In Canada, C17 Council (C17) represents the network of Canadian pediatric oncology professionals, promoting the collaboration necessary for advancements in the care of children with cancer and their families, through research. Since 2004, doctors, nurses, social workers, researchers and research associates have formed a united front to conduct more research in Canada.
Pediatric cancers are unique. Childhood cancers are often biologically distinct from adult cancers and children may handle cancer drugs quite differently from adults. Because of this, research must be targeted specifically for this population.
Cancer research is a broad topic. Studies may look at the biology of cancer; genetic factors that can make a person prone to develop a certain cancer; treatment with drugs, radiation, or surgery that target specific characteristics of a tumour; better ways to diagnose cancers; a better understanding of the prognosis or predicted outcome for specific cancers; the effectiveness or side effects of different treatments; ways to improve quality of life for children with cancer; understanding the psychological and social issues children and their families face; the incidence and prevalence of various cancers or; the coping mechanisms used by cancer survivors and their families. All of these are important areas of research that require funding.
Canadian pediatric oncology researchers are regarded as world-renowned experts in childhood cancer. In support of these research goals, C17 holds an annual research competition for investigators developing and conducting research in Canada. The awards from the 2013 C17 grant competition have just been announced. This year, the following research grants are being awarded with funding from our major partner, the Childhood Cancer Canada Foundation, and funding from the Kids with Cancer Society (Edmonton):
1) An Initiative to Maximize Progress in Adolescent Cancer Therapy (IMPACT) by Drs. Nancy Baxter and Paul Nathan at St. Michael’s and Sick Kids Hospitals in Toronto;
2) A Phase I and Enrichment Cohort Study of Low-Dose Metronomic Topotecan and Pazopanib in Pediatric Patients with Recurrent or Refractory Solid Tumours and CNS Tumours by Drs. Sylvain Baruchel and Arif Manji at Sick Kids Hospital in Toronto that will be conducted in 8 centres across Canada;
3) Determination of molecular signatures that allow differentiation between unilateral and bilateral Wilms’ tumours using genome‐wide arrays and whole‐exome sequencing by Drs. Rosanna Weksberg and Armando Lorenzo at Sick Kids Hospital in Toronto; and
4) Preclinical models of natural killer cell-based immunotherapy to cure refractory childhood acute lymphoblastic leukemia by Dr. Michel Duval at Hopital Ste Justine in Montreal.
Clinical trials are one form of research study and may have goals that range from studying a new chemotherapy drug or combination of drugs that may be better than current standard care, to determining a suitable dose of a drug used to treat adults for the pediatric population, to comparing the effectiveness and safety of different drugs or treatments.
There are several stages of research that occur before a new drug(s) is considered safe and effective for standard treatment. Before being tested in humans, pre-clinical or laboratory studies are done to establish how the drug works and to predict how it might work against cancer in humans. Following this, phase I, II and then III clinical trials are conducted in humans, using a greater number of participants at each stage as the drug becomes better understood. Phase I clinical trials are designed to understand what dose is needed and what effects (good and bad) a new drug has in humans. For new cancer drugs, volunteer cancer patients are recruited to determine the safety and potential effective dose of the drug. Phase II studies are conducted with a larger number of participants to determine short-term risks, start understanding what cancers are best treated and the effectiveness and the safest dosing regimen of the drug. Phase III clinical trials are done with the greatest number of human participants, and determine the drug’s effectiveness and long term safety.
The Children’s Oncology Group (COG) is an academic cooperative group formed in 2000 that unites more than 200 children’s hospitals, universities, and cancer centres in the United States, Canada, Australia and New Zealand. COG takes an active role in developing and conducting research studies, including clinical trials, to understand the causes of cancer, find more effective treatments, or improve the quality of life for children with cancer. Sixteen centres in Canada belong to COG.
