Despite years of treatment to prevent recurrence of skin cancer, Ian McDonell’s melanoma –a disease that killed his brother– spread to his brain and body. In 2017, he started an innovative immunotherapy treatment. A year later, all scans showed his cancer was gone.
Category: Clinical Trials
A melanoma diagnosis
Ian McDonell received immunotherapy in 2017, which erased any trace of his melanoma.
Several years ago, Ian McDonell, a Staff Sergeant with the Ottawa Police and father of three had just lost his father to cancer and his brother was dying of melanoma. Ian’s wife insisted he see his physician to check out a mole on his back. It turned out to be an ulcerated nodular malignant melanoma – an aggressive form of skin cancer.
Ian had surgery to remove it along with a lymph node from his left groin. Several weeks later, he had a lymph node removed from his armpit. Following these surgeries, he had no signs of cancer, but due to his family’s history, Ian was at high risk for relapse.
Sobering news
Ian was feeling well, but during a standard monitoring visit in June 2017, his CT and MRI scans showed sobering news. He had half a dozen tumours in his groin and abdomen, and three more tumours metastasized to his brain. Ian’s cancer was stage 4.
Given the severity of the findings, Dr. Michel Ong at The Ottawa Hospital suggested an aggressive approach – a recently approved immunotherapy treatment.
Unmasking cancer
Scientists have tried for decades to stimulate the immune system to attack cancer cells. But the game changer was the discovery that cancer cells make key molecules, called immune checkpoint proteins, that suppress immune cells and prevent them from attacking the cancer. These immune checkpoint proteins cloak the cancer from the immune system. New drugs called immune checkpoint inhibitors remove this cloak and allow immune cells called T-cells to naturally attack and destroy the cancer.
“The idea of chemotherapy is to kill off cancer directly,” said Dr. Ong. “There are potential side effects, because chemotherapy tries to poison the cancer.
“Immunotherapy does not directly affect the cancer itself. Instead, immunotherapy unmasks the cancer to your immune system by flipping some switches on T-cells, and the body’s own immune system does the rest.” – Dr. Michael Ong
Ian McDonell with his wife Michelle (left), and their daughters, hiking in the Adirondack Mountains in 2019.
CyberKnife treatment
Ian started on a combination of two immunotherapies given intravenously in the chemotherapy unit at The Ottawa Hospital’s Cancer Centre. He also underwent CyberKnife radiotherapy treatment where high doses of radiation were directed at his brain tumours. He bravely continued with the second round of immunotherapy, but was so sick, he had to be taken off the treatment and started on steroid medications to slow down the immune system. Ian felt better, but his immunotherapy was on hold.
Shrinking tumours
When Ian began to develop weakness in his face, he worried his cancer was getting worse. It wasn’t. Scans showed one tumour had shrunk from 25 to 10 mm, and another had shrunk from eight to four mm.
Dr. Ong recommended trying a single immunotherapy rather than two, and while the treatment made Ian very sick, it did the trick.
Two months later, the results of a PET scan, MRI, and a CT scan showed that he was tumour-free. All trace of his cancer was gone.
Oncologist Dr. Michael Ong said recent immunotherapies are hugely successful for treating melanoma.
Advances in immunotherapy
When Dr. Ong first met Ian in 2013, options for immunotherapy or targeted chemotherapy weren’t available. Thanks to incredible advances in immunotherapy, there is now hope.
“In the last few years, we’ve gone from having very poor options to having many effective options for melanoma. That’s because cancer therapy continues to develop at a very rapid pace,” said Dr. Ong. “We, at The Ottawa Hospital, are constantly participating in practice-changing clinical trials. The standard of care is constantly changing, as it should. We are continually trying to push the limits of cancer treatment.”
The Ottawa Hospital is a leader in cancer immunotherapy research, both in terms of developing new therapies and in offering experimental treatments to patients. Currently, there are approximately 70 active cancer immunotherapy clinical trials being conducted at the hospital involving nearly 700 patients. The hospital also hosts a national network for immunotherapy research and has developed a number of unique immunotherapies made directly of cells and viruses.
Hope for the future
Because of successful immunotherapy treatments, patients like Ian are now planning a future of living cancer-free.
“When the provincial exams for police services came up, I said, ‘I’m gonna write it, because I’ve got a bit of hope now.’” said Ian.
More importantly, in addition to his career plans, immunotherapy has allowed Ian to plan for the future with his family and a chance to watch his daughters grow up.
Hear more about oncologist Dr. Michael Ong’s work with immunotherapy.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Immunotherapy
Annette ringing the bell of hope following her final cancer treatment.
In July 2016, Annette Gibbons had a routine mammogram. She didn’t expect that day would become a pivotal moment in her life and lead to a breast cancer diagnosis. This unexpected news sent her on a journey of treatment, surgery, and uncertainty that required she place her complete trust in her medical team at The Ottawa Hospital for both her physical and emotional well-being.
