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The Promise of Precision Medicine

The Terry Fox Research Institute is embracing a novel framework for care that holds great promise for cancer patients across Canada and is funding pilot projects to help make it a reality. 


WHENEVER A PERSON IS DIAGNOSED WITH CANCER, their doctors generally put them on a standard treatment plan similar to that of other patients with the same diagnosis.

For some, these treatment plans prove to be extremely effective, allowing them to defeat the disease and return to life as “normal”. But in many other cases, these “one-size-fits-all” treatments fall short, leaving patients and doctors searching for new options.

Recent technological advances in the field of genomics are enabling researchers to gain a clearer picture of the genetic and biological makeup of each cancerous cell, as well as the mutations that make them develop. This deeper understanding is allowing researchers to learn why standard treatment procedures don’t work for everyone—and to reach the conclusion that each cancer – and each patient – is truly unique. This new knowledge and approach to cancer has the potential to revolutionize care and treatment for patients through an individualized approach known as precision medicine

The Future of Cancer Care


RECOGNIZING THAT CANCER
is an extremely personal disease fueled by specific mutations in specific cells has allowed researchers to identify exciting new opportunities for accelerating the pace of improvement in detecting, diagnosing and treating cancer to improve survival and quality of life for patients.

Precision medicine is at the centre of these exciting new opportunities. This revolutionary approach to cancer care takes the genetic make-up of each tumour – and the personal characteristics of each patient – into consideration, allowing doctors to create highly individualized treatment plans that target specific cells with specific drugs.
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Precision medicine is the medicine of the future, but making it a reality won't be easy. It will require that we approach cancer challenges in new ways. It will demand that Canada's top cancer institutions, researchers and practitioners come together to create a vast digital library of "Big Data", so that researchers can all access and analyze patient data and bio-specimens to more precisely tailor cancer care to each individual. 

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New DNA-sequencing methods have provided scientists with insights into the genetic make up of cancerous cells, allowing them to identify key mutations that drive different cancers as well as targets for treatment. 

A Road Map to Cure Cancer

WHEN TERRY FOX BEGAN HIS MARATHON OF HOPE back in 1980, he set off on a journey to unite Canadians under a single dream and goal: finding a cure for cancer.

Today, we have a road map to reach that goal.

By creating a collaborative framework that fosters innovative research and allows the genetic information of thousands of patients and their tumours to be shared, stored and analyzed, we can accelerate the pace at which we develop new treatments for cancer, getting us one step closer to achieving Terry’s dream.

This collaborative framework is now coming to life through two major pilot projects that are helping accelerate the implementation of precision medicine in Canada. The first of these pilot projects is the Terry Fox Canadian Comprehensive Cancer Centre Network (TF4CN), an innovative network born out of a collaboration between the Terry Fox Research Institute, the Princess Margaret Cancer Centre in Toronto and BC Cancer in Vancouver.

Launched in April of 2017, this network brings together world-renowned researchers working in these top-tier cancer centres with the goal of harmonizing their research and creating the methods, procedures and infrastructure needed to seamlessly share, store and analyze Big Data.  

The network currently features cross country collaborative research projects operating simultaneously in four key areas of cancer research, including the genomic profiling of colorectal tumours, immunotherapy for ovarian cancer and molecular imaging for prostate cancers, as well as the development of an IT infrastructure and a data governance strategy that will allow the network to safely share and analyze vast amounts of patient data.

One year after its launch, the project is implementing several of the key procedures needed to harmonize data collection across institutions, while also moving closer to the development of IT software that will allow this information to shared, stored and analyzed in ways that could impact physicians and their patients in the short term. 

The second pilot project was launched in Montreal in June of 2018. This ambitious network is bringing together researchers from institutions across Montreal to harmonize research methods and share data in an effort to better understand why some patients with malanoma and acute leukemia respond to immunotherapy, while others don't. Partners in the Montreal Cancer Consortium (MCC) include: Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Goodman Cancer Research Centre (GCRC), Centre de Recherche Hôpital Maisonneuve-Rosemont, Institute for Research in Immunology and Cancer (IRIC), Jewish General Hospital (JGH), McGill University, the Université de Montréal, Génome Québec Innovation Centre, and the Research Institute of the McGill University Health Centre (RI-MUHC).

