Clinical studies | These patients who advance medicine

In hospitals around the world, patients take part in clinical studies every year and contribute to the development of new treatments for various diseases. Suffering from metastatic breast cancer, Quebecer Mélanie Dufour took part in the exercise this year. To “give it to the next”. The Press followed her in this experience.

Ariane Lacoursiere
The Press

Photos: Alain Roberge
The Press

Photos: Marco Campanozzi
The Press

A study as a gift

We are a few days away from Christmas, in December 2021. Mélanie Dufour receives the gift she was hoping for: she learns that she is eligible to take part in a phase 1 clinical study aimed at developing a new cancer treatment. She will become the third person in the world to test the whole thing.

A few weeks earlier, The Press had met the 45-year-old mother at the premises of the University of Montreal Hospital Center (CHUM). M^me Dufour was there to meet his attending physician, radiation oncologist and researcher at the CHUM Research Center David Roberge.

The latter had explained in detail to his patient the research project he is conducting. Basically: the objective is to test a new radio-immunotherapy treatment intended to slow the progression of cancerous tumors in the brain.

teacher, M.^me Dufour was first diagnosed with breast cancer on December 8, 2014, at age 38. “I caught it late. I had metastases everywhere,” says the mother of two children aged 11 and 14. Several parts of his body are invaded at this time by cancer, including the lungs, liver and brain.

The first treatments that M^me Dufour receives work very well. So much so that the cancer completely disappeared from all parts of his body except his brain, where a handful of small tumors cling. Then begins a race for treatment to try to slow down the growth of tumors or, better, to eliminate them.

The D^r Roberge explains that the treatment of brain tumors is not simple. Penetrating the blood-brain barrier, designed to be tight, is difficult. Most patients with this type of cancer can at best hope to halt the development of their tumors for as long as possible.

“There are different drugs. Patients use a drug until it wears off. We then have to move on to another, ”explains the D^r Roberge.

M^me Dufour says she has “chronic cancer”.

Rapid developments

In recent years, the development of cancer drugs has accelerated a lot, notes Dr.^r Roberge. Before, a new drug appeared every 10 years, he says. Whereas today, “it tumbles much more quickly”. In particular thanks to the multiple clinical research projects on new drugs.

M^me Dufour herself was able to benefit from a new treatment, Herceptin, a few years ago. But today, his options are dwindling. His latest tests showed that his current treatment is beginning to have less and less effect. Under these circumstances, Mr.^me Dufour chose to participate in the phase 1 study of D^r Roberge.

The patient knows that the project may not work for her. And that the disease progresses a little. “At worst, we will fall back on ordinary treatments,” she said. But we will have added an option to what I had before. »

Third patient in the world

In a CHUM examination room in mid-December, Ms.^me Dufour meets the D^r Daniel Juneau, nuclear medicine specialist. The latter explains to the patient, whom he will treat jointly with Dr.^r Roberge, what the clinical study treatment will consist of.

Several months ago, a pharmaceutical company contacted the CHUM and MUHC teams to participate in this phase 1 study. The research is in its infancy.

The treatment consists of sending radioactive treatments directly to the cancerous tumors of the patients. To penetrate the blood-brain barrier of the brain, a molecule created from fragments of camel antibodies is used and acts as a kind of vehicle. Another molecule is coupled to it: a radioactive isotope. The “vehicle” carries the radioactive isotope to the tumors and the radiation that is released kills the cancerous cells, sparing healthy cells as much as possible.

One of the interesting aspects of this treatment is that the radioactive isotope emits different types of radiation, some of which are detectable by camera, explains the Dr.^r Juneau.

M^me Dufour will become the third patient in the world to receive the treatment.

With her spouse, Patrick Leblanc, Mr.^me Dufour listens attentively to the explanations. The D^r Juneau explains that since very few patients have received this treatment so far, it is difficult to determine what the side effects may be. Nausea and loss of appetite are possible. Tired. A risk of damage to kidney function can also be considered, but preventive medication is given accordingly.

The D^r Juneau specifies that at any time, Mr.^me Dufour can withdraw from the study. But the woman is determined: she wants to move forward. “We have done a lot of the rounds of traditional medicines. This program will enable progress. If it can give others a chance afterwards to have more treatment choices, why not? It has to start somewhere, research,” she says.

“My best path so far”

Mélanie Dufour received a first injection of the experimental treatment on January 11, 2022. Then a second on February 8. In mid-February, M^me Dufour tells The Press feeling “very good”. Side effects are non-existent. “I don’t have stomach aches. Nor heart. No headaches,” she says. Her husband notes the “beautiful complexion” of his wife. “She’s gaining weight too, which is good,” he says.

The absence of symptoms is apparently “good news” for the patient. But she is also suspicious. Because M^me Dufour knows that by participating in phase 1 of the research project, the dose of treatment he has been given is low. May be too much…

Time will prove him right. 1^er March, M^me Dufour suffers a scanning full of his body. The D^r Roberge realizes that the tumors of M^me Dufour do not diminish. Worse: one of them has slightly increased in volume.

No more question of continuing in the research project; we go back to ordinary treatments.

“My body has had chemotherapy treatments for a long time. It’s as if the dose was too low for him,” says Ms.^me From the oven.

Although his patient will not have had any direct benefit from participating in the clinical study, Dr.^r Roberge explains that his participation will not have been in vain. Because since the low dose gave few side effects to the first patients, phase 2 of the research project can go ahead, with a higher dose.

The race continues

Met at her home in May, M^me Dufour does not have the morale in the heels. Quite the contrary. She has already resumed the course of treatment. “I’m trying a new drug. It’s called ENHERTU,” she says. A new molecule, “developed by other patients, like her”, notes the D^r Roberge.

M^me Dufour had just received a first dose, on May 10. And reacted quite well. ” I hope it’ll work ! I hope every time,” she says.

M^me Dufour knows that his situation is fragile. That one day, his body could say that he can’t take any more treatments. But she refuses to be upset. For her, her years of living with cancer, “it’s [son] nicest way so far”.

When she received her diagnosis in 2014, she set herself a goal: to bring her children to majority. “Afterwards, if it continues, so much the better,” she said. And if another clinical study presented itself, would she participate in it? ” Yes. I want to heal. But I also want others to benefit from what I do. »