Discussing the innovative CCTG IND.234 study with Dr. Alexander Wyatt

my name is Alexander Wyatt I’m a genomic scientist working in Vancouver at the University of British Columbia. I’ve got an involvement in the Correlative Sciences Committee and also in the Trial Design Committee for Genito-Urinary cancers. So the the IND.223 and 234 trials are important because in prostate cancer, particularly late stage prostate cancer, the cancers can be very aggressive but they’re also very heterogeneous so the standard therapies that we use are only effective in a proportion of patients and there are some patients that don’t respond at all and that only gets worse as you move down the line so when we think about how to introduce new therapies into prostate cancer if we sort of use these therapies indiscriminately across a whole population they’re likely to fail because we’ll see low response rates but if we can instead enrich the population in which we’ll test these drugs potentially by finding certain molecular subtypes that are likely to sensitize a tumor to treatment we can find a way to get these drugs to patients and therefore show efficacy in subsets so it’s about trying to find a strategy that we can get targeted agents in to prostate cancer without them failing through a large population screening and testing so we’re seeing from sort of the cutting edge research at the moment that tumor biomarkers can actually help understand which patients are likely to respond or not. But if we want to prove that and we want to really make that a you know able to be sort of implemented on a wide scale we have to prove it within the framework of a dedicated clinical trial and so that’s where I think the sort the next important trials are to be run in prostate cancer. We need to understand why and we need to think about in those patients where there isn’t a response can we elicit one through combination therapy can we understand the extreme responders the patients that responded really really well. It’s sort of about about understanding the patient because then the next time a patient comes along we are sort of better equipped to treat them appropriately. Collaborative clinical research is is many-fold but it’s mostly about leveraging expertise you can’t be good at everything. I’m a genomicist and a biomathematician and I can learn second languages in the sense of medical oncology or urology but I’m never going to be an expert in them so I’m relying on sort of leveraging other people’s expertise so so it’s critical to have experts at all levels at the table, but also from the point of view of patient diversity if you limit your sort of impression of patients to a small population within a single Province it’s probably not representative of the whole of Canada so so again collaborative research and a Canada wide scale allows you to sample that diversity and make sure that they haven’t missed things that might be present of a large population level.

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