A doctor writes: My experience with clinical trials for cancer patients

By Dr Conleth Murphy I love many aspects of my job, but one of the things that give me most satisfaction is being able to offer clinical trial options to my patients.    Along with my colleague Dr Brian Bird, I run a busy medical oncology service in the Bon Secours Hospital, Cork.  We have always felt that the availability of clinical trials is an essential component of a modern high quality oncology unit. I want to explain why we feel this way. 

The benefits of clinical trials

 Firstly, clinical trials provide the basis for new advances in cancer care. All of the treatments we currently consider 'standard' exist because of the patients with cancer who participated in clinical trials.  The history of effective therapies for cancer is actually relatively short, approximately 70-80 years. The fact that such astonishing advances have been made over that time is a testament to the patients who participated in successive generations of clinical trials.  Each generation of clinical trial built upon the success of the prior ones, so that the 'standard of care' was continuously refined and improved.  For me this is especially obvious in chemotherapy given after surgery for early breast cancer.  New therapies evaluated in successive generations of clinical trial from the 1970s onward have each resulted in small incremental improvements, but taken together they have resulted in dramatically improved outcomes for women diagnosed with breast cancer today composed with women diagnosed in those years.  

Developing new treatment options

 Clinical trials can provide a treatment option for patients when standard treatments have run out.  One area where we sometimes see this happening is advanced colon cancer. We find ourselves in a situation where we have a patient who is very well but whose cancer is progressing without a standard chemotherapy option to offer them.  For that reason we were delighted to take part in a recent study of a new treatment for patients with colon cancer without standard treatment options.  Our hospital was the first in Ireland to treat patients with this new therapy. Results of the trial confirmed the benefit of this treatment, which is expected to become one of the new 'standard' therapies for colon cancer.  Even for trials that don’t end up showing very impressive improvements, participation can be a positive experience for patients.  Because the conduct of trials are very closely monitored (to ensure high quality) by agencies such as the Health Products Regulatory Authority and even international groups, they tend to be associated with a very high level of patient care.  My participation in clinical trials also makes me strive to replicate those high standards in the care of all my patients. I would like to stress that trials are not just a 'last resort' for patients without other treatment options, although this is a common perception.  Some trials involve the addition of new therapies to standard therapies and can potentially build on the success of current treatments.  

Irish collaboration with international groups on clinical trials

 One of the most exciting trials I have been involved with in recent years is the B47 study, run by a large collaborative group based in North America whose trials we can become involved with due to our membership of ICORG.  ICORG is a network of Irish oncologists and researchers across all of the cancer centers in the country who collectively can access such large international groups.  The B47 study explores the addition of a drug called trastuzumab (Herceptin) to standard chemotherapy for women with early breast cancer.  This drug is already in common use for women with one kind of breast cancer (called HER2-positive breast cancer) but we are trialling it in women with other kinds of breast cancer.  For me the highlight of participating in this study has been the chance to offer a potentially better treatment to women with very high risk breast cancer, where I know our current standard treatment is often not good enough.  Similarly, we have taken part in several studies evaluating a whole new type of cancer drug (called a CDK4/6 inhibitor) which is added to hormonal therapy for women with hormone-sensitive breast cancer.  It was very rewarding to see one of these studies presented at our large international meeting in Chicago in June 2015.  The results showed an improved outcome for women receiving the new drug. I felt very proud of the women who took part in this study at our hospital, and also of all of our research team.  

The trials and tribulations of clinical trials

 Results like the ones I mention above make the hard work of running clinical trials worthwhile. And it is hard work! Clinical trials are very demanding. Because we are testing new ways of giving treatment we have to put a lot of safeguards in place to protect our patients. These include very strict rules for everything from what type of patients can take part, to when we can go ahead with treatment.  In addition there is a huge amount of paperwork which is very time-consuming. We are very lucky to have a fantastic and very committed group of people working in our clinical trial unit, each of whom feels as strongly about clinical research as we do. I think that patients pick up on that positivity and commitment; research shows that trust in your doctor and medical team is an important factor in whether or not someone will decide to take part in a trial. 

In-house studies 

We also conduct some 'in-house' studies, through which we can investigate issues relevant to our patients, but which might be applicable to patients throughout the world.  These in-house studies often involve looking back at a group of patients who have already received treatment to try to answer questions about how things can be improved.  An example is a study we are conducting with a final year medical student at UCC. We are taking cheek swabs from patients who have received a particular kind of chemotherapy, to see if there is any difference between the people who developed more serious side effects and those who did not.  Any differences we identify could help us to spot people who are more likely to run into trouble more easily in the future so that we could reduce their dose of drug or pick a different treatment. 

The importance of team work in clinical trials

 Over the last five years, we have seen the clinical trial department in our hospital grow each year. For example we had one half-time research nurse five years ago, and now we have two full-time research nurses. In addition we have a data manager, a pharmacist with a special interest in clinical trials, as well as the medical team consisting of two consultants and two registrars who are very actively involved in research.  Outside of the core research team, this important work could not be carried out without the hard work of a much wider group of people within the hospital, from the staff of the x-ray department, to the nurses on the oncology inpatient and daycase wards.  In addition the hospital management have been hugely supportive of what they also see as an integral part of the oncology service. I am constantly amazed by the bravery and generosity of spirit of the patients I encounter in my daily work.  I think the participation of oncology patients in clinical trials over decades is a testament to this spirit. I would like to applaud all of those patients who continue to contribute to the improvements in cancer survival which we are witnessing today.  [[{"type":"media","view_mode":"media_large","fid":"4586","field_deltas":{},"link_text":null,"attributes":{"height":"312","width":"460","class":"media-image media-element file-media-large","data-delta":"1"},"fields":{}}]]The clinical trials team together: Dr Conleth Murphy Consultant Oncologist,  Aoife O’ Shea, Research Nurse Clinical Trials for Cancer drugs and Dr Brian Bird Consultant Oncologist, Bon Secours Hospital Cork. Picture:Gerard McCarthy  Cancer Week Ireland takes place between 14-19 September 2015. Find out more information www.cancerweek.ie

Dr Conleth Murphy is  a Consultant Medical Oncologist with Bon Secours Hospital in Cork. You can find out more about his work on his webpage .