Kids' cancer treatment shouldn't hurt
Dr. Jim Whitlock sees the future of kids' cancer treatment – in a pill. Dr. Whitlock is the Director of the Garron Family Cancer Centre, Division Head, Haematology/Oncology/Bone Marrow Transplant and Women's Auxiliary Millennium Chair at SickKids. He emphasizes the importance of 'translational research' – clinical trials, often based on laboratory research at SickKids or other research-intensive hospitals, that lead to new treatments. Clinical trials with new forms of oral anti-cancer medications are happening now. Dr. Whitlock sees a day, a little farther ahead, when genetically targeted medicine turns cancer from the largest disease-related killer of children in Canada into a chronic, manageable condition, akin to diabetes. He recognizes that the increase in the survival rate for childhood cancers to over 80 per cent today is remarkable. But the side effects of current treatments, and how tough they can be on patients and their families, weigh heavily on him.
I want to hasten the day when we don't treat cancer with the slash of surgery, the burn of radiation, and the poison of chemotherapy.
"No child should go through that. I want to hasten the day when we don't treat cancer with the slash of surgery, the burn of radiation, and the poison of chemotherapy," says Dr. Whitlock. The geniality of his Southern drawl – Dr. Whitlock came to SickKids after 13 years as Division Director of the Paediatric Oncology program at Vanderbilt University in Nashville, where he also trained – does nothing to mask his conviction.
Dr. Whitlock is a passionate advocate for equal access to new treatments. On this, he sounds very Canadian, channelling Tommy Douglas, the guiding spirit of Canadian medicare: "Equal access is a Canadian value." There are two new treatment approaches in which Dr. Whitlock sees great promise and real progress: precision medicine and immunotherapy.
'Precision medicine' is Dr. Whitlock's preferred term for personalized medicine. "Precision medicine," he says "is based on genetic understanding. A mutation in the DNA code – when the 'computer program doesn't work' – that's cancer." Having the tools to identify genetic changes in cancer cells, means medications often taken orally – pills – can target the genetic abnormality, suppressing the cancer, without harming non-cancerous cells. Anaplastic lymphoma kinase (ALK) inhibitors are one such medication. Successful in targeting the ALK gene mutation present in some adult lung cancers, they're proving effective in treating cancers common in kids, like neuroblastoma and anaplastic large cell lymphoma.
Originally skeptical, Dr. Whitlock has seen convincing proof of the benefits of harnessing the body's own immune system to fight cancer – immunotherapy – in the last five years. "Some immunotherapies have better response rates than chemo. The effects can be longer-lasting." One example is chimeric antigen receptor (CAR) T cell treatment, in which white blood cells are extracted from a patient, genetically engineered, and reintroduced into the patient, where they attack the cancer cells. A clinical trial for this particularly promising treatment is anticipated in Canada before the end of the year.
Precision medicine and immunotherapy: this is the future of cancer care at SickKids. But Dr. Whitlock is thinking even bigger picture, which he acknowledges is only possible with the help of donors. At SickKids, a $2.5 million investment from SickKids Foundation to support the precision medicine program, and $500,000 in grants annually to support the Clinical Trials Support Unit, advances Dr. Whitlock's mission: "I came to SickKids because we can be the greatest childhood cancer program in the world."
