Made-in-Ottawa platinum seeds are improving an already incredibly powerful and precise radiosurgery treatment system for tumours in the head, neck, and organs, such as lungs and liver.
Category: Cancer
For tumours in the head and neck, or in organs that move constantly, like the lungs, kidneys, and liver, platinum seeds, about one third the size of a grain of rice, are implanted around a tumour. The seeds improve the CyberKnife robot’s accuracy in delivering precise doses of radiation by helping its software detect and track the motion of the tumour. These made-in-Ottawa platinum seeds are improving an already incredibly powerful and precise radiosurgery treatment system for tumours in the head, neck, and organs, such as lungs and liver.
Platinum seeds, a third the size of a grain of rice, are improving the accuracy of CyberKnife treatments.
It was March 7, 2018. Leata hadn’t seen Joellie in five weeks. She had been at CHEO, in Ottawa, with their 3-year-old daughter who needed dental surgery.
When they got home from the airport, Joellie said he wasn’t feeling well and went to bed. He woke with a fever. Leata called her aunt who wondered if he might be having a stroke.
“I called the nursing station and they said to bring him in. Our truck wasn’t working, so we took the Ski-Doo. He [Joellie] drove it to the nursing station,” said Leata. The nurses could see something was wrong and started calling doctors in Iqaluit who arranged for medevac from their northwest Baffin Island community.
Joellie lost consciousness at the nursing station. He didn’t come to until he arrived at the Qikiqtani General Hospital in Iqaluit where a he had a CT scan. The results were bad news.
7-hour surgery and 52 stitches
Joellie Qaunaq from Arctic Bay, Nunavut.
“First, the doctor told us that Joellie had a tumour, then they told us he had brain cancer,” said Leata.
She had only been home less than 48 hours when she found herself headed back to Ottawa. The Ottawa Hospital Cancer Centre, through an agreement with the Government of Nunavut, provides cancer services to residents of eastern Nunavut. Usually, only one family member or close friend accompanies a patient. The Qaunaqs knew that cancer treatment could be lengthy—weeks, even months. They prepared to leave family, friends, and their community support network for an undetermined amount of time while Joellie had treatment.
The couple, who’ve been married for 29 years, have four children. So before heading south, Leata arranged for their two youngest (13 and three years) to stay with their oldest son, whose wife was expecting a baby in April. It would be Joellie and Leata’s first grandchild, and they knew they would miss the baby’s birth.
Joellie had a seven-hour surgery to remove his brain tumour. He woke up with the left side of his head shaved and 52 stitches curving up from his ear to his temple.
“That’s not a kind of cancer that we cure”
“Joellie had a tumour called a glioblastoma—it is the most common kind of brain tumour that adults get,” said Dr. Garth Nicholas, Joellie’s medical oncologist. “It’s not a kind of cancer that we cure with our treatment. The goal is to try and keep that cancer from progressing, or worsening, for as long as we can.”
Glioblastoma multiforme is a deadly, extremely aggressive form of cancer that starts in the brain. Its tumour cells reach like tentacles into parts of the brain where neurosurgeons can’t see them and, therefore, can’t remove them.
1,000 Canadians are diagnosed with glioblastoma every year.
It affects 2 out of every 100,000 people.
Accounts for 12% of all tumours in the head.
Affects more men than women.
Usually adults between 45 and 75 years of age.
Less than 10% survival rate, 5 years post-diagnosis.
Tragically Hip lead singer Gord Downie and Ottawa politician Paul Dewar both died from this type of brain cancer.
In addition to hearing loss―a result of a life of hunting and being close to the sound of hunting rifles―Joellie spoke Inuktitut and had limited English. Understanding his diagnosis and treatment options was challenging. Fortunately, Leata was fluent in English and could be a strong advocate for his treatment. But this is not the case for many Inuit patients.
