This entry is part 5 of 5 in the series Google Hangouts
Much of the progress in cancer survival over the past few decades can be credited to life-saving and life-extending treatments.
In the first of this two part Google Hangout, we found out how scientists discover new drugs, and the challenges they face turning a bright idea into a medicine.
But once scientists have discovered a new medicine they think will be effective at treating cancer patients, what happens next? How does the medicine get tested in patients to find out if it does work?
In our latest Google Hangout, we were joined by cancer specialist Dr Emma Dean, based at the University of Manchester and The Christie hospital, and Diane Brooks – a breast cancer patient who has taken part in several clinical trials at The Christie, to find out more.
Dean opened the Google Hangout by explaining the “safe and structured” way new drugs are tested in patients through clinical trials.
To get to a point where drugs are licensed and more widely available to patients, they need to be tested to make sure they’re safe, don’t have too many side effects, and are better than the standard treatments given to cancer patients.
What we’re trying to do all the time is speed up the process and increase the chances of success
– Dr Emma Dean
Next, Dean told us about the different ‘phases’ trials are broken into and what happens at each point.
“The first and most important thing we do when we test a new drug in patients is to check that it’s safe. We also need to find out how well patients tolerate the drug, and how best to give the treatment. This is called a phase I trial,” she says.
Once doctors are assured a new drug is safe, know what doses to give patients and how serious the side effects are, the trial progresses to phase II.
“This is where we test the drug in more patients, and focus in on the type of cancer where we think the drug will be most effective,” says Dean.
The final stage, phase III, compares the new treatment to the best existing treatments. “Only when the phase III trial is positive can we take the new treatment to be licensed,” says Dean.
But she goes on to explain that the process is lengthy (around 10 years), and most drugs fail along the way and don’t make it to the point of being licensed.
“What we’re trying to do all the time is speed up the process and increase the chances of success.
“It also means we’re trying to select patients based on their tumour characteristics and who are most likely to respond to a given drug. We call this precision medicine,” she says.
Dean then highlights that even when a trial finishes, it can take years to collect and carefully analyse all of the information to know how successful a new treatment might be.
Then the attention switched to Diane, who told us a bit of her cancer journey.
“I was diagnosed 15 years ago, back in 2001. I’m one of 4 sisters and we always knew there might be something bad in our genetic make-up because my mum, my grandmother and my grandmother’s sister all died at a young age from breast cancer.”
The sisters all had regular mammograms from the age of 30 at a genetics clinic because of the strong family history of the disease.
“It was after a mammogram that I got a phone call saying they’d picked something up,” Diane says.
Diane was told the tumour hadn’t spread, so she opted to have both breasts removed. But during the operation, the surgeon discovered another bigger tumour. And a genetic test revealed Diane had a faulty copy of the BRCA2 gene.
Diane joined her first clinical trial at The Christie Hospital 15 years ago, when she was offered a choice of the gold standard of care, or a new combination of chemotherapies.
“I chose the experimental treatment because there were more rounds of chemotherapy and I thought that must be better. It wasn’t very scientific, but that’s how I decided.”
Following her treatment she had 7 years in remission, but then it came back. And this time, it was Diane asking about clinical trials, and her doctor found one that was suitable for her.
The good thing, ultimately, for me and my family is that I’m still here. And the knowledge they’ve learned from me will help other people with the same genetic make-up as me
– Diane, a breast cancer patient and clinical trial participant
“I was given lots of information and lots of time to discuss it with my family,” she says. “Although I didn’t know at that stage whether I fitted the criteria I was both excited and apprehensive.”
There was a lot for Diane to take in, but she spoke highly of the doctors and nurses who were there to guide her through her decision.
Diane has now taken part in several trials. “These are not miracle cures,” she says. “But you’re part of research building the knowledge about your type of cancer and finding the latest cutting edge treatments.
“The good thing, ultimately, for me and my family is that I’m still here. And the knowledge they’ve learned from me will help other people with the same genetic make-up as me.
“The down side is the number of journeys to the hospital. I do have to travel a lot – luckily my husband chauffeurs me around – but that’s not always easy when you’re unwell.
“Sometimes you won’t get any benefit from that treatment, but I always turn that into a positive. It’s still a learning curve for the scientists and doctors.”
The Hangout drew to a conclusion with Dean explaining how she brings up clinical trials with patients, and how important she feels it is that they are offered the opportunity to take part.
She did however mention the criteria that have to be met to take part in some trials.
“The criteria exist not to exclude people, but to minimise the risks for patients taking experimental treatments. It can be very disappointing for patients who have spoken to their doctors, gone through all the information and prepared themselves to take part only to find they can’t.”
But it doesn’t rule out other clinical trials, which may be more suitable, and there are lots of centres around the UK where you can participate.
Dean’s final thought reflected those of Diane; that people should ask their doctor about clinical trials at any stage of their treatment.
“Have that discussion, it gives you another option – you might be surprised at what is open to you.”
You can watch the Hangout in full on YouTube.