Following the mammogram, Annette was told that she had dense tissue, which made it difficult to read the results. She wasn’t worried at all when she received a call to schedule another mammogram and ultrasound. But that all changed when her radiologist, Dr. Susan Peddle, gently told her that she thought it was cancer.
Annette, visibly emotional, recalls that fateful day. “Just like that, my life changed and I began my journey.”
The challenges of chemotherapy set in
Annette began chemotherapy treatment under the watchful eye of medical oncologist and scientist Dr. Mark Clemons. “He specializes in the type of cancer I had and is very active in clinical trials and research on leading-edge treatments and practices,” said Annette.
During these early days, she focused solely on getting through the wear and tear of chemotherapy. She recalls that “it’s not anything you can truly prepare for, or understand, until you’re the patient…There was the depressing hair loss, the constant nausea, the searing bone pain and the mind-numbing fatigue. Despite all that, I still tried to keep my spirits up with exercise, a support group, and lots of old movies.”
Research making a difference
During her treatment, Annette participated in several clinical trials led by Dr. Clemons through his innovative REthinking Clinical Trials (REaCT) program. This program engages patients and their loved ones in research every step of the way, from generating ideas to setting priorities to designing studies and sharing results.
She also put her complete trust in her medical team and was determined to stay positive. “I knew the stats for survivability were fairly good and I looked forward to resuming my ‘normal life’.”
Little did she know that the next steps – mastectomy and radiation – would be tougher than chemotherapy. The surgery itself and healing had gone well. She credits her amazing surgeon, Dr. Erin Cordeiro, for her compassion and skill.
“She held my hand as I lay in the operating room preparing for the operation to begin.” – Annette Gibbons
“In the end,” Annette says with a little smile on her face, “she gave me, dare I say, the nicest, straightest surgery scar I have ever seen on anyone.”
Sobering news
Annette wouldn’t have the full picture of her cancer prognosis until pathology results came back on her tumour. Several weeks later she received alarming results from Dr. Cordeiro. It was devastating news. “She told me that my tumour was much bigger than first thought. They had found cancer in many of the lymph nodes they removed. I was not expecting that, it was a huge blow.”
As she tried to absorb this news, she sat down with Dr. Clemons a few days later and was dealt another blow. “He gave it to me straight: because of the tumour size and number of lymph nodes affected, my risk of recurrence was high.”
Compassionate care during a dark time
That’s when Annette’s world came crumbling down. She recalls spiralling down into a dark place. “It was very hard to crawl out of this place. But my medical team saw the signs and knew how to help me. My dedicated radiation oncologist, Dr. Jean-Michel Caudrelier, spotted my despair and referred me to the psychosocial oncology program. With the amazing help of Dr. Mamta Gautam, I walked through my deepest fears and came out the other side.”
Annette completed her radiation treatment and then slowly reclaimed her life. But as all cancer patients know, the fear of recurrence can be a constant companion. “I don’t know if that will ever change. But I decided to make it my friend who reminds me to think, not about dying, but about the importance of living while I am alive,” said Annette.
She’s grateful to know the best medical professionals were right here in her hometown when she was diagnosed. As a self-proclaimed “frequent flyer at the hospital”, Annette is proud to say she’s reclaimed her life — including her return to work. “I am myself again, and life is strangely somehow better than it was before.”
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
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“Jillian was a true champion of The Ottawa Hospital. She not only shared her story to encourage and inspire others, but she reminded us that every day is a gift to be cherished. Jillian’s enthusiasm for life and positivity in the face of adversity was evident as she poured herself into her family and continued to move forward with hope. We are deeply saddened by her loss and offer our most heartfelt condolences to her husband, her three children, extended family, and friends. All of us at the Foundation remain profoundly moved by her determination, strength, and bravery.”
Tim Kluke, President and CEO of The Ottawa Hospital Foundation
The following story was written in early 2019, before Jillian passed away.
Jillian O’Connor stands in her living room laughing. A small boy hugs her leg, then takes off and disappears down the stairs to play with his older brother and sister. That was Declan. He turned four on February 1, 2019. The fact that his mother saw him blow out the candles on his birthday cake is extraordinary.
When Jillian was 18 weeks pregnant with Declan, she was diagnosed with metastatic breast cancer. She wasn’t expected to celebrate his second birthday. Two and a half years later, Jillian celebrated his fourth birthday with him—and still living life to its fullest.
Insatiable enthusiasm for life
The first thing that strikes you about Jillian is her smile. Next, it’s her insatiable enthusiasm for life. Then comes her contagious positivity. Hard not to think the latter alone is why she has made it so far against daunting odds. It may be anecdotal but Jillian definitely thinks, or rather knows, it’s the key.
