatment responses. This method is the first of its kind for patients in Alberta.
Using highly specialized nuclear imaging tools to enhance cancer diagnosis and treatment, Dr. Frank Wuest, department of oncology chair, and his research team at the University of Alberta and the Cross Cancer Institute, design short-lived, radioactive atoms which, when attached to molecules, act as probes that bind to specific biomarkers for cancer. With the probes in place and using PET imaging, these “metabolic spies” identify and track cancer cells to monitor tumour growth and assess the response to treatments.
Because the radiopharmaceuticals are applied only in limited doses, there are no pharmacological or toxicological effects.
“We can rapidly ‘translate’ our best findings into the clinic to enhance patient care,” says Wuest, who holds the Dianne and Irving Kipnes Chair in Radiopharmaceutical Sciences.
Wuest and colleagues from across Ontario and BC have designed a radiotracer for imaging prostate-specific membrane antigen (PSMA) in prostate cancer. That radiotracer is now being trialed in several cancer centres across Canada, including the Cross Cancer Institute. Dr. Freimut Juengling is leading the clinical PET/MRI program at the Cross Cancer Institute.
The hope is that finely tuned, targeted approaches like this will be advantageous for dealing with many cancers.