Moving forward, the TFRI's goal is to continue launching regional pilot projects across the country, and eventually start linking them together to create a pan-Canadian network of cancer centres that truly embraces the promise of precision medicine, helping to make it a reality.

 

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By using the genetic fingerprint of each patient and each tumour, doctors may be able to give each patient the appropriate therapies they need to treat their cancer. 

Other TFRI-funded Precision Medicine Projects 

AS WE MOVE FORWARD WITH OUR BOLD VISION OF BUILDING A PAN-CANADIAN NETWORK OF CANCER CENTRES, some of our currently-funded research teams are already applying the main precepts of precision medicine in their work. 

Precision Oncology for Young People (Terry Fox PROFYLE)

Over the past three decades, there has been dramatic improvement in treatments and outcomes for many pediatric cancers. While today 80 per cent of young people manage to survive cancer thanks to these advances, outcomes remain grim for many children and young adults living with hard-to-treat cancers. The Terry Fox PROFYLE project is for these very young Canadians.

PROFYLE is a pan-Canadian project that brings together more than 30 pediatric cancer research and funding organizations to give children, adolescents and young adults who are out of conventional treatment options another chance to beat their cancer. To do this, the Terry Fox PROFYLE team of leading pediatric clinicians and scientists is sharing genetic tumour data from patients to help identify potential alternate options. Any child enrolled in the study will have their tumour sample profiled; the results will then be discussed by a national tumour board of research and clinical experts – and if the patient meets criteria for a clinical trial suitable for their cancer they will be enrolled. 

Enhanced Pancreatic Cancer Profiling for Individualized Care (EPPIC)

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.

The EPPIC team, which is made up for researchers from across the country, 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 through sequencing and bioinformatics, with the goal of individualizing treatment strategies and creating new treatment options. 

Pan-Canadian Ovarian Experimental Unified Resource (COEUR)

Ovarian cancer is the fifth-leading cause of cancer-related deaths in the western world. More than one in four women do not respond to standard first-line chemotherapy treatment — an alarming number that the TFRI is hoping to reduce through the creation of the pan-Canadian Ovarian Experimental Unified Resource (COEUR).

Since 2009, the COEUR team has collected thousands of ovarian cancer samples from patients across the country. Researchers are analyzing and comparing different tumour types to identify biomarkers and classify different sub-types of the disease. They hope that identifying different sub-types earlier will help determine the best course of action for each patient.

Multiple Myeloma Molecular Monitoring (M4)

Between 2,000 and 3,000 Canadians are diagnosed with multiple myeloma each year – and only 40 per cent of patients are alive after five years, with many living just months after diagnosis. These staggering statistics have one possible explanation: despite being a heterogeneous disease, multiple myeloma is currently treated and monitored the same way for each patient. That’s why the TFRI is funding the pan-Canadian Multiple Myeloma Molecular Monitoring (M4 study) program, which is comprised of researchers and clinicians at multiple sites including Vancouver, Calgary, Toronto and Montreal.

The M4 team is working with more than 250 patients across Canada to advance the ability to characterize and monitor multiple myeloma in the blood and the bone marrow by using cutting-edge technology and newly discovered research techniques. Their goal is to better understand multiple myeloma and to discover why some treatments work and others don’t so they can develop new, more effective ways to fight this disease.

Canadian Prostate Cancer Biomarker Network (CPCBN)

The Prostate Specific Antigen (PSA) is the biomarker commonly used to diagnose prostate cancer. But despite being the go-to option in clinics around the world, PSA has one major limitation: it can’t differentiate between aggressive and indolent cancer tumours.

Research shows effective treatment for prostate cancer depends on doctors and patients understanding exactly what kind of cancer they are facing. That’s why TFRI funded the groundbreaking Canadian Prostate Cancer Biomarker Network (CPCBN) for six years.

The project, involving centres in Quebec, Ontario, Manitoba, and B.C., has been collecting and studying tumour samples to develop biomarkers that will allow doctors to detect the disease earlier and more accurately, enabling more options for managing it. To date, 2,000 tissue samples and patient histories have been acquired for the project’s research biobank, something researchers are confident will lead to better patient outcomes.

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