“I am totally full of cancer, pretty much from my head to my toes,” said Jillian. “Every day I get is a blessing, ‘Oh, I woke up. Perfect!’ You just want to go at it as hard as you can, for as long as you can. Just being optimistic, I think helps. I really believe it helps.”
Jillian’s petite frame belies her light-up-the-room personality. She is gregarious with an enthusiasm that bubbles infectiously out of her. She talks about her cancer matter-of-factly. It is part of her life, but doesn’t rule her. She has other things to focus on—her precious family. The 35-year-old laughs and chats so easily about her life and her journey with cancer that it takes a second to realize how extraordinary her journey has been.
Diagnosis during pregnancy
In 2014, Jillian was still nursing Landon, her second child, when she went to see her physician about a blocked milk duct. It turned out to be breast cancer. Doctors wanted to do CT scans to determine the extent of her cancer, but Jillian couldn’t. She was 18 weeks pregnant. Without treatment, she was told she wouldn’t survive to give birth. It was unfathomable. She had a three-year-old daughter and a one-year-old son at home. It was a devastating diagnosis but Jillian met it head on with her own special brand of optimism and determination.
Terminating the pregnancy was not an option for Jillian and her husband David. Her oncologist, Dr. Mark Clemons, told her she didn’t have to. He could provide a chemotherapy cocktail that would keep her cancer at bay without harming her unborn child. Jillian had a mastectomy and a dozen chemo treatments tailored to her special case. On February 1, 2015, she gave birth to a healthy baby Declan.
“I received chemotherapy right up until I delivered him. He was healthy—a wonderful birth weight. He was absolutely perfect,” said Jillian.
Every day is a gift
After Declan was born, Jillian had scans to see where the cancer was. It had spread, and had metastasized to her bones, liver, and lymphatic system. That was when she was given less than two years.
“Basically, they said, ‘We can’t give you a long timeframe. It’s stage IV, so every day you wake up is going to be a gift,’” said Jillian, who stopped working as a nurse at the Queensway Carleton Hospital and became a patient there, receiving treatment at The Ottawa Hospital’s satellite cancer centre, the Irving Greenberg Family Cancer Centre. “Two years passed, then three, and then I passed four years this past summer. I’m hoping I’ll have another 40 plus years. I got a pretty doom and gloom diagnosis, but I continue to pull life off.”
Jillian has pulled life off in a big way. After all, when she brought Declan home from the hospital, she had three children under the age of three to look after. She poured herself into motherhood, enjoying every moment with them. Between weekly trips to the cancer centre for treatment, she was busy changing diapers, making meals, caring for, playing with, and loving her little ones.
Four-year-old Declan sits on his mom’s knee.
Celebrating milestones
Declan is back and clambers onto his mother’s knee—for about 30 seconds—before scrambling off onto the couch beside her. He is a typical four-year-old. His big sister Myla, who is seven, and brother Landon, who is five, appear, and the three play on the floor near their mom. Jillian chatters happily with them.
Jillian has celebrated all her children’s early-year milestones: learning to walk, talk, run, play, read, and become independent little people. Both Myla and Landon are now in school. Declan will be joining them in September. In mid-January, Jillian and David registered him for junior kindergarten. Nowadays, while the two older ones are in school, she and Declan have fun hanging out. They fill their days with activities that include volunteering at the school, as well as the more mundane household chores.
“I got a pretty doom and gloom diagnosis, but I continue to pull life off.”
Jillian is exuberant about life. She lives each day as it comes.
“She has, with all the help that modern radiotherapy and medical oncology can offer in Ottawa, in addition to her tremendous personality and drive, done amazingly well in a tragic situation for any young mom,” said Dr. Clemons. “At the same time, she has been involved in practice-changing research that is going to improve the care of patients—she continues to give.”
ReACT program
Jillian has participated in several clinical trials led by Dr. Clemons through his innovative REthinking Clinical Trials (REaCT) program. This program engages patients and their loved ones in research every step of the way, from generating ideas to setting priorities to designing studies and sharing results. The results are helping people with cancer not only in Ottawa, but around the world.
Over the past four years, Jillian has participated in clinical cancer trials with new therapies that have kept her cancer in check. When it spread to her brain a couple of years ago, she had whole-brain and CyberKnife radiation. Then she was put on new medication that can cross the blood brain barrier, which her regular chemotherapy couldn’t do. The medication halted new tumour growths in her brain. Her cancer is not getting better, but it’s not getting worse, either.
“I’m happy to stay status quo, because there is nothing I want to do that I can’t do right now,” said Jillian.“Status quo—I’m good with that. I feel great. I don’t have aches or pains or anything. I don’t have time to think about how I feel.”
An inspiration
Jillian sits on the floor laughing and playing with her three children. She looks at the little doll her daughter Myla shows her, and hands a ball to Landon. “I really think it’s the kids. They have so much to do with it, because they are so great. They are so fun. They keep me really busy and that’s half the fun. By the time I go to bed at night, I don’t think about cancer. I don’t think about tests coming up. I don’t think about that stuff because I’m too tired. So I think that is helpful.”