C17 supports the 16 Canadian COG sites to ensure that clinical trials are available for children across Canada. The regulatory office is responsible for ensuring that clinical trials can be opened in Canada, that the drugs will be available and that the studies are conducted in Canada following Health Canada’s Division 5 regulations and are conducted according to the International Conference on Harmonization Guidelines for Good Clinical Practice (ICH-GCP). There are currently 72 COG phase I, II or III clinical trials open to enrollment and/or treating patients in Canada, and over 200 have opened in Canada since 2002. Approximately 30% of children will be enrolled on a clinical trial to treat their cancer in Canada (CPAC 2012) and over 50% will be enrolled in a study designed to understand the biology of their cancer (C17).
Finn was diagnosed with Rhabdomyosarcoma, a rare form of childhood cancer and treated at BC Children’s Hospital. Finnspiration, a charitable organization dedicated to childhood cancer research, was started to commemorate his short life.
The most important outcome of this research is that the five-year survival rate for childhood cancer has increased dramatically for several types of childhood cancer in the past few decades. Today, the overall survival rate after diagnosis with a childhood cancer is estimated at 82% (PHAC 2013). This is a significant improvement in survival, even compared to the late 1980’s when only 71% of children survived 5 years after their initial diagnosis (PHAC 2013). This still means that one in five children will not survive; meaning the need for better treatments continues.
Most of the funding C17 provides for research grants and supporting clinical trials in Canada is philanthropic. Childhood cancer charities raise funds from the general public, and thanks to these donations, cancer research is being funded at Canadian pediatric cancer centres. Both COG clinical trials and Canadian-initiated studies depend on public support. C17 has several funding partners, and continually strives to create and sustain new relationships with pediatric cancer-related fundraising agencies to help fund these large international academic cooperative group clinical trials and national multi-centre research projects.
C17, in funding pediatric oncology research, has increased the amount given to investigator-initiated research by ten-fold since 2004 when the first grant was awarded (CCRA 2012). From 2004-2013, C17 has awarded $4.15 million to fund 34 Canadian pediatric oncology studies, resulting in several new discoveries and publications. Overall, of all cancer research investment in Canada, pediatric oncology receives about 3% of funding (CCRA 2009).
Support of academic cooperative group clinical trials is equally as important for providing access to cutting edge treatments across Canada for children with cancer. Funding for this behind-the-scenes work is critical yet highly overlooked. Opening new trials, ensuring that the drugs will be available to Canadian patients and monitoring current ongoing trials is an essential component of care. The need for funding for pediatric oncology research is undeniable, and the need for reliable sources of funds to support research still continues to escalate.
(added as Hyperlinks throughout, full references for information only)
Childhood Cancer Canada Foundation: http://childhoodcancer.ca/
Kids with Cancer Society: http://www.kidswithcancer.ca/
COG 2013: http://www.childrensoncologygroup.org
CPAC 2012: Canadian Partnership Against Cancer (2012) The 2012 Cancer System Performance Report. Toronto: Canadian Partnership Against Cancer; C17 personal communication. http://www.partnershipagainstcancer.ca/wp-content/uploads/The-2012-Cancer-System-Performance-Report.pdf
CCRA 2012: Cancer Research Investment in Canada, 2005-2009: The Canadian Cancer Research Alliance’s Survey of Government and voluntary sector investment in cancer research in 2009. Canadian Cancer Research Alliance, 2012. http://www.ccra-acrc.ca/index.php/publications-en/investment-reports-annual
CCRA 2009: Investment in Research on Childhood and Adolescent Cancers, 2005-2007 Canadian Cancer Research Alliance, 2009. http://www.ccra-acrc.ca/index.php/publications-en/investment-reports-annual
CCS 2008: Canadian Cancer Statistics 2008. p.60-65 Special Topic: Childhood Cancer (Ages 0 to 14) Canadian Cancer Society/ National Cancer Institute of Canada. Toronto, Canada 2008. http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2008-EN.pdf
Melissa Johnson is a Research Coordinator with the C17 Council.