Cancer Expert: The Value of Clinical Trials for All Patients

If you, a family member, or a friend has been diagnosed with advanced cancer, there are a few questions you should take time to discuss.

• Have you been evaluated for a clinical trial?
• Has next-generation sequencing been performed on your tumor or your blood?
• Should you undergo genetic testing?

It’s always a good idea to seek a second opinion or explore the opportunity to be enrolled in a clinical trial. By participating in a clinical trial, potentially a more effective, additional line of therapy option is added to the currently approved interventions while allowing research and science to make more progress.

There is a misconception that clinical trials are only for patients who have exhausted the standard options for care.

That’s not the case. I have patients that have been on three or four clinical trials before they started using the standard of care options.

Unfortunately, we also see many patients for second opinions who have never had next-generation sequencing (NGS) on their tumors. NGS could give them an opportunity to go on a trial that could match an “actionable mutation” with a targeted medication that potentially can be less toxic and more effective than conventional chemotherapy. Occasionally we have witnessed “miracles” with patients who came to us thinking there were no more options.

They exhausted traditional treatment options and were in hospice. Then, they were able to enroll in a clinical trial; and two, three years into it, they are still without evidence of cancer and some have resumed their normal lives.

The goal of precision medicine is to deliver the right treatment, to the right patient, at the right time and with the right dose.

Our ability to do this depends on finding what every patient needs based on their genes and the genetic makeover of their tumor.

By performing genomic testing, we can make better treatment recommendations based on the cancer’s molecular alteration. NGS can be performed on the solid tumor obtained through a biopsy. When a biopsy of the tumor is difficult to obtain, or the location poses an increased risk of complications, a great alternative is a “liquid biopsy” by testing the patient’s blood and looking for circulating tumor cells that are freely floating in the bloodstream.

What we are looking for in these tests are molecular alterations that are actionable, which means you have something that you can do about that mutation.

So basically, we’re looking for actionable mutations and then giving the patient the drugs that potentially will interfere with the cell growth pathway. By doing that, we’re hoping to improve patients’ outcomes and give them options that before they didn’t have.

I explain it to my patients in this way: if you have something coming at you, like a car coming at full speed and you try to stop it, it would take a lot more effort that will come with a lot of damage. On the other hand, if you find and use the breaks, the touch would be gentle, and the intervention would be very effective.

Especially in patients with advanced or late-stage cancer, we need to identify what’s driving the cell or cancer growth – and what’s making it resistant to treatment.

Depending on those results, we give them the treatment that will be specific to the mutation that is driving the cell growth. Also, if we can identify the alteration responsible for the resistance, we can change treatment to overcome that resistance.

There is currently a boom in cancer research.

The next 5 to 10 years will change the landscape of cancer treatment completely.

Several new drugs have been approved, and there has been an acceleration in precision medicine clinical trials using molecularly targeted interventions to improve patient outcomes.

We’re moving away from just calling the cancer based on the site of origin, like ‘breast cancer’ or ‘colon cancer’ or ‘lung cancer.’ We’re now calling the cancers based on their genetic mutation, and we treat them such. Eligible patients with all types of solid tumors and some hematological cancers can be a part of the TAPUR trial, for which I’m Sylvester’ s principal investigator.

I encourage everyone to see clinical trials as an opportunity.

Patients should feel comfortable and empowered to ask questions, form a team with their treating oncologist and together navigate the cancer treatment process, including seeking a second opinion and looking for clinical trials.

Our Sylvester cancer experts are here to provide recommendations and help in the fight to conquer cancer.

Written by:

Carmen Calfa, M.D.
Breast Medical Oncologist, Braman Family Breast Cancer Institute
Medical Co-Director, Cancer Survivorship & Translational Behavioral Sciences
Sylvester Comprehensive Cancer Center
Assistant Professor of Clinical Medicine
Associate Director of Community Outreach
Sylvester Comprehensive Cancer Center-Plantation

Tags: cancer clinical trials, Dr. Carmen Calfa, late stage cancer, Precision Medicine