Dr. Clemons agrees.
“She is a gem, and her attitude of living life with true meaning is a humbling lesson for all of us,” said Dr. Clemons. “Too many people in society spend too much time moaning about the trivial, as well as things they can’t do anything about. Life is for living, and Jillian encourages people to do that—live!”
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
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Three years ago, Sandy Patenaude was given the devastating news that she had stage 4 colorectal cancer. It had spread to her liver and lungs, and was inoperable. Sandy’s oncologist asked if she would like to go on a clinical trial, testing a new cancer stem cell inhibitor drug along with her chemotherapy.
“Cancer stem cell inhibitors, why not?” said Sandy who agreed to be part of the trial.
Dr. Derek Jonker, Medical Oncologist at The Ottawa Hospital, is leading the international trial for people with colorectal cancer, with the experimental drug napabucasin. He explained that cancer stem cells are the rare, immature cells in a tumour, which are often resistant to chemotherapy. They can give rise to the more mature cancer cells that make up the bulk of a tumour. Cancer stem cells are not the same as the normal stem cells that live in many healthy adult tissues and help with healing and repair.
“With chemotherapy, we can deliver treatment that can shrink the vast part of the cancer,” said Dr. Jonker, who is also an associate professor at the University of Ottawa. “Often the bulk of the tumour disappears, but what’s left is a small tumour with lots of these chemo-resistant cancer stem cells, which are able to spread and seed other places in the body. Often, we keep giving the same chemotherapy and find the tumour has regrown, but it’s not the same tumour it was when we started.”
Dr. Derek Jonker led a clinical trial for colorectal cancer with a cancer stem cell inhibiting drug that has helped Sandy Patenaude.
Dr. Jonker is switching up the treatment to target the cancer stem cells that aren’t affected by standard chemo. In a previous randomized clinical trial he led , patients either received a placebo or napabucasin to test its effectiveness at inhibiting, or preventing, the growth of the cancer stem cells. The trial was carried out at 40 sites in Canada, Australia, New Zealand, and Japan. The 562 patients enrolled had advanced colorectal cancer and chemotherapy no longer worked for them.
Looking at the results of the trial, Dr. Jonker said they didn’t see much benefit in the group overall. “But when we looked at patients who had a tumour that had characteristics of a high cancer stem cell (phospho-STAT3) over expression there was very significant improvement in their survival.”
Dr. Jonker presented his findings in October 2016 at the European Society for Medical Oncology, showing that where the cancer stem cell inhibitor didn’t work in all patients, there was an improvement in the survival of the 22 percent of patients who had tumours with high phospho-STAT3. He said it’s “proof of principle that stem cells are an important target for cancer patients.” Napabucasin is now being combined in the current trial with chemotherapy to attack the cancer on two fronts at the same time.
“We know with results of the clinical trial that the majority of patients did not respond to it, but we have two patients here in Ottawa who have responded and definitely developed benefit from the clinical agent,” said medical oncologist Dr. Christine Cripps.
I thought I’d be part of the trial, because I thought well, it’s new.”
Sandy is one of those patients who benefited. Her tumours shrank, and the surgeons were able to remove spots in her liver and the primary tumour in her rectum. Dr. Cripps said she believes that part of the success in keeping Sandy’s cancer at bay is the napabucasin she is taking as part of the clinical trial.
“A stem cell inhibitor works differently than traditional chemotherapy, in that it prevents new disease from appearing,” said Saara Ali, research coordinator for clinical trials in gastrointestinal cancers. “The hope is that the pill [napabucasin] will prevent new disease from showing. And in Sandy’s case there hasn’t been new disease since her treatment. Everything was there before, so it may be doing its job.”
Next steps: Dr. Jonker hopes to start another clinical trial with the cancer stem cell inhibitor that will be used specifically for patients who have lots of phospho-STAT3 in their tumour. These patients could be identified for the clinical trial with molecular testing, using The Ottawa Hospital’s Molecular Oncology Diagnostics lab. This would target the patients presumed to be the most likely to benefit most from the drug.
“We would repeat our study, randomize those patients with napabucasin and a placebo, and if we can prove that napabucasin is effective for them, then it would be an option for patients who have run out of all other treatment options,” said Dr. Jonker.
Dr. Cripps said that Sandy is a candidate for this next trial, and her tumours will be analyzed by the molecular lab to see whether she has high phospho-STAT3 cancer stem cell expression. Regardless, Sandy will continue using the trial drug as long as it is working for her. And it is working. The mother of three adult children said she’s busy doing a million things, playing euchre, the ukulele, skiing, hiking, biking, and enjoying life.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Stem Cell, Stem Cell
A strange thing happened before John Chafe started working in Kenora in 1993. His eyes crossed. He didn’t know it at the time, but it was the first sign of a debilitating disease that would change the course of his life forever.
