Molecular testing helps patients get into clinical trials

Patient Cathy Chapman, and her sister Enid Holohan, discuss her clinical trial treatment with Clinical Research Coordinator Saara Ali.

Chemotherapy wasn’t working for Cathy Chapman. However, a genetic test identified a specific gene mutation that meant she was eligible to participate in a new cancer drug trial.

Chapman was diagnosed with colon cancer in February 2016. She lives in Deep River, so began receiving chemotherapy at The Ottawa Hospital’s satellite office in Pembroke. Unfortunately, the chemotherapy did nothing but give her side effects. The cancer continued growing, so her treatment was stopped in April. However, a gene mutation was identified when Chapman’s tumour was analyzed by The Ottawa Hospital’s Molecular Oncology Diagnostics Laboratory that offered another treatment option. Only about five percent of colon cancers have this mutation. Dr. Bryan Lo, director of the molecular lab, flagged the mutation to Chapman’s oncologist Dr. Rachel Goodwin.

Dr. Goodwin was aware of an upcoming trial opening at The Ottawa Hospital Cancer Centre for this specific sub-type of colon cancer, which was designed to block this mutation and slow down the cancer growth. 

Oncologist Rachel Goodwin identified a clinical trial that would treat Cathy Chapman’s rare type of colon cancer.

“Dr. Goodwin told me she sent my biopsy to the new lab at the hospital and that was where they found the mutation,” said Chapman. “She knew there was a clinical trial for a drug that was having great success with that mutation, and thought I could be eligible for it.”

In 2016, The Ottawa Hospital’s Molecular Oncology Diagnostics Lab began analyzing the genetic makeup of colon cancer patients’ tumours using its new Next Generation Sequencer (purchased entirely with donor support).  By identifying the genetic makeup of each individual’s tumour, oncologists can tailor the cancer treatment to be more effective for them. 

Dr. Goodwin said The Ottawa Hospital’s Next Generation Sequencer is helping her identify gene mutations that might mean her colon cancer patients are eligible for new drug trials or even for a drug approved for other cancers.

“When we get the genetic sequencing report back for a colon cancer patient, we might see that the patient has a gene mutation that could make their cancer susceptible to a drug we never would have considered, like a kidney cancer drug, or to a new drug.” This was the case with 60-year-old Chapman.

Cathy Chapman visits the Cancer Centre for weekly treatments as part of a clinical trial.

“Because there is currently no drug being used as a standard of care for her type of colon cancer, Cathy could only get the drug on a trial,” said Dr. Goodwin.  “That is why we take the efforts to open new trials here with new drugs to provide patients like Cathy with up and coming treatments.”

“Cathy wasn’t doing so well on her other treatments, so the timing was perfect that this trial was coming up,” said Saara Ali, Clinical Research Coordinator. “Thanks to the molecular testing done by Dr. Lo and the networking between him, Dr. Goodwin, and myself, we were able to put forward this new patient for this clinical trial as a treatment option when it was noted that her cancer was growing despite the standard of care chemotherapy.”

“I was randomized into the trial, which gives me multiple drugs,” said Chapman who drives to the Cancer Centre at the General Campus once a week for treatment. “Within several doses, the CT scan showed a reduction in my cancer. The tumour shrank 40 percent after me being on the clinical trial for seven weeks. In December, a CT scan showed it had shrunk 63 percent.”

“She’s at full dose and doing well on it,” said Ali. “As long as she is benefitting, the drugs will be provided for her through the clinical trial.”

Cathy was the first patient in Canada on this international trial. At The Ottawa Hospital, the Molecular Oncology Diagnostics Lab is prepared to identify mutations in the genetic profile of other patients with this rare mutation, so they might also participate in this trial and benefit from trying innovative and untested therapies. 

 Update: October 2018 - Now, the tumour is so small it is difficult to see on the CT scan.

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