My Search for Clinical Trials
By Eric Grush (Stomach Cancer Patient)
I am a patient who was diagnosed with Stage 4 cancer at the GE junction in October 2010. Although I am no medical expert, this post outlines what I have learned searching for and participating in clinical trials.
I have been encouraged by my doctors to participate in clinical trials, which they say can provide potentially helpful treatments. It was clinical trials that led to the approval of the drug Herceptin for HER2-overexpressing stomach cancer, for example, which has been a very positive development.
Clinical trials might be available at any stage of disease or treatment. Your own hospital may offer clinical trials for your cancer - although you may have to ask your doctor to learn about them. Sometimes you may have to look for trials at other hospitals, either with the help of your doctor, or by yourself.
Aside from talking to my doctor about clinical trials at my hospital, I have also looked for trials at other hospitals in my area. Debbie's Dream Foundation has an interactive map that shows the clinical trials for gastric cancer in each state (seehttp://debbiesdream.org/portal/web/guest/clinical-trials1). Even a trial that requires travel, however, could be a good treatment option - for example, if it targets your specific genetic tumor profile. I live near Chicago and am participating in a trial in Philadelphia now. How often you may need to travel varies from trial to trial.
Because many trials are for targeted therapies directed at specific gene alterations, amplifications, deletions or over expressions, it is often necessary to have your cancer tissue tested for the relevant alteration. As it has been explained to me, cancer is often driven by alterations in genes that are not inherited, but instead develop since birth, and it is those alterations that are often the targets of clinical trial drugs, as was the case with Herceptin and HER2.
To have your tissue tested for the genetic alteration or modification relevant to a clinical trial, you can send a sample of your cancer tissue to the trial. Or you can be tested for hundreds of different genetic alterations at the same time by sending your cancer tissue to a company that specializes in such testing. I had testing done by Foundation Medicine in Boston, which provided a summary of my alterations and clinical trials with drugs that address them. This led me to the clinical trial I am in today. There are other companies that provide the same sort of services as well, which your doctor may be able to recommend.
Once you know about the amplifications or alterations in your cancer tissue, you can also look for relevant clinical trials by searching for the name of the gene atclinicaltrials.gov or at the website mycancergenome.org. The trials do not always need to be specific to gastric cancer (although many are); some instead are open to all patients with solid tumors.
Other clinical trials do not address these types of alterations, but may nevertheless require testing of your cancer tissue. For example, the trial for an immunotherapy drug targeting PDL-1, which has received a lot of press coverage lately, requires testing of tissue by the trial sponsor. Other trials may not require any testing of your cancer tissue, for example, if they are not targeted at specific alterations.
For those trials that do require tissue testing, it is better to use a more recent biopsy rather than an older one, I've been told, because cancer mutates over time.
Participating in a clinical trial has also given me satisfaction that I am playing a part (however small) in the development of new treatments for cancer.