His family doctor told him he had the flu and prescribed antibiotics. But after a week, when his eyes remained crossed, he bought an eye patch and drove five hours from Thunder Bay to fill the temporary posting at a bank in Kenora. A week later, his eyes straightened and returned to normal. But then other symptoms started appearing, he was losing his balance and couldn’t walk in a straight line.
“I then started have difficulties walking straight. I completely failed a simple balance beam experiment at the Ontario Science Centre,” said John. “I mentioned these symptoms to a friend, who mentioned them to a friend, who fortunately happened to be Dr. Heather MacLean, a neurologist at The Ottawa Hospital.”
To Dr. MacLean, John’s symptoms sounded like multiple sclerosis (MS), an autoimmune disease where the body’s immune system attacks its own central nervous system, brain, and spinal cord. John needed an MRI and spinal tap to properly diagnose his symptoms. The results were analyzed by Dr. Mark Freedman, Director, Multiple Sclerosis Research Unit, Neurology, who confirmed his diagnosis. John had an aggressive form of multiple sclerosis.
John Chafe skiing at Blackcomb just after diagnosis in 1994.
A different life after MS diagnosis
Incredibly interested in rock climbing and skiing, John didn’t give up his active lifestyle after his diagnosis, despite the fact that he was experiencing MS exacerbations – an attack that causes new MS symptoms, or worsens old symptoms – every eight months. He returned to Thunder Bay and opened a rock-climbing gym, thinking, “MS is not going to affect me.”
But it did. It completely sidetracked his life.
After suffering another MS exacerbation, John realized it was becoming more difficult for him to get out to see clients for financial planning sessions.
“I was stumbling along and thought, ‘How can I ask them to trust me with their money?’ My MS was getting worse and worse,” said John. “I needed a desk job, so I went into computer programming.”
His treatments weren’t helping. He needed a miracle. So he moved to Ottawa to be close to The Ottawa Hospital where we could receive the very best treatment.
Leading-edge clinical trial in Ottawa
Dr. Harold Atkins and Dr. Mark Freedman conducted an innovative stem cell treatment for MS that has halted the disease in over 50 patients
One day, John heard Dr. Freedman on the radio talking about an innovative stem cell transplant study that he described as akin to pressing reboot on the immune system. Dr. Freedman was working with hematologist and scientist Dr. Harold Atkins, a professor of medicine at University of Ottawa, to see if a groundbreaking treatment would halt an aggressive form of MS.
When John met with Dr. Freedman, he told him he was interested in participating in this new study. Dr. Freedman agreed he might be a good candidate because he was young, generally healthy, and his symptoms were quickly getting worse.
“If you saw his trajectory, how fast he was becoming disabled going into the transplant. He should’ve been completely wheelchair bound, or worse, within two to three years,” said Dr Freedman.
John was willing to try an experimental treatment that had the potential to change that trajectory. “MS robbed me of my ability to climb, ski, and walk. I said, ‘I’m going to take a chance.’”
“John was very enthusiastic. That was a very important facet of his recovery,” said Dr. Freedman. “John has never been a quitter. He’s a stubborn guy. His goal was someday to end up on the ski hill again.”
Preparing for treatment
For almost a year, John underwent the exhaustive testing by Dr. Atkins and Marjorie Bowman, the bone marrow transplant nurse, to see if he was physically and mentally suitable for the clinical trial. They wanted to ensure he was prepared to go through the intensive trial treatment and accept the risks, which included death.
“This is fundamentally different than every other treatment,” said Dr. Atkins. “What we’re doing is getting rid of the old immune system and creating a new one that behaves more appropriately.”
“MS robbed me of my ability to climb, ski, and walk. I said ‘I’m going to take a chance.’”
— John Chafe
Replacing his immune system was a rigorous procedure. John would undergo intensive chemotherapy to help eliminate his immune system. In November 2001, he was given a dose of chemotherapy to stimulate and move his stem cells into his blood stream. These stem cells were then collected and cleansed of any traces of MS.
A month later, John was given huge doses of chemo in an attempt to destroy his immune system and started getting weaker and weaker. On December 13, 2001, after the chemo had wiped out his immune system, John had the cleansed stem cells re-infused by an intravenous drip.
“I didn’t feel better immediately,” said John, who was only the second patient in the world to undergo a stem-cell transplant of this kind for multiple sclerosis. “But I started getting stronger in the days following, so much so that Dr. Atkins released me on Christmas Eve.” He spent three months living with his parents while he recuperated. By spring, he was ready to move back into his own home again.
John Chafe rock climbing outside Thunder Bay in 1994 after his MS diagnosis.
Groundbreaking research in Ottawa
Dr. Freedman said that he and Dr. Atkins had anticipated that by rebooting MS patients’ immune systems, they fully expected the disease was going to restart.
