Clinical trials can extend life, CancerCare Manitoba is working to catch up

Nine years ago, Winnipeg resident Mark Domko, 52 at the time, went for a routine checkup with his family doctor.

“My doctor said that, ‘I’ve noticed something, and I’d like to refer you,'” Domko said.

Domko went for testing and a biopsy at CancerCare Manitoba.

“Then they came back, and the words ‘cancer’ were right there,” he said.

He was diagnosed with prostate cancer. About a month later, he had a prostatectomy, followed by radiation. But two years later, his cancer returned.

That’s when Dr. Jeff Saranchuk, the CancerCare Prostate Centre’s medical director, asked him about participating in a clinical trial for a drug called enzalutamide, which is used to treat prostate cancer in patients who have undergone surgery or hormone therapy.

“There was a new method of treating it … which at the time, otherwise wouldn’t have been available in Manitoba,” Saranchuk said.

Prostate cancer depends on testosterone to grow, Saranchuck explains, but it can adapt to survive without it, a state called castrate resistance. Enzalutamide works to prevent that type of growth. It can effectively pause the cancer’s growth for months or years.

Domko took the drug for four years and was followed closely by CancerCare. He continued his work as a truck driver and led a relatively “normal” life.

“It was nothing short of amazing,” he said. “Everybody was fantastic.”

“They gave me another tomorrow.”

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Clinical trials are used to research procedures or drugs to treat disease. A patient participating in a trial will receive treatment that differs from the standard course of action for their disease.

“These are very well-regulated. These are not experiments on people,” said Jim Slater, CancerCare Manitoba’s chief of research, adding that many trials are followed nationally and internationally.

If a facility doesn’t participate in a clinical trial, it can mean some patients lose out on life-prolonging — or life-saving — care.

In recent years, CancerCare Manitoba’s participation in clinical trials has dwindled. In 2019, CancerCare had 65 trials open to accrual, or accepting eligible participants. Fourteen new trials were also activated. Since then, those numbers have trended down. There are just 28 trials open currently, six of which began this year.

LISTEN: 680 CJOB’s Richard Cloutier podcast on cancer and clinical trials

“We had issues with our clinical trials, in particular in how we were organizing and operationalizing them,” Slater said. “We overuse the word ‘crisis,’ but we were at a point where we were not getting trials open in a timely way.”

The pandemic slowed things down, he added, but that’s “no longer an excuse.” Internal red tape slowed things to the point Slater was hired about a year ago to turn things around.

“COVID made us grumpy with each other, so that wasn’t happening. It is now,” he said.

“I would like to be able to say a year from now, we’ll be talking to you about more locally initiated trials, investigator-initiated trials.”

Slater also wants Manitoba to become a leader in clinical trial research.

“I want to be sure that we’ve left a system here that is continuing to be at the table to initiate and develop clinical trials, if not new drugs and novel treatments, and that we can be hosting or co-ordinating or leading across the country.”

That kind of work could give patients like Domko more time.

“I know my cancer isn’t gone, and it will come back, and I’m OK with that. And that’s because I have an amazing team,” he said.

He’s no longer part of the clinical trial after doctors found a new tumour, but he hopes the trial and others like it can help other patients in their treatment. He recalls seeing another patient at CancerCare handing in empty forms, declining to take part in a study.

“I looked at him and I said, ‘You know what? I’ve been in this study for nine years now at this hospital, and they take phenomenal care of you. I would think about it dearly if I was you.’ And he kept the paper. So if I help one person, hopefully it was him.”