Conducting cancer clinical trials on five continents

This is part of a continuing series showcasing some of Ontario’s many clinical trial strengths and assets.

As Canada’s largest adult cancer cooperative group, the Canadian Cancer Trials Group (CCTG) is dedicated to answering a question that is critical to every cancer patient: what is the best treatment for me?

Since 1980, the CCTG (formerly NCIC-CTG) has conducted over 500 national and international clinical trials, including practice-changing studies in all types of cancer and all modalities of treatment. Almost 80,000 patients in Ontario, Canada, the United States and other countries have taken part.

CCTG is a remarkable network that engages international leaders in academic clinical trials, both domestically and around the world. In Canada, it works with more than 80 cancer centres and hospitals, with over 2,100 investigators. Worldwide, CCTG has collaborated with single sites and cooperative groups in over 40 countries on five continents.

Simply put, “the network provides excellent clinical trials ideas and excellent execution,” says CCTG’s Scientific Director Dr. Janet Dancey, who is based at CCTG’s central operations and statistics office located at Queen’s University in Kingston, Ontario. With about 100 employees and 12 faculty members, the office occupies three floors in the newly-opened Queen’s Cancer Research Institute building.

Attracting up to $25 million in funding annually, CCTG is supported by the Canadian Cancer Society, with additional program funding from the U.S. National Cancer Institute. (CCTG is the only international cooperative group that receives funding as part of the NCI’s National Clinical Trials Network.) Peer-review granting agencies and industry provide project-specific funding.

Trials run by CCTG include all phases and range from cancer prevention and supportive care to new cancer drugs and improved quality of life. Leading large, long and complex trials is one of its fortés. Take MA 17, a five-year study involving nine countries and over 400 sites. The trial demonstrated the benefits of letrozole (a new aromatase inhibitor) after tamoxifen in reducing breast cancer recurrence in post-menopausal women with hormone receptor positive breast cancer.

The impact of that study has been huge. According to a case study conducted by the Canadian Cancer Society Research Institute, the trial “led to immediate and traceable changes in world-wide standard of care practices and is responsible for thousands of disease-free years in women worldwide.”

CCTG data has led to new drug indications in 13 different areas involving 11 different drugs, says Dr. Dancey. She cites as examples CCTG-led studies in pancreatic, advanced lung and advanced colon cancer that have supported new drug indications and led to changes in practice.

Marc Zarenda, Scientific Director at AstraZeneca Canada, says CCTG can be counted on to deliver “high-quality work, on time, on budget, and to bring world-class experts into these trials.” AstraZeneca has collaborated with CCTG for two decades, starting with small molecule trials and recently focusing a lot on immunotherapy. In 2015, the company signed a collaboration agreement with CCTG to deliver a number of large and high-profile trials across numerous tumour groups.

One of them is BR.31, an international clinical trial of a new class of cancer drug aimed at curing non-small cell lung cancer in patients who have had surgery and chemotherapy for disease confined to the lung. Lung cancer is the leading cancer killer in both men and women, and non-small cell lung cancer accounts for 80-85% of all lung cancer cases. The Phase III randomized double-blind, placebo-controlled study will enrol 1,100 patients in 14 countries.

“It serves to highlight CCTG’s incredible track record within oncology of running large and complex international trials, that of all the different options available to us to conduct this trial, we chose CCTG,” says Mr. Zarenda. Meanwhile, another trial that is part of the collaboration agreement has set a record as “the quickest AstraZeneca has ever seen a protocol go from final protocol to first subject”—just 75 days.

For Dr. Dancey, answering “important questions” is core to CCTG. She points to an investigator-initiated trial that set out to determine the best treatment—in the long-term—for earlier stage Hodgkin’s disease: chemotherapy with radiation, or chemotherapy alone. Both approaches are associated with excellent outcomes. But the trial found that chemotherapy alone is probably better in the longer-term because there are more late complications with radiation treatment.

Over the years, CCTG has published more than 2,000 articles in scholarly journals, given hundreds of presentations at international scientific meetings and made headlines in mainstream media. There is tremendous interest right now in a CCTG-coordinated trial that is the first of its kind. Funded by the Ontario Institute for Cancer Research, the trial is testing two viruses given in sequence to kill cancer cells and stimulate the immune system to wipe out cancer cells. The therapy was developed by researchers in Ottawa and Hamilton, Ontario.

Says Dr. Dancey: “CCTG is unique in Canada. And the accomplishments of the group are accomplishments of the Canadian cancer clinical trial researchers. We do great work because of the great cancer research in Canada.”

For more information, visit The Canadian Cancer Trial Groups website

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