“I think challenges and the difficulties―above and beyond his brain tumour―were not related to Joellie’s tumour but to being far from home, and the language barrier,” said Dr. Nicholas.
Realizing these challenges. Dr. Nicholas referred the Qaunaqs to Carolyn Roberts, the First Nations, Inuit, and Métis Nurse Navigator for the hospital’s Indigenous Cancer Program. She helps many Inuit patients understand and navigate the health-care system throughout their cancer treatment.
“Our whole system of ethical practice has autonomy as its foundation stone. People can decide what they want to do and people are meant to be involved in what they want to do with their health. But the combination of language and education and cultural expectation makes it hard for people from the North to be involved,” said Dr. Nicholas. “That’s where the program with Carolyn is useful, because she helps get them around to the idea that this is not being done to you, but with you and for you.”
“When I meet patients, I tell them I’m a different kind of nurse,” said Carolyn. “I’m not here to just answer questions about cancer. I’m here for any question at all―doesn’t have to be about health. That’s the message I give to every patient.”
There are few similarities between Ottawa and the small Arctic communities where many Inuit patients live. Undergoing cancer treatment in a place that is so fundamentally different than their home takes a toll on patients and their mental health.
Connecting with someone’s culture and breaking down barriers with the universal language of compassion and laughter helps patients feel more comfortable and confident about going through their cancer journey.
“What we really worked towards is not to focus too much on the cancer. It brought us together, but that doesn’t define who they are.” –Carolyn Roberts, First Nations, Inuit, and Métis Nurse Navigator.
Dr. Nicholas said he sees the difference Carolyn and the Indigenous Cancer Program make for patients. “I can think of individual patients who would not have been treated and who would’ve just gone home. They were overwhelmed by everything and they would’ve just left but they dealt with Carolyn. They ended up staying and having some treatment, and the treatments were useful,” said Dr. Nicholas. “The program’s got measurable medical outcomes.”
Joellie Qaunaq taught Arctic survival skills to Canadian Armed Forces members in Resolute Bay, Nunavut.
Back home, surrounded by family and friends
Leata Qaunaq hugs her husband Joellie.
Joellie had his last radiation treatment in Ottawa on May 29, 2018. He was then discharged and eagerly headed home, back to Arctic Bay—to family and friends.
Dr. Nicholas’s follow up with Joellie and his treatment to help keep the cancer at bay continued. Every month, he would have blood work done and the results were faxed to Dr. Nicholas who then called Leata about whether Joellie could go ahead and take the chemotherapy pills he was prescribed to use at home. After Joellie finished the six-month chemo treatment, he had follow up CT scans that Dr. Nicholas received on his computer as if Joellie was a local patient.
Fortunately, Joellie was still relatively well when he went home last May and was able to enjoy time with his new granddaughter and family.
Glioblastoma is one cancer that always returns. And Joellie’s did. After almost a year since his discharge, Joellie’s health deteriorated and sadly, he passed away on May 5, 2019. He was cared for by people who loved him and his family beside him.
“In 2012, I was diagnosed with early stage breast cancer. Despite the standard treatment of surgery, chemotherapy, radiation and hormonal treatment, the cancer returned four years later, having spread to my lungs, bones and lymph nodes.
I received my diagnosis of incurable stage 4 metastatic breast cancer on my son’s birthday. He was nine.
My world as I knew it ended. I was sitting upstairs on my bed. I could hear the kids playing downstairs. I called my husband at work and he came home and we cried.
It is a tradition in our home that on our kids’ birthdays, we go out to a restaurant of their choosing for dinner. So on the day my world ended, I sat in a restaurant and ordered some food and tried to eat cardboard, but couldn’t get the food to go down. I looked at the birthday boy and held the tears in, and my heart shattered in a million pieces.