“At that time, genetic researchers said, ‘If people are genetically prone to develop MS, there’s nothing you can do to stop it. They’re going to keep redeveloping MS,’” said Dr. Freedman. “If that was true, it would be a matter of time before people started having active disease again.”
Dr. Freedman explained that nobody knows what causes MS. He and Dr. Harold Atkins hoped that through the trial they could reboot a patient’s immune system and monitor it with all the latest immune system monitoring and imaging technology, and then watch as the disease restarted and discover the secret of what triggers MS. However, none of the 24 patients in the trial developed new symptoms of MS again.
“In that respect, the trial was a failure. It halted their disease and in some cases their disabilities went away too,” said Dr. Freedman. “We’ve followed these patients for 18 years, and nobody’s developed anything.”
“Those patients at the beginning, like John, are probably the bravest because there were more unknowns about the treatment,” said Dr. Atkins. “Each patient we’ve treated over the years has taught us something, but we learned more from the early patients at that time.”
A second chance at life
Prior to his stem cell transplant, John had a final exacerbation, which crippled him. After the transplant, his MS did not return. John remained healthy, but the damage caused by the disease wasn’t reversed and he still walks using a cane and walker.
“You almost wonder what would’ve happened to John if he’d had the transplant five years earlier,” said Dr. Freedman. “Today, when we see a patient that has the same profile as John’s, we offer them the stem cell treatment. We’re not waiting years. We’ve become more savvy, able to pick out individuals who warrant this aggressive approach.”
About 77,000 Canadians live with MS. However, only five percent of patients with MS warrant a stem cell transplant. They are generally young and have the most aggressive and debilitating forms of the disease.
After his transplant, nothing was going to hold John back. Three years later, he met Patricia, and they married in 2005. Five years later, his beautiful daughter Mary was born.
John Chafe with his daughter Mary and wife Patricia in 2013.
“I recall that as Mary started moving more, she motivated me to get more active again. She became my personal trainer,” said John. “I joined the Canadian Association of Disabled Skiing. I was terrible at first because I didn’t have the strength. But I’m stubborn and refused to give up, and today I can ski independently for hours – albeit with outriggers for balance.”
“I saw John a few years ago. The problem with this business is patients get better and so I don’t see them much afterwards,” said Dr. Atkins. “I do remember him showing me pictures of his young baby, and pictures of him on the ski slope. It is exciting to hear that people can have these treatments and go skiing again.”
John Chafe, Mary and Patricia skiing at Edelweiss in 2016.
“I’m not a bank president, but my life is better than incredible. I ski, I dance with my wife, and have an nine-year-old daughter. Because Dr. Freedman and Dr. Atkins were persistent about finding the answers to stop a disease like MS, they saved my life.”
— John Chafe
The following video focuses on Jennifer Molson who was also one of the early patients on the MS clinical trial, and includes interviews with Drs. Atkins and Freedman.
The Ottawa Hospital, in partnership with BC Cancer, is launching a clinical trial using the first made-in-Canada CAR T-cell therapy.
Designing clinical trials is something The Ottawa Hospital does very well. At the moment, 825 clinical trials are underway — 200 of which are cancer trials.
For patients in the region this can mean better access to some of the most cutting-edge treatments available. For the hospital, it means better patient care, and an environment that attracts some of brightest research minds in the world to come here to collaborate, to develop better treatments, and to get closer to answering some of health care’s biggest questions.
World-class research expertise
“A lot of the clinical trial expertise is here,” said Dr. Manoj Lalu, associate scientist, and anesthesiologist at The Ottawa Hospital. “It’s well recognized that Ottawa is a world leader in clinical trials and innovative trial designs. A lot of the guidelines produced internationally around trial design and reporting originate from The Ottawa Hospital.”
The Ottawa Hospital has put all this expertise to work in designing and launching a made-in-Canada approach for CAR T-cell clinical trials.
Drs. Manoj Lalu and Dean Fergusson developed a protocol for the upcoming CAR T-cell clinical trial.
They have created a rigorous program, assessing current information about the therapy, looking at data and chart reviews from different health science centres, investigating the costs, and reviewing production. The team also interviewed patients to better understand what the barriers might be for them to enter a clinical trial.
“We’ve found that researchers dramatically overestimate the potential number of patients there are and the factors affecting them,” said Dr. Fergusson, Director of The Ottawa Hospital’s Clinical Epidemiology Program, and President of the international Society for Clinical Trials. “They all assume patients want to be part of a new therapy. But we’ve shown that is not the case.”
Involving patients in the process
Dr. Fergusson said there are many things that affect recruitment of patients to a clinical trial such as the distance they must travel to participate, or their family or caregiver situation. So, when Drs. Fergusson and Lalu were designing the trial, they assembled a team of people who were involved in both the creation and delivery of the therapy, such as the scientists and clinicians, while also including the patients, who would ultimately receive the therapy, as members of the team.
