World-first lymphoma research discovery!

Before we get into next month’s blogger, I’m pleased to inform you of an exciting discovery that was announced today at the BC Cancer Agency.

A study published in the prestigious international journal Nature outlines the discovery of a gene, CIITA, by researchers at the Agency’s Centre for Lymphoid Cancer (CLC). This discovery is a world-first because Agency researchers have found that this single gene is responsible for 40 per cent of patients with primary mediastinal B-cell lymphoma (a type of non-Hodgkin lymphoma) and 15 per cent of all Hodgkin lymphoma patients. This is also the first time that a commonly occurring gene fusion has been identified as a cause of this type of B-cell lymphoma.

The study clearly shows how cancer evades the body’s immune system through CIITA’s “one-two punch” to the immune system. When this gene starts fusing with other genes, the body’s killer white blood cells lose their ability to detect cancerous cells. In addition, the fusion causes an increased expression of a molecule that destroys these important white blood cells. This chain of events leads to the proliferation of cancer in this sizable percentage of patients.

Not only does this study mean a huge gain in knowledge about the mechanism of cancer, but it also means that targeted research can now be undertaken to start engineering drugs that will specifically target CIITA. The bottom line is that the research that is going on at the BC Cancer Agency is working. Improvements to care come from new evidence. And new evidence only comes from groundbreaking research.

Thanks again to Dr. Brad Nelson for being February’s guest blogger. Keep reading to see who takes over the blog this month.

Cheers,
Douglas

Dr. Brad Nelson: Looking to the future

Where does the Deeley Research Centre (DRC) hope to be in five years?  We want to take the ideas we’re developing today and apply them in the clinic.  So, we’re putting together a clinical trials program that will allow – for the first time – new immune-based treatments to be offered to patients at the Agency.  We envision clinical trials where, for example, a cancer patient who has completed standard treatments such as chemotherapy or radiation therapy is given a cancer vaccine designed to prevent the tumor from ever coming back.  Our work with the Genome Sciences Centre will help us design a vaccine that is tailored to an individual’s specific tumor, which we think we greatly increase effectiveness and reduce side effects.  The prospect of launching these trials in the near future is what excites me and my team most about our work — the opportunity to help real patients in the real world.

Dr. Brad Nelson: Explaining cancer immunology

So, I hope that I’ve built some anticipation for my explanation of cancer immunology.  I’m really proud of my team at the Deeley Research Centre (DRC) in Victoria and that we’re one of only two dedicated sites in Canada that explore the link between your immune system and cancer.

Dr. Brad Nelson: Why the Deeley Research Centre is a great place to work

As I mentioned, coming back to B.C. to work at the Deeley Research Centre (DRC) in the Vancouver Island Centre was an exciting moment in my career.  Coming to the DRC in Victoria was a unique opportunity, and I’m so happy that I made the move.  I’m also deeply grateful to all the donors who created the DRC by supporting the BC Cancer Foundation.

Dr. Brad Nelson: How I got interested in cancer research

Although I’m now the Director of the Deeley Research Centre (DRC) at the BC Cancer Agency’s Vancouver Island Centre, I actually came to cancer research quite late in my academic career.  I was completing my Ph.D. in embryology (the study of how animal and human eggs develop) at the University of California at Berkeley when I started to think about what my next challenge would be.

The Future of Genomics: Personalized medicine

It really is a very exciting time to work at the BC Cancer Agency’s Genome Sciences Centre (GSC). We are working with many other research teams, both at the Agency and around the world, to help better understand cancer and to use this advanced knowledge to succeed in treating cancer cells.

In the last 18 months, there have been a number of world-class genome science breakthroughs at the BC Cancer Agency in breast, ovarian and lymphoid cancers — and the GSC has been involved in all of them.

In these studies, many new genes with “spelling mistakes” (mutations) in them have been identified.  We have analyzed these spelling mistakes to find that, in some cases, they inactivate genes, and in other cases the spelling mistakes appear to activate other genes.  When we see the same genes activated or inactivated in many tumours of the same type, we think this means that the tumour favors cells that either gain, or alternatively lose, very specific functions that in either case help the tumour grow.  If we are right, it means that the DNA sequencing has revealed functions that the tumour needs to survive.  If so, this is important — if we can interfere with those functions, we can eliminate the mutated cancer cells while ideally leaving the normal cells, which don’t have the mutations, alone.  We hope that this might mean more effective treatments and less toxicity for cancer patients.