Metastatic breast cancer is treatable, but not curable. When I was first diagnosed, my life expectancy was being measured in months. Now with cautious hope, it might be a few years. I go to the Hospital every 28 days to get injections. They are part of a series of targeted treatments I receive to keep the cancer cells at bay. One day, the cancer will figure out how to grow despite this treatment, and I will move onto something else. And I’ll continue this endless cycle of treatments and scans and progression and change until I am out of options. But I am a 43-year-old mother. And wife. And daughter. And sister. I need more time. Time to see my young children through elementary school. Time to watch my family grow and share in all the joys that life brings. Time to celebrate anniversaries with my husband and birthdays with my niece and nephews. Time with my beloved family and friends.
There is so much that needs to happen to make this a reality for me. I will need new treatments when my current regimen stops working – because it will stop working. I need research in cancer therapies and a health-care system that is streamlined and accessible.
Sadly, early detection does not prevent all cancers from returning and spreading. We need research to understand why, and treatment to extend our lives.
When I was first diagnosed, my focus was limited, directed inwards, focused on those dearest to me. During that time of learning about this new world, I absorbed every detail I could about metastatic breast cancer; living with metastatic breast cancer, treating metastatic breast cancer, dying metastatic breast cancer. A few names came to the forefront; those making noise, shifting opinions, moving the dial on research and progress. Months into treatment, when I could finally breathe again, I knew that I wanted to be part of this movement, part of the noise, part of the shift. I needed to validate this situation that I didn’t ask for in order to accept that it was part of my story whether I liked it or not.
For now, I have energy to cast outward. Not every day, but some days. Writing, fundraising, speaking, meeting. And I would say that the way I live my life has influenced my children who actively participate in my fundraising efforts with enthusiasm. They don’t need to feel embarrassed that their mom has cancer. Instead, they can feel like they are doing something to help me by climbing trees and selling apples, doing presentations on their fundraising efforts, wearing pink laces, and making signs, helping the doctors and researchers to find better medicines. Regardless of where we eventually land, I want them to be able to look back on all the good things that they did, and know that their efforts warmed many, many hearts… mine most of all.
On behalf of all of us living with incurable cancer – finding joy between injections and scans and blood work and appointments, living with hope and making a difference – thank you for your support.”
– Vesna
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: World-Leading Research
“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.
Categories: Clinical Trials, Clinical Trials
Update: Sadly, Ida Chen passed away on November 6, 2019. The following story was written earlier this year, after Ida had undergone fluorescence-guided surgery at The Ottawa Hospital.
Symptoms strike and reveal shocking brain cancer diagnosis
While out on a bike ride enjoying the warmth of Palm Beach, Florida, in December 2016, Ida Chen noticed something was wrong with one of her legs. She had experienced some minor symptoms in the weeks prior, but suddenly, her right leg stopped working. Unable to balance, she fell and couldn’t continue her ride.
The fall left her stunned. “After I fell, I could walk. It wasn’t a permanent issue,” said Ida. However, a gash in her leg sent her to a walk-in clinic near where she and her husband, Clarence Byrd, have their vacation property.
When Ida recounted what happened to the doctor, he assured her there wasn’t an infection in the leg but he was deeply concerned about what had led to the fall. He advised her to contact a neurologist.
The neurologist scheduled an MRI, which revealed Ida had a 4 cm sized tumour in her brain which had features concerning for a malignancy. Recognizing that she may not survive a trip back to Canada for surgery, the neurologist contacted a neurosurgeon at the University of Miami Hospital who performed surgery only days later. Ida’s tumour was identified as a glioblastoma multiforme, an aggressive form of brain cancer. Unfortunately, not all the tumor could be completely removed, with 25% left behind due to the involvement of the tumor with the motor control areas for Ida’s leg.
Glioblastoma multiforme – brain cancer
For Clarence, it was hard news to absorb.
“It’s a particularly nasty cancer because it has fuzzy edges and they have trouble ensuring they get all of it.” Clarence Byrd, Ida’s husband
Ida advised her Ottawa doctor of the situation. Despite the fact that it was Christmastime, Dr. Lisa Lezack of the University of Ottawa Health Services made great efforts to ensure that when Ida returned to Canada, she would get prompt treatment.
