Advancements in Cancer Care Made Possible By Clinical Trials

By Jenny Owen and John Wallace

Cancer has recently been a hot topic in the mainstream press since actor Michael Douglas was diagnosed with stage IV throat cancer and Elizabeth Edwards died of breast cancer. While this common disease has affected so many Americans – experts note that one in two men and one in three women will be diagnosed with cancer in their lifetimes –the public is still shocked to see celebrities afflicted with cancer. “It reminds us that cancer doesn’t discriminate and that none of us is exempt,” said John D. Roberts, M.D., associate director for clinical research at Virginia Commonwealth University Massey Cancer Center.

“The good news is that there have been medical breakthroughs in the prevention, diagnosis and treatment of cancer,” Roberts said. “Take, for example, the treatment of childhood leukemia. In the 1940s and ‘50s, every child that developed acute leukemia in this country died. In the ‘60s and ‘70s, some children were being cured of acute leukemia. By the ‘80s, most children were being cured.”

According to Roberts, these medical advances are due to decades of research in the laboratory that was then translated through clinical trials to patient care. A clinical trial is a research study involving consenting patients that is used to find better ways to diagnose, prevent or treat diseases with new drugs or devices.

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 “We treat cancer with three different approaches: surgery, radiation therapy and drug therapy (chemotherapy),” said Roberts. “Cancer treatments today mostly involve drugs because drugs treat the whole body by traveling through the blood stream, whereas surgery and radiation therapy are localized in that they target the specific infected areas of the body. But because cancer cells arise from our normal tissue cells, it’s hard to develop drugs that target cancer cells without affecting healthy cells. This is why progress has been frustratingly slow and why more clinical trials are needed.”

Roberts explained that there are generally three kinds of clinical trials. “The case of childhood leukemia I described is one example of how clinical trials both find and refine treatments. While an effective treatment for the disease was discovered through continued laboratory and clinical trials research, it had a lot of side effects. It made the children ill in the short term, and it affected some children’s growth development in the long term and impaired them as adults. As researchers, we thought, ‘This can’t be the best possible therapy, it’s just the best available.’

“A clinical trial was conducted to evaluate new ways to administer this treatment so as to produce fewer side effects. As a result, today 85 percent of children are cured of leukemia, and their treatments are tailored to the nature of their disease,” explained Roberts. “So if a child has a lesser form of the disease, she gets the lesser (but just as effective) treatment with fewer side effects. If the child has a higher form of the disease, he gets the full treatment that involves more side effects but is needed to beat the disease.

“Another kind of trial tests the efficacy of a brand new therapy for a specific disease for which a ‘best available’ treatment does not currently exist. The new therapy was found to be promising in laboratory experiments involving test tubes or mice. The most appropriate patients for those trials are those who, unfortunately, the current treatments aren’t enough.

 “A third kind of trial seeks to find the ‘best possible’ treatments for diseases for which the ‘best available’ treatments are only modestly effective. These trials generally assess new combinations of drugs.”

Said Roberts, “While what we have today are the ‘best available’ treatments, certainly the best treatments are in the future. How we bring that future forward is through patients working together with their doctors on clinical trials.”

VCU Massey Cancer Center is currently conducting more than 100 clinical trials on a variety of cancers from brain and breast to pancreas, prostate and more. View a complete list of ALL active clinical trials available at VCU Massey.