Dr. Antoinette Wozniak, associate director of Clinical Research at UPMC Hillman Cancer Center, discusses the importance of clinical trials in cancer care and the development of a new app to make physicians and patients aware of trials in which they may take part.
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– [Host] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.
– The role of research in pioneering new treatments and cancer care. Welcome to the UPMC HealthBeat Podcast. I’m Tonia Caruso, and joining us right now is Dr. Antoinette Wozniak. She is an oncologist and the associate director of clinical research at the UPMC Hillman Cancer Center. Doctor, thanks so much for joining us.
– Thank you, I’m glad to be here.
– So let’s really begin by talking about the importance of research and clinical trials when it comes to cancer treatments.
– Our clinical trials are really very, very important. They are tests to try to find better treatments, and they’re used in medical research — not just in oncology, but in other forms of medical research. For instance, with the current COVID crisis, many of the vaccines are being tested on a clinical trial. And they actually span a variety of phases. They can be testing totally new drugs for their safety and whether they work or not. They’re looking at specific treatments in certain types of cancer, or they can actually be larger studies that compare an old treatment to a new treatment. But the goal is to try to find better treatments.
– So how many clinical trials might be underway at the Hillman Cancer Center at any given time?
– There are actually close to 500 clinical trials. And they, as I said, span a variety of phases, from new novel drugs to looking at older treatments and trying to improve on them.
– And it’s really this research that helps to set UPMC apart when it comes to cancer treatment and cancer care.
– It does. We’re actually a leader in this area of the country and probably in the whole country with regard to developing and running clinical trials. By participating, patients are actually hoping to get a better treatment, and they also contribute to our fund of medical knowledge and to helping other patients as well.
– So with 500 trials underway, can you talk a little bit about one that you’re particularly excited about? Or one you think that people might want to learn about?
– I’ll bring up one particular trial that I’m actually in charge of, and that is a trial to look at length of treatment of immunotherapy. Immunotherapy has become very important in the treatment of multiple cancers. And this is pretty much in the last five years. Unfortunately, there are many things we still don’t know, and one of them is how long to treat patients. Currently, many of the drugs are used indefinitely. And with indefinite treatment, there can be many issues, including more side effects. And it may be that patients don’t need to be treated indefinitely. And it’s a very important trial because it’s going to teach us something about what is the best length of treatment for these patients.
– And to stress the importance of clinical trials, at some time before this, there were clinical trials to test immunotherapy.
– That was a major breakthrough a number of years ago, and it has resulted in longer disease control and longer survival for many patients with a variety of tumors. I can bring up one particular cancer, and that’s lung cancer. That’s a cancer that I pretty much treat exclusively, and the immunotherapy has made great strides for many of these patients who are being treated for advanced lung cancer. They’re living longer, and they’re living better. So if it wasn’t for clinical trials, we would not come up with these treatments.
– Clinical trials are highly regulated. Can you talk about some of the standards and regulations in place?
– So the trials are very, very regulated experiments. So we start with a concept. Then, the trial is written by our physicians. And it then goes through a board — it’s called the Investigational Review Board — to make sure that everything is in check with regard to safety. We are involved in trials, not only that start here, but that are actually national trials. Some of them go through to the National Cancer Institute for approval. So there are a variety of regulations and regulatory boards that we have to go through. Once a trial starts, we have what’s called a Data Safety Monitoring Board that reviews the trials at certain time points to make sure that it’s safe and all regulations are followed.
– And really ethical standards across the board as well.
– The ethical standards are extremely high. For instance, if a Data Safety Monitoring Board review finds that the trial is not safe enough, the trial will be halted or stopped. Also, if we have a trial that’s comparing one treatment to another and we find one treatment is better than the other, then the patients are informed and the trial may be stopped for that reason as well. So it is very carefully monitored.
– So one of the benefits of coming to UPMC for treatment is that a patient may have the opportunity to take part in a clinical trial. How do they find out if they’re eligible?
– So there are a number of ways that they can find out if there’s an eligible trial. The first way is actually by talking to their oncologist in terms of whether there is a clinical trial available and whether they are eligible to participate. And the eligibility is different from trial to trial. Patients generally have to have, for certain trials, have to have good organ function. They have to have a certain level of what we call a performance status. That means they have to be healthy enough to participate in the trial. And their physician or their oncologist should be able to tell them if there’s a trial available for them. I also want to bring up the point that even though we do many of the trials here at the Hillman Cancer Center, that some of these trials, a number of them, are available in the community as well with community oncologists that are closer to home. We also have a clinical trial app that can be downloaded, and that can be searched to see if there are clinical trials available.
– If folks would like to find the app, they can search “UPMC Hillman Cancer Center Trials Finder.” Why was creating this app so important?
– UPMC wanted to create it so that for physicians, oncologists, as well as patients, they could search this app and see what is available with regard to treatment. And I think there are many patients who are very interested in looking at the possibility of participating in a clinical trial. Because I think there are many patients who are aware of their importance and the potential for improved outcomes.
– Are only cancer patients needed? Or is there ever a time when you need someone from the general public who has not had cancer to take part in research?
– Actually, it’s a good question because there are, in addition to treatment trials, there are also other trials: for instance, screening. We do have trials that are important with regard to trying to screen for cancers. Many of them include breast cancer trials. We had a large trial using radiologic techniques to try to improve on our screening for breast cancer. We also are very involved in screening for lung cancer as well. So there are other trials.
– Let’s talk for a moment about COVID-19. Did you have to put any clinical trials on hold because of it?
– So COVID-19 really did have an impact on our trials. However, what we did was we looked at the ones that we felt were most important in terms of providing good care for our patients, and those trials remained open during this crisis. Certainly we had less patients coming in because of the crisis, but we still were able to recruit patients to the clinical trials. They still got involved, and we went down in terms of the number of patients who went on, but still maintained them. And I would say we probably went down by about 50% when COVID was at its peak, but now we’re back and all the trials are currently available for patients.
– There are lots of safety precautions in place.
– Everyone has to wear masks. We screen everybody before they come into the clinic. The physicians and all the nurses and other personnel wear masks. We practice good hygiene in terms of handwashing and social distancing. But I think it’s really important to come in for your care and to consider clinical trials because they can all be safely done. We’re not done with the pandemic. We still have issues with regard to it. But I think that here at the Hillman, we’ve been very proactive about making sure that patients can come in and participate in trials and continue to get excellent care.
– In closing, the joy for you when you see a breakthrough or a patient is doing well, thanks to a clinical trial.
– Well, I get very excited, actually. When I have a patient do much better than expected, that’s probably the biggest gift I could get. So when someone does well, it’s great for not just the patient, but for us as well.
– Well, doctor, thank you so much for your time today. We certainly do appreciate it.
– Thank you.
– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.
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UPMC Hillman Cancer Center provides world-class cancer care, from diagnosis to treatment, to help you in your cancer battle. We are the only comprehensive cancer center in our region, as designated by the National Cancer Institute. We have more than 70 locations throughout Pennsylvania, Ohio, New York, and Maryland, with more than 200 oncologists. Our internationally renowned research team is striving to find new advances in prevention, detection, and treatment.