Once back in Canada in early January, Ida was scheduled for radiation and chemotherapy. However, a new MRI showed that the tumour had returned to almost 100 percent of its original size.
Once again, just weeks after her first surgery, Ida was wheeled into the operating room, this time at The Ottawa Hospital under the care of neurosurgeon Dr. John Sinclair. It was a seven-hour surgery, followed by six weeks of radiation treatment and chemotherapy.
Ida’s initial prognosis was 12 – 15 months to live. Eighteen months after her diagnosis she had surpassed the odds, but the cancer was back, and she needed another surgery – her third in less than two years. This time, Dr. Sinclair had access to a revolutionary microscope, which was on loan to The Ottawa Hospital.
Ida, at home, enjoying every moment she gets to play piano.
Illuminating cancer
Dr. Sinclair had traveled to Switzerland to receive training for fluorescence-guided brain surgery and was able to perform such surgery in the context of a trial using a microscope on loan to The Ottawa Hospital. The technique requires patients to drink a liquid containing 5-aminolevulinic acid (5-ALA) several hours before surgery. 5-ALA concentrates in the cancerous tissue and not in normal brain tissue. As a result, malignant gliomas “glow” a fluorescent pink color under a special blue wavelength of light generated by the microscope while the normal brain tissue does not fluoresce. This permits surgeons to achieve a complete resection of a tumour in many more patients, with recent studies demonstrating that this can now be achieved in 70% of surgeries as opposed to the previous 30% average.
“Seeing the brilliantly coloured tumours helps neurosurgeons remove more of the cancerous cells,” said Dr. Sinclair. “It’s like turning on the lights. You can actually see the difference between the tumour and the brain tissue. It’s dramatic.”
Added Dr. Sinclair, “Survival and quality of life are both dramatically impacted by this technology.”
In later discussions with Dr. Sinclair, it was clear that, without the use of the microscope Ida would have lost the use of her right leg. Ida explained, “He would have had to take out more of my brain matter and disable me to be sure he had all of the cancer cells.” She also learned that, because the microscope was available for a limited time on loan from the manufacturer, she was one of only ten people in Canada who benefited from the loan of the microscope.
Shortly after Ida’s surgery, a fundraising campaign was initiated to acquire a permanent microscope for Fluorescence Guided Surgery at The Ottawa Hospital. Recognizing how vital this piece of equipment was, Ida and Clarence made a substantial contribution towards its purchase. Dr. Sinclair performed the first surgery with the new microscope on August 26th.
“He saved my life.”
Thanks to the revolutionary care she received right here at home, Ida is enjoying a normal life style. “The Ottawa Hospital has given her outstanding service. Dr. Sinclair in particular has been very impressive,” said Clarence.
Ida is quick to add, “He saved my life. Twice.”
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Donors, Neuro
When Annie and Hernan moved to Ottawa, they had two suitcases, a toddler, and $500 in their pockets.
Annie became Chief Financial Officer of The Ottawa Hospital Foundation. Over the years, she saw first-hand the importance of life-saving care: when a rare virus devastated her kidneys and put her on dialysis, the doctors at The Ottawa Hospital fixed her up. And, Hernan received a successful corneal transplant there.
“I noticed that a growing number of people in and around Ottawa were leaving gifts in their wills to the Hospital. Even though this type of giving doesn’t usually generate much attention, I came to learn what an important source of revenue it is to clinical research, the purchase of medical equipment and the delivery of world-class patient care.”
So, around the time that Annie’s kidney disease was resolved, the couple decided to include a gift to The Ottawa Hospital in their estate plans.
They didn’t think much on it until 2015, when Hernan was diagnosed with appendiceal cancer (or cancer of the appendix, a very rare form of cancer). The Ottawa Hospital was there once again. He fought with everything he had. Tragically, the cancer won, taking Hernan’s life in the end.
