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TFRI Explainers

The Promise of Personalized Precision Medicine

For years, the Terry Fox Research Institute has embraced a novel approach to medicine that holds great promise for cancer patients across Canada. Now, it is piloting projects that are helping make it a reality. 

TODAY, WHENEVER A PERSON IS DIAGNOSED WITH CANCER, doctors follow a standard treatment procedure identical 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.

For years, the mechanisms that led to these mixed results remained a mystery, but recent technological advances in the field genomics are enabling researchers to gain a clearer picture of the genetic makeup of each cancerous cell, as well as the mutations that make them develop. This deeper understanding is allowing researchers to decipher 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 approach known as personalized precision medicine

The Future of Cancer Care

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 cancer care.

Personalized 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. This development has the potential of making cancer treatments more effective, while decreasing the side effects associated with current treatments.

Precision medicine is the medicine of the future, but making it a reality won't be easy. It will require that we completely change the way we approach cancer challenges today. It will demand that Canada's top cancer institutions, researchers and practitioners come together to create a vast library of "Big Data", so that we can all access and analyze the genetic makeup of individuals tumours and patients and learn from past cancer success stories in real time.

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 Ending 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.

At the Terry Fox Research Institute, we believe that by creating a collaborative framework that fosters innovative research and allows the genetic information of thousands of patients and 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 the Terry Fox Canadian Comprehensive Cancer Centre Network (TF4CN) an innovative pilot project born out of a collaboration between the Terry Fox Research Institute,  the Princess Margaret Cancer Centre in Toronto and the BC Cancer Agency in Vancouver.

Launched in April of 2017, this network is by far the biggest and boldest initiative undertaken by the institute to date. It brings together world-renowned researchers working in 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 collaborative research projects operating simultaneously in several key areas, including genomic profiling, immunotherapy and molecular imaging, while also developing the IT infrastructure that will allow the network to safely share and analyze vast amounts of genetic 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 pilot project has also started collecting and profiling genetic data from patients with metastatic colorectal cancer in an effort to put this cutting-edge infrastructure into practice.

Moving forward, our goal is to grow this pilot project and create a pan-Canadian network of cancer centres that truly embraces the bold vision behind The Terry Fox Canadian Comprehensive Cancer Centre Network. We are convinced that this model is the foundation on which the medicine of tomorrow will be built.



Other TFRI-funded Precision Medicine Projects 

AS WE MOVE FORWARD WITH OUR BOLD VISION OF BUILDING A PAN-CANADIAN NETWORK OF CANCER CENTRES, we hope to incorporate some of our currently-funded research teams. These teams are already helping to make personalized precision medicine a reality by using genetic sequencing and “Big Data” as a central tool to improving outcomes for cancer patients.

These currently funded projects include:

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 defeat 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 children.

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 helping to fund 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 ambitious: 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, which involves centres in Quebec, Ontario, Manitoba, and B.C., has been collecting and researching 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 collected for the project’s research biobank, something researchers are confident will lead to better patient outcomes.

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