When bringing in a new drug for clinical testing, Dr. Quincy Chu says there’s one overriding rule: expect the unexpected.
“Sometimes the unexpected is very severe side effects,” he says, listing nausea and fatigue as two common reactions. But he adds that, every once in a while, the unexpected result is discovering that a new drug causes the patient’s tumour to shrink dramatically. “You have to approach it with an open mind.”
Chu is an investigator with the Cross Cancer Institute’s New Drug Development Program, which compiles data with other clinics across Canada to help usher in new cancer treatments.
Phase One studies are the first step to getting a new drug approved. When a medication has reached Phase One, it’s been tested on animals, but not on people – Chu’s job is to find patients who are eligible for the treatments and perform extensive monitoring and follow-ups to make sure the side effects are tolerable, and to follow any progress.
At first, only a few patients are on the new treatment, but once side effects and dosage levels are tracked and guidelines established – all the while working alongside other clinics in Canada who are also testing the same drug – it can be opened up for more testing with more patients.
“We’re trying to find out early who will benefit from these drugs the most, and then figure out who else might benefit,” says Chu. “It’s very stimulating work, and if you bring one of these drugs forward and it’s successful, that’s very rewarding.”
Chu never intended to pursue a career in oncology. He enrolled into the biochemistry program at McMaster University in Hamilton, Ont., planning to keep on trucking through the world of biochemistry until he earned his PhD. But in his third year of the program, he found himself drawn to medical school and the idea of directly working with patients. In his second year of med school, while he was doing a summer project that involved both lab work and seeing patients twice a week, he decided to specialize in oncology. Why? Because it meant he would always be learning. “As an oncologist, you’re continually having to apply other areas of medicine,” Chu explains. “A patient with cancer can have heart disease or kidney disease. You need to be well-equipped with knowledge.”
In 2002, Chu entered a clinical research fellowship at the Institute for Drug Development in San Antonio, Texas, where he studied the development of anti-cancer drugs. This training gave him the experience to spearhead, alongside fellow Cross oncologist Dr. Michael Sawyer, the Cross’ formal New Drug Development Program.
You could say that becoming an oncologist heavily involved in research was a natural compromise between his interest in biochemistry (which is, essentially, studying the makeup of living things) and the medical field. And he finds the constantly changing treatment landscape to be invigorating. In the early 2000s, he explains, a drug company might have one or two new drugs a year. Now, there are 10-15 new drugs each year from each drug company. “I knew the development would be fast, but I didn’t imagine it would be this fast,” he says. “Every three or four months one of the cancer types will change practice.”
Chu specializes in thoracic (lung) and soft tissue cancers, and explains that all Cross oncologists choose one to three types of cancer to focus on. “We can’t treat everything,” he says. “The amount of new knowledge in each type of cancer is exploding so fast. If you can read everything you want to read in a month, you’re pretty lucky.” Specialization allows the doctors to keep on top of their chosen field.
At the Cross, Chu has put the most patients on Phase One trials. His reasoning for this is simple: “The way I think, there are standard treatments available, but there is always room for improvement. It’s very important to keep the momentum going, to find new and better treatments.”
The ultimate goal? To turn incurable cancer into a chronic disease rather than a death sentence. To have cancer be regarded just like high blood pressure: dangerous but, with the right medication, a chronic disease that can be managed with limited quality of life changes. Of course, not every drug that’s tested will turn out to be a breakthrough treatment, and that’s where an open mind comes in. “Magical discoveries don’t happen every day,” Chu says. “If it happens once every two to three years, I’ll be absolutely happy.”
To be eligible to go on a Phase One drug, a patient must meet the eligibility criteria, which is a checklist of about 30 items. Patients need to have normal organ functions and be healthy enough to look after themselves. Many trials require that patients do their own shopping and driving. Dr. Chu says many people assume incurable cancer automatically translates into being house- or hospital-bound, but he says just over half of patients are fairly active and, other than their cancer, are in good health.
If a patient meets the criteria, there’s still another test they must pass in order to proceed to the Phase One testing: their gene abnormality must match the abnormality that the drug seeks to treat. This narrows down the patient choice, with somewhere between two and seven per cent of patients able to meet all the criteria depending on how the trial is designed. But Chu says it increases the chance that the test will be effective. Most Phase One trials require patients who have exhausted all other treatment options. Right now, Chu is treating an American woman who came to Canada for treatment because the drug wasn’t yet available in the United States. Although she’s not cured, Chu says she’s going on six years with the trial drug. Another patient he’s treating has been taking their trial drug for five years.
In many cases, the definition of a successful treatment is stabilization rather than elimination. “Many tumours shrink but aren’t completely gone,” Chu explains. “But after it shrinks, to a certain extent the cancer stabilizes.” The two patients who have been on the trial drugs for several years, he says, “are doing everything that they wish to in life.”
And this, says Chu, is what keeps him going. Although the outcomes are not always successful, he knows he’s making a difference in patients’ lives. “Whether or not the outcome is good, the patient is very grateful,” he says, “and that gives meaning to your job.”
Chu’s mother once asked him if he regretted his career choice, if he wished that he was doing something a little happier than treating incurable cancer. His response? A very emphatic “no.”
Once he chose to go into medicine, and especially oncology, he knew he would be dealing with unhappy situations, but Chu points out that there are bleak places in every area of medicine. “I’m in an area that’s traditionally considered as a very bad disease to have, but we’ve made a lot of gains.
“Riding the wave of a new drug to see if it will let people live longer compared to the standard treatment is a very exciting situation,” he says. “The responsibility is huge, but the stimulation and knowledge you gain, you can’t beat that. I have no regrets.”
Asked and Answered
We asked Dr. Quincy Chu to finish our sentences.
I will retire: I don’t even know when I can retire. I look at my family history and I have family members still travelling the world in their late 80s, early 90s. I have quite a lot of outside interests, I like to travel. I like to go to the places that don’t make sense to visit for two weeks, you have to go for a month.
The last time I used a payphone: It has to be over 10 years ago. I’ve had a cellphone since 2000, the ones that would give you a concussion.
My motto is: Expect the unexpected.
I struggle with: Time management. I’m trying to start learning to say no.
Right now, I’m reading: A novel by Peter Robinson. I tend to like detective stories.
My job has taught me: That cancer sucks, but we can help.
What I might do if not medicine: Merchandising, shopping for other people. Ask [executive assistant Chantal Carriere] about my shoe collection.
My favourite things:
Favourite piece of clothing: Shoes.
Favourite food: Rustic flavourful food that is not frou-frou: Italian food, Spanish food and Southern French food. Very dainty Parisian food is not my thing.
Favourite drink: Single-malt scotch.
Favourite city: Amsterdam