Today, Annie misses Hernan terribly–but she does her best to live life to the fullest, like her husband would have wanted. And, she knows that his legacy of kindness and community lives on, thanks to the gift in their will.
“When I look back on my life, I think of me and Hernan as a pair. We have built so much–and we will leave so much. We made beautiful, bright children. We worked hard for the betterment of others. And, we left our bequests to The Ottawa Hospital Foundation, so that those who follow us will receive the best possible healthcare when they need it most.”
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Donors, Gift In Will, Kidney
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: Clinical Trials, Stem Cell
Although the connection between the immune system and cancer has been recognized for over a century, understanding how the immune system works against cancer has been the biggest challenge for scientists like Dr. Michele Ardolino.
Initially, efforts were made to stimulate the immune system to make it attack the cancer. But the game changer was the discovery that there are key molecules, called immune checkpoints, on cancer cells that suppress the immune cells and prevent them from attacking the cancer. There are many types of immune cells. T-cells have been recognized as key immune cells and the ones that immunotherapy drugs have been designed to target.
Dr. Michele Ardolino’s discovery focused on ‘natural killer’ immune cells.
“What we didn’t know before is that some of these receptors are present in other immune cells,” said Dr. Michele Ardolino, scientist at The Ottawa Hospital and assistant professor at the University of Ottawa. “What we discovered is that these receptors are present on another type of immune cell called natural killer cells.”
He said that even though most of the immunotherapy drugs target the T-cells to make them work better, not all cancer tumours are responsive to T-cells.
“But,” said Dr. Ardolino, “These tumours might be very effectively killed by natural killer cells. So, if we know what kind of tumour the patient has, we can design therapies to elicit the most effective immune response. Which in some cases could be a T-cell response and in other cases could be a natural killer response.”
“We now have a better idea of how the immune system suppresses cancer. This means that we can now target the mechanism that suppresses the immune system in a more specific way.”
“This is cool for a number of reasons,” said Dr. Ardolino. “We now have a better idea of how the immune system suppresses cancer. This means that we can now target the mechanism that suppresses the immune system in a more specific way. And we can elicit a stronger natural killer cell response against cancer.”
It is becoming widely recognized that not only is cancer unique to each patient, but the immune system is also unique to each person. Researchers and clinicians are realizing the importance of tailoring the immunotherapy not only to each person’s cancer but to their own unique immune system. It is a complex problem to give a drug that would have maximum therapeutic effect with the least side effects, to be as targeted as possible.
Dr. Ardolino recently published a breakthrough discovery that has potential to make immunotherapy treatments to work for more people, and more types of cancers.
In October 2018, immunologists James Allison and Tasuku Honjo were awarded the Nobel Prize in Medicine for their discoveries of immune checkpoint inhibitors, considered a landmark in the fight against cancer.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Immunotherapy
Patients don’t need to have a metal halo screwed into their skull when they receive radiation treatment with the CyberKnife. That was one of the appealing factors for neurosurgeon Dr. John Sinclair to bring the radiosurgery robot to The Ottawa Hospital.
With other radiosurgery, patients with brain tumours had to have their head held perfectly still during treatment. A metal frame or “halo” was screwed into their skull and then fastened to the table they’d lie on for treatment.
However, patients do not need to be held still when receiving CyberKnife radiosurgery. The robot uses x-rays and complex precision software to accurately track the tumour. It gives a high dose of radiation to the precise location of the brain tumour while the patient, who is fitted with a custom-made plastic mask, lies on the table.
“CyberKnife has an advantage over regular radiation because it is so much more accurate; its precision is less than a millimetre,” said Dr. Sinclair, Director of Cerebrovascular Surgery at The Ottawa Hospital. “You can give very high doses of radiation right to the lesion [tumour] and get almost no spill over to normal tissue. And as a result, we see greatly improved responses to this type of treatment compared to regular radiation.”
