In Pursuit Of A Cure: Cancer Research In Northern Michigan

Jan. 8, 2016

For most, the term “cancer research” conjures up images of university laboratories, scientific institutes and metropolitan medical centers. Yet local community hospitals across northern Michigan are also playing a crucial part in the search to find a cure. Regional research coordinators, oncologists and medical investigators discuss how studies being done in our own backyard are helping advance cancer treatment breakthroughs.

A registered nurse with a background in research and oncology, Munson Medical Center Cancer Research Coordinator Leah Holden- Corbett acts as a key liaison between patients, physicians and outside agencies. Holden-Corbett’s primary responsibility: Enrolling and monitoring patients in clinical research trials, or national studies used to improve the detection, treatment and prevention of cancer.

Munson has participated in clinical trials for over 30 years, but the organization expanded its scope in 2014 when it joined with 10 other health care systems to form the Cancer Research Consortium of West Michigan. The Consortium receives $1.9 million annually from the National Cancer Institute (NCI) to offer cancer education, and to provide patients with enrollment access to federally funded research studies.

An estimated 25–30 Munson patients are enrolled annually in such studies, according to Holden-Corbett, who helps review patients’ diagnoses and health histories to match them with qualifying trials.

“A lot of what we look for is dictated by the protocol itself, because there are certain demographics the study is looking for,” said Holden-Corbett, such as age, gender and type and stage of cancer. “We also want to find someone willing to participate and willing to commit to the trial (requirements).”

Munson primarily focuses on “phase three” clinical trials, or those involving large numbers of patients in which drugs or treatments that have already been tested safely in humans are further evaluated for effectiveness, dosage levels or comparison to standard treatments (“phase one” trials – the most experimental, involving a small group of people on which a drug is first tested — are typically not available in northern Michigan. “Phase two” trials — those where a newly, safely tested drug is expanded to a larger study group – occur more frequently).

While enrolled in phase three trials, Munson’s patients “are always getting at a minimum the standard treatment” given to other patients, Holden-Corbett explained, with a nearly identical care process. Deviations in treatment then, are in excess of or beyond standard care. A colon cancer patient, for example, might receive a standard cycle of treatment, plus a new oral medication being evaluated for use in reducing the risk of recurrence. Or the effectiveness of a proven drug might be further improved by testing different dosage levels, and/or combining the drug with other treatments.

Throughout the trial process, Holden- Corbett — working in conjunction with the patient’s oncologist — carefully collects data, monitors patient symptoms and follows the patient’s health status, even after they’ve completed treatment. “It’s a special kind of relationship,” Holden-Corbett said of trial patients. “It’s a lot of one-on-one time.”

Tangible benefits have resulted from northern Michigan patients participating in clinical trials — both for the involved individuals, and for the medical community as a whole. “I’ve had a couple of really good responses in my experience, where the cancer is responding well and people are given hope when they’ve seen remarkable tumor-sized shrinkage,” said Holden-Corbett.

Even in trials with no immediate apparent effects, patients have responded positively to knowing “that even if it doesn’t help them right now, it could help people in the future as we’re able to rule out whether treatments are beneficial or not,” she said.

Radiation oncologist Dr. Thomas Boike of McLaren Northern Michigan and Traverse Bay Radiation Oncology has heard similar feedback from patients. Seventeen percent — or 138 — of McLaren Northern Michigan’s new oncology patients in 2015 were enrolled in clinical trials. “Cancer is a life—changing diagnosis,” Boike said. “A lot of people are searching for something they can do to take some control back over cancer. Patients in clinical trials get the immediate benefit of knowing they’re making treatment better…if not for themselves, then for their kids or friends or people in the future.”

Instead of limiting clinical trials to academic centers or major city centers, conducting studies in communities like Traverse City and Petoskey benefits patients and researchers, according to Boike. “It doubles the number of patients that are exposed to clinical trials, which helps (studies) complete quicker,” said Boike. “It also gives patients a chance to access medicine or treatment they might not otherwise receive.”

Boike gave the example of a recent breast cancer trial involving 15 McLaren patients that called for reducing a radiation treatment period from 4–6 weeks to three. With many northern Michigan oncology patients having to travel considerable distances to receive care, patients were “eager to participate” in the study, which helped alleviate that burden, he said. Without the ability to participate in clinical trials, patients are limited to traditional standards of treatment and can’t benefit from alternate options offered by research studies.

Boike also said that with the majority of U.S. cancer patients receiving treating at local community health centers, “it’s incredibly important that research get done in the community.”

“If we really want medicine to get better, we have to focus our research on the most common types of cancer,” Boike said, not just rarer forms of the disease prioritized in academic settings.

Oncologist Dr. Joshua Ruch, who practices with Munson in Traverse City and Grayling, echoed Boike’s remarks. “It’s not realistic to think universities are going to be able to tackle all the research needs in oncology,” Ruch said. “These studies require a large number of patients to participate. Most patients with cancer are going to be treated in a community setting, so trials like these give us a more accurate flavor of what the real-world experience is going to be like for treatment.”

So what types of breakthroughs might northern Michigan research ultimately contribute toward advancing? Both Boike and Ruch point to “targeted” or “precision” therapies and immunotherapy as the next big leaps forward in treatment.

“We’re getting ready to open a lot more phase two trials looking at specific genetic mutations, and whether we can guide therapy for patients who have those mutations,” said Boike. “With the advent of immunotherapy, it’s looking at…whether there may be a cocktail that harnesses the power of the patient’s own immune system to help fight or cure the disease.”

“It’s a rifle versus a shotgun approach,” Ruch explained. “It’s targeting specific genetic alterations, as opposed to standard chemotherapy, which kills a lot of normal cells along with the cancer cells. It’s the next big shift.”

And with each clinical trial that area hospitals — and patients — contribute toward completing, researchers get closer to unlocking the secrets of conquering cancer. “Every year, there are new therapies coming to the market,” Ruch said. “But they don’t come to the market without extensive clinical trial testing. So our role is hugely important.”