Cancer Research And Trials

November 04, 2009
By Dr. Jonathan Cho

Dr. Jonathan Cho
Principal investigator - Minority-Based Community Clinical Oncology Program (MBCCOP),
University of Hawaii/Cancer Research Center of Hawaii professor of oncology

What have been the most significant changes in oncology since you started?

Oncology is a very interesting field because there are new developments occurring all the time. These developments are occurring mainly because cancer incidence and deaths are increasing, so there’s an emphasis on research to develop strategies to prevent, detect and treat cancer. With major advances in technology, researchers now have the means to develop new strategies for cancer prevention, screening and treatment. Additionally, strategies to minimize side effects from cancer treatments have been developed. This in itself has had major impact in the care of the cancer patient over the past five to 10 years. We’ve gone from very basic and crude ways of treating cancer to providing treatment that specifically targets the tumor. Patients will realize that cancer treatment will be more “personalized.” So we now analyze the genes of an individual’s tumor and decide on the appropriate treatment based on the genetic makeup of that tumor. We now have the technology to do this. That’s where cancer therapy is moving. We are already applying this knowledge in the clinic in the treatment of the common cancers such as breast, colon, lung and not-so-common cancers as lymphomas and leukemia. This is why continued emphasis on research is so important.

So do all the therapies and treatments go through a trial period? Can you explain that process?

Anything we do in the field of oncology today, in terms of prevention, screening and treatment, must go through a rigorous testing process. Before any cancer treatment is tested in humans, it must be tested in animals. It is then tested in a Phase I trial, which is a study to determine the maximum tolerated dose of the treatment, whether it be drugs or radiation. Most of the patients treated on a Phase I study have already been treated with conventional or standard therapies and have very few if any remaining treatment options. Once the maximum tolerated dose is determined in the Phase I trial, it enters Phase II testing, where one is looking to further assess the toxicity and effectiveness of the new treatment. If the treatment is found to be effective against a particular cancer in the Phase II study, it is then tested in a Phase III trial. Phase III trials compare this new treatment to the most widely accepted treatment at the time. If, in Phase III testing, the new treatment turns out to be more or equally effective and less toxic, it will frequently be considered a new standard. Presently the Cancer Research Center and its affiliated hospitals and clinics conduct only Phase II and III cancer-related clinical trials in Hawaii.

Do you often encounter problems getting patients to participate in clinical trials?

Oh, yes, there are a number of obstacles to overcome to get patients to participate in clinical trials, anywhere from physician bias to patient bias. Some people feel like they’re guinea pigs. And then there’s eligibility criteria that’s very strict, so not all patients are eligible for these trials. In Hawaii, we also encounter cultural factors such as attitudes toward Western medicine. Then there are cancers or stages of a particular cancer where a clinical trial is not available.

How does the Cancer Research Center decide what trials to participate in?

We have a mechanism called the Community Clinical Oncology Program (CCOP). This is a program that was mandated in 1983 by the National Cancer Institute-NCI. The purpose of the CCOP is to make NCI-approved cancer clinical trials available to community physicians and hospitals. Minority-Based CCOPs are very similar to CCOPs, but to be considered a Minority-Based-CCOP, 40 percent of the patients enrolled onto clinical trials must be of a minority group. The University of Hawaii/Cancer Research Center of Hawaii is one of 13 Minority-Based-CCOPs funded by the National Cancer Institute. We are affiliated with seven nationally and NCI-approved research groups, which enables us to conduct more than 100 clinical trials in Hawaii.

Do you think a cure for cancer is in the making?

Cancer is a very complex disease, so I don’t think that we’re going to find a cure for all cancers. Instead in the near future, we’ll find or improve treatments that will improve cure rates for patients who have stages of cancer that are curable, and improve survival duration for patients who have stages of cancer that are incurable. We see that now. If you look at testicular cancer, in the past treatment cured 50 percent of patients. Now we cure 80-90 percent of patients with improved treatment. The same can be said for early breast cancer, early colon cancer and lymphomas. Similarly, advances in prevention and early detection have resulted in fewer patients dying from certain cancers.