“Patient input has been essential to designing the clinical trial from the very beginning,” said Dr. Fergusson. “A patient panel helped create the information and consent forms that help patients understand the trial. So, when the actual patient who would be eligible for the trial reads this, there have been others, not just researchers, who have looked at this.”
“Patient input has been essential to designing the clinical trial from the very beginning.” – Dr. Dean Fergusson
Ottawa broadcaster ‘Stuntman’ Stu Schwartz, who was treated for leukemia at The Ottawa Hospital, is one of the patient partners involved. Stefany Dupont is the only patient involved who has received CAR T-cell therapy. Patient partners such as Stu and Stefany, not only helped determine the outcomes researchers will be looking at in the CAR T-cell therapy trial, but also gave valuable feedback on the design of the trial. They offered a patient’s perspective on how the information was worded and on some of the processes that will help patients understand the study.
“They tell us if they understand, or if this doesn’t make sense, or ask, ‘Can you clarify this?’,” said Dr. Lalu. “It’s other patients, with the experience of having had a blood cancer, that really informs the whole process for the patients who will be enrolled.”
Building from the ground up
As with most trials designed at The Ottawa Hospital, patient care is embedded in it, with its design mimicking practice in the clinic and standard referral patterns. What makes The Ottawa Hospital exceptional is the way clinical trials are built from the ground up; including the right people at the right time, and most of all giving patients the opportunity to weigh in on everything from communication and recruitment to delivery options.
Drs. Fergusson and Lalu are also applying these concepts of building clinical trials to other health-care challenges, including post-surgical heart problems, stroke, and neonatal lung disease.
Organizations such as BioCanRx, the Canada Foundation for Innovation, and the Government of Ontario have supported The Ottawa Hospital’s CAR-T research and the Biotherapeutics Manufacturing Centre, but additional funding is essential to make this program a reality.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
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Published: February 2019 For an update on Stefany’s story, click here to see what Stefany is doing now.
A game-changing cancer treatment
Stefany Dupont’s leukemia symptoms have disappeared. Her cancer was put into complete remission by a revolutionary new treatment called CAR T-cell therapy. This emerging form of immunotherapy has the potential to transform how cancer patients are treated in Canada and around the world.
Daunting odds
Stefany was first diagnosed with acute lymphoblastic leukemia (ALL) when she was just 13 years old. Children with leukemia are given a strict chemotherapy protocol that effectively cures more than 90 percent of patients. Unfortunately, this was not the case with Stefany.
She was in remission for five years but, in 2010, her leukemia came back. By then she was 18, an adult, and began receiving treatment at The Ottawa Hospital. In 2015, she received chemotherapy followed by a hematopoietic bone marrow stem cell transplant. She was on the mend until a year and a half later when she had another relapse. Adults with leukemia who relapse after a transplant have less than a 10 percent chance of survival.
“Stefany was unlucky enough to relapse within two years of her transplant,” said Dr. Jill Fulcher, Stefany’s doctor, who specializes in malignant hematology and is a clinician-investigator at The Ottawa Hospital. “But her leukemia came back with a blast and she was very sick. Palliative management was all we had to offer patients with ALL who relapsed so soon post-transplant.”
Hematologist Dr. Jill Fulcher confirms that Stefany Dupont is in remission over one year after her CAR T-cell therapy. Previously, Stefany was given a 10 to 20 percent chance of survival, pre-CAR T-cell treatment.
New hope
Dr. Fulcher and her colleague Dr. Natasha Kekre, a hematologist and associate scientist at The Ottawa Hospital, knew that clinical trials in the United States, using CAR T-cell immunotherapy, showed promising results in children and adolescents with leukemia and blood cancers, putting many into long-lasting remission.
For patients like Stefany who are extremely sick and out of options, CAR T-cell therapy offers new hope. That’s why Dr. Kekre is leading the charge to bring CAR T-cell immunotherapy to The Ottawa Hospital.
Giving Canadians access to leading-edge treatments
As one of Canada’s leading research and treatment centres, equipped with world-leading expertise, The Ottawa Hospital is ideally positioned to help bring this innovative treatment to Canada, and to Canadian patients. The Ottawa Hospital is one of the first hospitals in Canada to participate in internationally-led CAR-T trials, and the Hospital is now playing a lead role in a made-in-Canada CAR-T research program.
“Our goal is to build Canadian expertise and capacity for innovation in the promising CAR-T field through both laboratory research and clinical trials,” said Dr. Kekre, who is working with a team across the country. “This could lead to better CAR-T therapies that work for more kinds of cancer, as well as innovative approaches for providing CAR-T therapy in the Canadian system.”
