Photo: Dr. Ronik Kanani, Chief of Paediatrics and Dr. Joanne Yu, Oncologist and Cancer Clinical Trials Lead
Currently, at North York General Hospital (NYGH) there are over 30 ongoing clinical trials which involve multiple physicians and staff members from different departments across the hospital. We spoke with two of our physicians who are on the front lines, Dr. Ronik Kanani (Chief of Paediatrics) and Dr. Joanne Yu (Oncologist, Cancer Clinical Trials Lead) and asked them about their involvement with clinical trials at NYGH and their hopes for the future.
What made you get into clinical trials. What brought you to this path in your life?
Dr. Kanani: The reason we started embarking on paediatric research was that we wanted to join several other institutions that were coming together to develop an inpatient paediatric research network in the GTA. The goal of the network is to study common paediatric topics and childhood illnesses. At NYGH we have a busy paediatric inpatient ward where children with common illnesses are hospitalized. This is different to Sick Kids where they deal with more rare, complex cases. My goal was to enable NYGH to be an important part of the development of this network.
Dr. Yu: I've been involved in research for some time. Before I became a medical oncologist, I completed a PhD in cancer research, in the area of angiogenesis, looking at how tumors recruit blood vessels. At that time, the field was just starting, and they were developing the first anti-angiogenic drugs, so it was an exciting time. After my PhD I did a post-doctoral fellowship at McMaster in thrombosis and cancer. During my post-doc I had an epiphany and decided I was going to apply for medical school. I wanted to have more of an impact day-to-day on patients, I wanted to do more. As an oncologist, I am always looking for the best treatment options for my patients, so it was just natural that I would get involved with clinical trials here.
What do you value about conducting research and the clinical trials in your fields. What's the biggest factor for you?
Dr. Kanani: I think that the value for us is to try to improve and standardize the care of hospitalized children to provide the best possible care and minimize their length of stay.
Dr. Yu: Oncology is a field that changes very rapidly, there is a lot of ongoing research, but the reality is that unfortunately most patients with advanced cancer still have very poor survival outcomes. I think that we have a lot of work to do to improve survival rates, find new treatments and make life better for people with cancer, not only advanced cancer but also early stage. We need to push the envelope and increase the chance of a cure.
Could you tell us a bit about the clinical trials you've been involved with here at NYGH?
Dr. Kanani: The most recent study that we were involved with was looking at bronchiolitis and whether we were over monitoring babies admitted with a common respiratory infection. Over monitoring can lead to an increased length of stay and parental anxiety. Our goal is always to minimize the patient stay and get them back home while still providing the safest possible care. It was a randomized trial looking at what is the best monitoring strategy for patients when they're hospitalized. It was a multi-centred trial across five sites in which we recruited around 220 patients. We finished our final recruitment as of April. We don't have the results yet, hopefully in the coming months we will finish the data analysis which we will then be able to present and publish.
Dr. Yu: KEYNOTE-355 was a clinical trial for metastatic triple negative breast cancer. Triple negative breast cancer is unfortunately a difficult cancer to treat, with a poorer prognosis compared to other types of breast cancer. This trial looked at immunotherapy and was one of the first trials looking at adding immune checkpoint inhibitors to first line chemotherapy for breast cancer. I believe the only two sites involved in Ontario were Princess Margaret and NYGH. It was so great to be able to offer this trial to our patients here, at the hospital which is close to home. While many patients wish to access clinical trials, it is often hard for them to travel downtown or to other centres. Having the trial here at NYGH also enabled patients to continue care with the oncologists with whom they have a long-term relationship. When we are able to keep people here, they are often happier as the care they receive is so much more personal. That was a great trial for us.
The other trial I want to mention was called MonarchE, which aimed to improve survival in women with early stage breast cancer who are at high risk of relapse. The trial studied whether adding a medication, which is effective for stage IV breast cancer, to the standard of care could reduce their risk of breast cancer recurrence. The trial closed early because it recruited so quickly, we were able to meet our target number of patients. Hopefully we will see positive results from this trial.
To date, regarding your clinical trials research in general what do you feel is your biggest accomplishment or your team's biggest accomplishment?
Dr. Kanani: I think that as chief of the department one of my goals was to see if it was feasible to conduct research in our department. We have completed our first collaborative study on bronchiolitis with the network, which is a huge accomplishment. It will be great for us to continue to be part of the development of a Canada wide network and to encourage more of our staff to participate in research.
Dr. Yu: The clinical trials team has really grown under our manager Maria Schlag’s direction, and our oncologists and clinical trials staff are very engaged. When I started at this hospital, we had one research coordinator. Now, when we have our Clinical Trial Committee meetings, we fill up a big table, and half of the table is the trials staff, and the other half are the doctors, pharmacists and nurses. We have so many more trials open, providing more options for our patients close to home.
How important is it to have your own department team or even inter-departmental support during these clinical trials?
Dr. Kanani: You definitely need the support of the entire department. You need to make sure that the physicians, nurses and allied health staff that are working on the floor understand the importance of the research, and why we are conducting the study. They are the frontline individuals working with patients. If the patient asks you a question about a research study, the frontline individuals need to be supportive and well informed to answer those questions. You also need the support of the Office of Research and Innovation, research coordinators and the Research Ethics Board. For Paediatric research, it is also important for us to be partnering with The Hospital for Sick Children.
Dr. Yu: It's essential. Most oncologists would welcome the opportunity to be involved in clinical trials, but for some centres it’s just not feasible because of the lack of support. Here, we rely heavily on the trials team, including Maria Schlag and our research coordinators to provide that operational and regulatory infrastructure. We couldn't do it without them. It's been great to also have the support of Michael Wood and the Research and Innovation department, as we grow our clinical trials program.
And final question where would you like to see the future of clinical trials go here at North York General?
Dr. Kanani: I believe that in our department, we are still very early in our clinical trial journey. An idea for the future would be to have more dedicated resources for paediatric research. Eventually, we would like to have a chair of research for our Maternal Newborn & Pediatrics program. Hopefully we can participate in more research studies focused on common Paediatric topics that will help our patients.
Dr. Yu: I would like to see our program continue to grow, but also hang on to the things that are great about clinical trials at NYGH, including the ability to open trials quickly and select trials carefully so that we are always meeting the needs of our patients.