"For many years it's been hopeless from a patient perspective, and we are hoping to help shift this," says Dr. Daniel Renouf (BC Cancer, University of British Columbia) who, along with Dr. David Schaeffer (UBC, Vancouver General Hospital), is leading a $5-million pan-Canadian, precision medicine initiative recently funded by the Terry Fox Research Institute.
A lack of early detection tests. Few known symptoms. Very limited treatment options. No known biomarkers that can be used to direct therapy. These are among the clinical challenges team EPPIC, short for Enhanced Pancreatic Cancer Profiling for Individualized Care, is tackling over the next five years to improve personalized treatments for patients with pancreatic ductal adenocarcinoma (PDAC), a disease with just a nine per cent five-year survival rate.
"Our project focuses on metastatic cancer versus surgically resectable primary tumours, because this is the clinical problem we see most often," says Dr. Schaeffer, noting a priority is to discern if the metastatic and primary tumour differ in their genetic make-up. Four out of five patients have metastatic cancer at the time of diagnosis and most will succumb within a year.
Patients are very keen to participate in the research study. "My push is to keep the support coming for the research, and to bring hope to other pancreatic cancer patients. This is a disease that needs more hope," says Susan Stewart, 57, a North Vancouver resident who was diagnosed with Stage IV terminal pancreatic cancer in January 2017. She was enrolled immediately in EPPIC as well as a clinical trial where she received an experimental therapy. Although it is early days yet, her results today are promising. Her pancreatic cancer tumour is no longer visible on CT scans, and the metastatic cancer on her liver has shrunk considerably. Her doctors are using the EPPIC results to try and understand why her tumour has had such an incredible response to the experimental treatment.
The EPPIC team aims to sequence metastatic pancreatic tumours of 400 patients in Quebec, Ontario, Alberta and British Columbia. They hope to improve understanding of pancreatic cancer biology to individualize treatment strategies, and to facilitate the development of new treatment options.
This project is currently under way in Toronto and Vancouver, through two clinical trials (COMPASS and PanGen), and will be expanded shortly to include eligible patients in Kingston, Ottawa, Calgary, and Edmonton. The Montreal site opens this week. Genomic sequencing and bioinformatics analyses of patient tumours will be conducted at the Ontario Institute for Cancer Research (OICR) and the BC Cancer Genome Sciences Centre.
The team will also store and analyze the genomic and clinical data collected in a knowledge bank that will be shared by Canadian and international researchers seeking ways to improve treatment. The bank will be the first of its kind in Canada.
Dr. Victor Ling, TFRI president and scientific director, is thrilled TFRI is funding this high-calibre precision medicine team to tackle such a hard-to-treat cancer. "Pancreatic cancer research has been historically underfunded, and we are very excited to be expanding such a successful personalized medicine project to patients across Canada. We hope precision medicine may hold the key to finding better treatments for this incurable disease."
EPPIC's multidisciplinary team comprises clinicians and scientists from BC Cancer, Vancouver Coastal Health Research Institute, University of British Columbia, University of Calgary, University of Alberta, Princess Margaret Cancer Centre, University Health Network, OICR, McGill University Health Centre (MUHC) and the Research Institute of MUHC, Centre hospitalier de l'Université de Montréal, Queen's University and the Ottawa Hospital.
In addition to Drs. Renouf and Schaeffer, other principal investigators of EPPIC and the COMPASS and PanGen trials are: Dr. Jennifer Knox and Steven Gallinger (Princess Margaret Cancer Centre/UHN/ OICR), Dr. George Zogopoulos (MUHC/Research Institute of MUHC/McGill University), and Dr. Oliver Bathe (Tom Baker Cancer Center, University of Calgary). Many of the team's investigators are members of PancOne™, an initiative of Pancreatic Cancer Canada (PCC).
TFRI's investment in EPPIC also builds on funding from BC Cancer Foundation, OICR, Princess Margaret Cancer Foundation, PCC and VGH and UBC Hospital Foundation.
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BC Cancer, an agency of the Provincial Health Services Authority, is committed to reducing the incidence of cancer, reducing the mortality from cancer and improving the quality of life of those living with cancer. It provides a comprehensive cancer control program for the people of British Columbia by working with community partners to deliver a range of oncology services, including prevention, early detection, diagnosis and treatment, research, education, supportive care, rehabilitation and palliative care. For more information, visit www.bccancer.ca or follow us on Twitter @BCCancer. About The Terry Fox Research Institute (TFRI).
BC Cancer Foundation is the fundraising partner of BC Cancer. Together with our donors we are changing the outcome for people affected by cancer in B.C. and beyond by connecting personalized care, innovative research and opportunities to contribute. We are the largest funder of cancer in B.C. and every dollar raised stays right here at BC Cancer to advance research, enhance care and break down cancer to benefit the people of B.C.
Launched in October 2007, The Terry Fox Research Institute is the brainchild of The Terry Fox Foundation and today functions as its research arm. TFRI seeks to improve significantly the outcomes of cancer research for the patient through a highly collaborative, team-oriented, milestone-based approach to research that will enable discoveries to translate quickly into practical solutions for cancer patients worldwide. TFRI collaborates with more than 80 cancer hospitals and research organizations across Canada. TFRI headquarters are in Vancouver, B.C. For more information please visit www.tfri.ca and follow us on Twitter (@tfri_research).
Communications Officer, BC Cancer
Provincial Health Services Authority
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