From translational research to trial design to manufacturing, The Ottawa Hospital, alongside BC Cancer, is ideally positioned to shepherd this complex trial of an experimental therapy to our patients.
“It’s well recognized that Ottawa is a world leader in clinical trials and innovative trial designs,” said Dr. Manoj Lalu, associate scientist and anesthesiologist at The Ottawa Hospital who is part of the CAR-T team. “Many of the guidelines produced internationally around trial design and reporting originate from The Ottawa Hospital.”
Dr. Natasha Kekre is working with other hospitals across Canada to develop a “made-in-Canada” approach for CAR-T cancer therapy.
About CAR-T Therapy
CAR T-cell therapy harnesses the power of a patient’s own immune cells, known as T-cells, to treat their cancer. T-cells play a critical role in the immune system by killing abnormal cells, such as cells infected by germs or cancer cells. In some cancers, like acute lymphoblastic leukemia (ALL), cancerous cells become invisible to the T-cells that are meant to kill them. In CAR-T therapy the T-cells are collected and reprogrammed in the lab to recognize and destroy the cancerous cells.
“This type of immunotherapy research is groundbreaking,” said Dr. Kekre, “but it is important to remember that CAR-T therapy is still very new and there can be serious side effects. We need more research to learn about this therapy and make it work for even more people.”
A well-deserved reprieve
CAR-T treatment was not yet available in Canada when Stefany needed it. So, her only option at the time was to try to join a CAR-T clinical trial at the Children’s Hospital of Philadelphia. Since the hospital’s clinical trial was still accepting patients with ALL up to 25 years of age, Stefany was eligible to participate.
Three months following Stefany’s CAR T-cell infusion in Philadelphia, she had a bone marrow biopsy that showed she was in remission — her treatment was working.
Three months after that, Stefany went on a well-deserved trip.
“After the sixth month waiting time, I went to Australia,” said Stefany. She visited Sydney, Brisbane, Melbourne, went scuba diving at the Great Barrier Reef, and hang-gliding over the shores of Byron Bay. It was a wonderful break after the intensive treatment.
“It is a really good sign that Stefany has remained in remission for over 2 years after having CAR T-cell therapy,” said Dr. Fulcher. “Without this therapy, she definitely would not be with us today.”
Unique biotherapeutics facility
CAR-T therapy needs to be individually manufactured for each patient, using a patient’s own cells combined with large amounts of highly pure virus to deliver the CAR gene. The Ottawa Hospital’s Biotherapeutics Manufacturing Centre is ideally positioned to manufacture this kind of therapy because it has the most advanced system to make the clinical grade virus needed to create CAR T-cells for clinical trials. This is the only facility in Canada that has produced this kind of virus for clinical trials.
“With our unique manufacturing facility, our expertise in clinical trials and our world-class cancer and hematology programs, The Ottawa Hospital is ideally positioned to lead the way in developing the next generation of CAR-T therapy,” said Dr. Rebecca Auer, Director of Cancer Research at The Ottawa Hospital.
“The Ottawa Hospital is ideally positioned to lead the way in developing the next generation of CAR-T therapy.” – Dr. Rebecca Auer
“Patients with ALL, lymphoma, and other blood cancers could benefit from this experimental treatment,” said Dr. Kekre. The hope is that one day CAR T-cell therapy may also be a treatment for a variety of cancers, such as breast and colorectal cancer. It is through clinical trials conducted at The Ottawa Hospital that innovative cancer treatments will be discovered and will continue to offer hope to patients like Stephany.
Organizations such as BioCanRx, the Canada Foundation for Innovation, and the Government of Ontario have supported The Ottawa Hospital’s CAR-T research and the Biotherapeutics Manufacturing Centre, but additional funding is essential to make this program a reality.
January 2023 update:
It’s been a rollercoaster of a ride for Stefany in the last year. Since December 2021, she’s struggled with lung infections, which she developed as a result of being immunocompromised and because, since 2017, she has important scarring on her lung. Such scars are the result of what happened to her while she was on a months-long waiting list to get to the CAR-T program in Philadelphia. “My [leukemic] condition got worse, I contracted pneumonia with no functional immune system, and despite overcoming it, I was left with considerable scarring on my lung, putting it at risk for various infections.”
It’s for this reason, Stefany is grateful to hear patients in a Canadian-first clinical trial at our hospital are getting access to CAR T-cell therapy right here in Ottawa. “Thankfully, the participants don’t have to go through what I’ve gone through with pneumonia and the waiting,” says Stefany.
She is slowly improving and is hoping to become a schoolteacher in the future. Stefany’s currently tutoring students and has given presentations on social justice topics to secondary school students. She’s also been enjoying some travel recently, including a nature expedition that supports youth affected by cancer and is looking forward to trips to Mexico and Costa Rica in 2023.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Biotherapeutics, Cancer, Cancer, Cancer, Cancer, Cancer, Immunotherapy, World-Leading Research
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