Tomorrow's Cures Today
Patients at Children’s have access to the newest and best treatments because our physician-scientists are national leaders in the effort to make childhood cancer a thing of the past.
A child diagnosed with cancer in the 1950s had a mere 20% chance of surviving the next five years. Today, those numbers are reversed: On average, 76% of pediatric patients beat cancer.
Dr. Douglas Hawkins betters the odds for kids like Nick Wilson by developing clinical studies that improve cancer treatments and lead to higher survival rates.
What's behind this dramatic turnaround, and why are the outcomes at Children’s among the best in the nation? The answer is clinical research trials.
Children’s physician-scientists are creating and leading national clinical trials that test the effectiveness of new treatments for a range of cancers, including very rare ones. This means that patients treated here have access to the cures of tomorrow, today.
In the middle of a soccer game, Nick Wilson developed excruciating back pain. Twelve years old at the time, Nick sat out the rest of the game, bewildered by the sudden pain. Mysteriously, the pain evaporated, only to reassert itself a month later. The pain increased in intensity and frequency, kept him from sleeping and defied diagnosis by his pediatrician.
After six months of fruitless searching for the pain's source, Nick had an MRI at a local community hospital in May 2005. He and his parents, Barb and Ernie Wilson, were alarmed to hear the MRI had "found something" on Nick's spine and that he needed to go to Children’s "within the hour."
After additional tests later that same afternoon, doctors at Children’s explained that Nick had Ewing sarcoma, a malignant tumor centered in the base of his spine.
Though the news was shocking and scary, the Wilsons were relieved to finally have a definitive diagnosis. "Once we were at Children’s and the diagnosis was so clear, we knew we were in the right place," says Ernie Wilson. "They described his pain exactly, and knew just what needed to be done."
A biopsy confirmed the diagnosis. Nick's oncologist, Dr. Douglas Hawkins, explained that the cure rate for cancers of that type was about 65%.
Changing the outcome
Pediatric cancer is rare — only about 1% of the cancers diagnosed in the United States each year are in children. The small numbers make pediatric cancer difficult to study; no individual hospital has enough patients to generate statistically significant samples. So, in the late 1950s and early 1960s, pediatric academic medical centers — including Children’s — started working together to develop cancer treatments specifically for children. They began to pool patient data and information about new treatments, and to systematically compare therapies to see which was most effective. Survival rates began to rise.
More than one option
Research nurses Celeste Oglesby and Lauren DePue make sure families of patients in clinical research studies have the information they need to feel confident about participating.
Fortunately for Nick, by coming to Children’s he was cared for by one of the nation's top pediatric physician-scientists studying the soft-tissue and bone tumors known as sarcomas. At the time of Nick's diagnosis, Dr. Hawkins was leading a clinical trial within the Children’s Oncology Group, an international consortium of pediatric cancer centers, testing a new way to treat Ewing sarcoma.
As he laid out the options to Nick and his parents, Hawkins explained the opportunity to participate in a clinical trial comparing the standard treatment of chemotherapy every three weeks with an accelerated regimen of chemo every two weeks. If Nick enrolled in the trial, he would be randomly selected to have either the standard or the experimental protocol.
Nick liked the possibility of a quicker treatment plan and was immediately interested in participating in the trial. "I just wanted to get it over with, pretty much," says Nick, now 15. But his parents were skeptical. "Well, you know, you hear about experimental medications and some people ending up worse off," says Ernie Wilson.
Hawkins explained that the treatment was part of a phase III trial — meaning the drugs had already been proven to be safe and effective for this type of cancer. The clinical trial would determine whether giving chemo more frequently over a shorter period of time was more effective than the less-frequent dose.
"Dr. Hawkins was very clear that the medicine was the same and that Nick would receive the same level of care whether we joined the clinical trial or not; there was no pressure to participate at all," recalls Barb Wilson.
Reassured, the Wilsons enrolled Nick in the trial, and he was selected for chemo every two weeks. Nick's treatment also included surgery to remove the tumor once the chemotherapy had shrunk it, and a month-long course of radiation.
Now, two years later, Nick is cancer-free.
The next wave of cancer care
The Ewing sarcoma study Hawkins recommended for Nick showed that shortening the time between chemotherapy treatments improved survival rates by 11%, and it is now the national standard of care for treating this type of cancer.
Hawkins is now studying the possibility that some chemotherapy can be individualized based on a person's genetics. He's collaborating with pharmacologist Jeannine McCune of the University of Washington School of Pharmacy and the Fred Hutchinson Center Pharmacokinetics Lab, and with Children’s oncologist Dr. Julie Park, to understand how genetics affect how medicine is metabolized. If the dose can be individualized, side effects could be minimized, says Hawkins.
He is frank about how much more remains to be done to cure childhood cancer. "Our failures are right in our face. Our treatments don't always work, and when they do, they have terrible side effects. So until those two things disappear — until we cure everyone, with no side effects — we have a mission."