How technology is helping genomics

As I mentioned in my last post, the amount of DNA in your body is astounding, as is the number of cells, which has been estimated at 100 trillion  When I started in genomics, searching for cancer-causing mutations was a huge and expensive endeavor, and simply could not be done comprehensively.  The tools to understand the structure and function of cancer cell genomes simply did not exist.

All of that has drastically changed thanks to advances in technology.  So called “next-generation” DNA sequencing has dramatically changed the rate and cost of doing DNA sequencing for cancer mutation detection.

What is genomics?

Since genomics can seem complicated, let’s start with the basics so that you understand a bit better what my team does.

Many people are aware that the cells of living organisms contain DNA that encodes the information that their cells need to grow and divide normally.  The term genome refers to the DNA within the cells.  Although most of the genome is similar between individuals, there are also a lot of differences.  For instance, the copy of the genome that we inherited from Mom is different than the copy of the genome that we inherited from Dad.

Why do clinical trials require/deserve funding?

When thinking about what I wanted to write in today’s post, I knew I first wanted to say thank you to George and Margaret Braun and their family for giving generously to the BC Cancer Foundation.  Their gift provided substantial funding for the Clinical Trials Unit in Abbotsford that now bears their name.  Without the Brauns, there would not be clinical trials in Abbotsford. Period.

Along those lines, I should also thank the 20 riders of the Wheel Warriors’ team who raised $50,000 for clinical trials in Abbotsford last year in the Ride to Conquer Cancer.

About Clinical Trials

I wanted to start by speaking a bit about the Clinical Trials Unit at the Abbotsford Centre. 

“Clinical trials” is a term that encompasses a lot of different research questions and goals. 

The National Institute of Health (NIH) has a definition (here it is), but for ease, I think of clinical trials as being any research experiment being conducted on human patients.

In our context, these include specific questions such as, “Is chemotherapy X better than chemotherapy Y?” and peripheral questions such as, “Does herb X reduce nausea better than drug Y?” or, “Is a PET/CT scan helpful prior to cancer treatment?” 

As one might imagine, there are a lot of research questions out there, and we have to answer them in a regimented, rigorous way.  If we didn’t, no one would take the answers and proof seriously. 

So to prove that chemotherapy X is better than chemotherapy Y, you can’t just give one patient X and another patient Y and see who has the best outcomes.  You might require hundreds or thousands of patients.  And of course you would want the patients who get chemo drug X to be similar to those who get chemo drug Y, so someone has to screen all the potentially eligible patients before the trial starts. 

During the course of chemotherapy, you will also want to carefully scrutinize how the patients are doing to see if one therapy is better tolerated than the other.  You may have to follow the patients for years after they receive the drug to see if the cancer comes back and/or if there are late side effects associated with the chemotherapy.

All of this takes time and effort and, therefore, it may be many years from the start of a clinical trial until we know if the new therapy is beneficial.  But this is how we advance our ability to treat cancer — a continuous process of layering new information over old.

Oncologists actually do get excited (maybe even giddy) as we approach answers  during a clinical trial.  For us, participating in something that may alter the care of cancer patients and potentially cure more patients is extremely rewarding.  Our patients matter and deserve the newest and best care.  

Sometimes, clinical trials tell us that what we’re testing won’t work as a new treatment.  That is tough for the medical team who devoted years to the trial and obviously more so for those patients hoping for new and better therapies. 

But proving that something isn’t useful is also helpful.  We can say that at least we did the trial; otherwise, no one would know this treatment isn’t beneficial, and patients would continue to receive less beneficial treatment. So it is still helpful overall.

And when a clinical trial is successful, all of our hard work really pays off.  That’s when we really get to make a difference for patients.

It’s rewarding when we can look back and show that we improved a treatment, or when statistics start to show that a group of patients are doing better now than they were before a treatment changed.

I hope that’s helped to answer some of the basics about clinical trials!

Devin