Dr. John Sinclair was instrumental in bringing the CyberKnife to The Ottawa Hospital.
Dr. Sinclair was first introduced to the CyberKnife when he did a fellowship at Stanford Medical Center in California. CyberKnife was invented at Stanford, so the neurosurgeon was one of the first to see the benefits of this frameless radiosurgery treatment.
When Dr. Sinclair was recruited to The Ottawa Hospital in 2005, he had hoped to bring this novel technology to patients here. At the time, it was a technology that wasn’t approved by Health Canada. So, Dr. Sinclair and his team made a case for robotic radiosurgery, presenting scientific data that validated its success.
The Ottawa Hospital was eventually one of two health research centres in Ontario allowed to test the CyberKnife. However, there was no government funding available to purchase the machine. The hospital appealed to the community, which pulled together and generously donated the entire $4 million to purchase it. CyberKnife began treating patients at The Ottawa Hospital in September 2010.
“Because it’s delivering a high dose, it’s considered similar to surgery without using a scalpel, so patients experience no blood loss, no pain, no ICU stay, or recovery time,” said Dr. Vimoj Nair, one of the radiation oncologists trained to prescribe CyberKnife treatment. “So CyberKnife radiosurgery does provide an option where people can be treated with outpatient techniques.”
With regular radiation, the daily doses were lower and patients had to come to the clinic for more radiation treatments overall. Regular radiation treatment could range from five to six weeks. With CyberKnife, radiation is focused precisely on the tumour, allowing larger doses to be given daily, therefore giving the total treatment in one to six days. The hospital’s CyberKnife has gained a reputation for improving treatment of various tumours. Dr. Nair said that because it is one of only three in Canada, patients from British Columbia to the Maritimes are occasionally referred to The Ottawa Hospital for treatment.
“At first, we would treat one tumour,” said Dr. Sinclair. “Now, we treat five or six individual tumours at a time and spare the rest of the brain. We’re sending radiation only to those metastatic tumours. There is a proportion of patients who develop cognitive problems a few months after whole-brain radiation. But with radiosurgery, because we give a higher dose of radiation only to the actual tumours, patients have improved outcomes, and so their quality of life is better.”
This has meant an increase in the number of patients having multiple tumours treated in the same session.
“Treating several tumours at once helps keep the patient’s clinic visits to a minimum,” said Radiation Therapist Julie Gratton, who has worked with CyberKnife since it was installed at The Ottawa Hospital. “Targeting individual tumours rather than treating the whole organ helps spare healthy tissues and reduce side effects.”
The CyberKnife at The Ottawa Hospital is one of only three in Canada.
Radiation Therapist Julie Gratton has given CyberKnife treatments to patients since 2010.
Until 2017, 1,825 patients had been treated with the CyberKnife. In 2018, 359 patients received 1,824 CyberKnife treatments. Gratton said that because more tumours are being treated at once in each patient, the number of treatments given per year has increased as expected.
Although 90 percent of CyberKnife treatments are for malignant or benign brain tumours, CyberKnife is also being used to treat tumours in other parts of the body. Because it doesn’t require a frame to keep the area receiving radiation still, CyberKnife’s image guidance system is used to treat tumours in organs that move constantly, such as the lungs, kidneys, liver, prostate gland, and lymph nodes. CyberKnife can precisely align the radiation beam to the tumour even when it moves. The method of tracking tumours in organs and soft tissue has been improved by research at The Ottawa Hospital.
Read more about how our team is increasing the success rate of this already powerful and precise treatment.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Innovation and Technology, Technology
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, Immunotherapy, World-Leading Research, World-Leading Research, World-Leading Research
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“In 2012, I was diagnosed with early stage breast cancer. Despite the standard treatment of surgery, chemotherapy, radiation and hormonal treatment, the cancer returned four years later, having spread to my lungs, bones and lymph nodes.
