Editor’s note: Despite so much of the world’s collective attention being focused on the COVID-19 pandemic, the war against cancer continues. In recognition of World Cancer Day on Thursday, WRAL TechWire talked with Patrick Nealon, head of oncology, at global life science firm Syneos Health which is based in the Triangle. A veteran of nearly 20 years in fighting the disease, he says he has many reasons to be hopeful about mankind’s ongoing struggle to better understand and treat the disease as he spells out in our exclusive Q&A. The theme of World Cancer Day is “I Am and I Will.” Nealan brings that kind of attitude to the fight.
- How has COVID-19 affected the continuing war against cancer? Has there been a diversion of resources and research? Is cancer a lower priority?
For the sake of patients, I’m happy to say that we are generally living in a “golden age” for cancer research and discovery. Our knowledge and ability to have direct impact on tumor cells is increasing at a rapid pace and patients are living longer thanks to advances in genetics, immunotherapy and precision medicine.
As with all parts of our life, COVID-19 has had an impact on this, including on research and patient care.
COVID-19 has posed unique and dangerous challenges for cancer patients. These patients are more vulnerable to infections because cancer treatments can suppress the immune system. For cancer patients who do contract the virus, they have an increased fatality rate. For example, in China, patients with cancer were more vulnerable when infected, with a case fatality rate of 5.6 percent, compared to 2.3 percent in the general population. This has caused challenges to patients receiving treatments and participating in clinical trial research.
One other consequence of the pandemic, I believe, is that people – cancer patients and others – are delaying their routine or annual physician visits, assessments and standard tests. In addition, a number of preventative screenings and biopsies have been delayed by the medical community who have been asked to focus on COVID-19. Once the medical community can return their focus to routine screenings I am truly concerned about the potential increase in the number of late-stage cancers.
On a positive note, the clinical development industry has adopted a variety of innovations to keep patients and clinical research staff safe; ultimately allowing research and development to continue during the pandemic. In fact, this public health emergency created under COVID-19, may well usher in a new wave of innovation in how we handle clinical trial execution in the future.
For example, now in person visits have been converted to telemedicine visits when possible and in-home care has increased. Instead of having a patient visit a site, trained staff or mobile nurses visit patient homes to administer the study drug or carry out visit assessments required by the protocol.
Additionally, at Syneos Health we continue to look at smart ways to use retrospective data and technology to streamline the oncology trial process. For example, we are partnering with a company to create standard or external control arms for oncology studies. This means that trials can be re-designed, decreasing the number of patients that need to be included and cutting down on recruitment time. This approach also avoids the need to give patients a placebo drug, but instead we can use retrospective patient data in a trial. This speeds research and is a more ethical alternative that can be used in some instances.
- Conversely, has the pandemic triggered more interest in fighting cancer, i.e. more attention to taking medications and making lifestyle changes – especially in at-risk groups – to avoid a COVID infection?
No, I don’t believe the pandemic is directly aligned to more interest in fighting cancer. Having a routine can be helpful at any time, particularly if you are trying to establish healthy habits, but these routines can be particularly important when aspects of your life feel uncertain. The disruptions caused by the COVID-19 pandemic have dramatically altered many people’s normal routines, which makes it that much harder to cope with the stress that people are feeling.
Research has consistently shown that routines can play an important role in mental health. One study, for example, found that routines could help people better manage stress and anxiety. Having a regular routine can help you:
- Take better care of your health, by taking medications on a routine basis
- Lower stress levels
- Form good daily habits
- Help you feel more productive
- Help you feel more focused
Getting necessary tasks out of the way can also help you find more time for healthy behaviors like exercise and leave you more time to enjoy fun activities and hobbies.
- Syneos Health is involved in a variety of clinical development and cancer therapies, including Immuno-oncology, targeted therapies, and novel and emerging therapies such as cell and gene therapies and rare cancers. Do you see advances being made (if so in what areas of significance) and are you optimistic about the future?
Absolutely, we see hope. The science is moving at a rapid pace and we’re seeing the life-saving impact that new treatments can have for patients. COVID-19 has only further fueled the urgency that we feel for the many patients still losing their battles with cancer and we strive to innovate to change the history of cancer.
For example, let’s look at immuno-oncology. In the last decade since the first checkpoint inhibitor was approved, treatment options with novel checkpoint inhibitor and immuno-oncology therapies (I-O) have been expanding as drug developers investigate their use in combination with other medications like chemotherapy, radiotherapy or targeted therapies to name a few. As a result, there are now numerous I-O therapies and combinations of therapies under study with the goal of improving the rate, depth and duration of response in patients.
We couldn’t do any of this without patients. We are deeply grateful to the cancer patients who, by participating in clinical trials, make it possible for all of us, working together, to collaborate for a cure.
- Gene therapy has become an emerging hub here in the Triangle. How could genetics and immunotherapies change the war against cancer? Are these the ultimate weapon?
Cell and gene therapy represents a new frontier in the fight against many devastating diseases, including certain cancers, providing hope to these patients. Although there are only seven approved gene therapies available in the US or EU market as of July 2020, there are hundreds more in development, including 67 oncology therapies. Additionally, as of the end of Q3 2020, there were approximately 202 cell therapy trials ongoing.
- Your company says it is an early pioneer in immunotherapy clinical trials and conducted several studies that led to the approval of the very first checkpoint.
At Syneos Health our ultimate goal is deliver life-saving therapies to patients. To do this we operate at the forefront of innovation. We have more than 4,400 employees dedicated to partnering with biopharmaceutical clients to pioneer novel approaches to oncology drug development. For example:
- We are proud to say that we worked on the clinical trials and commercialization for the first T-Cell checkpoint inhibitor immunotherapy for the treatment of skin cancer (melanoma). Checkpoint inhibitors work by blocking the receptors that cancer cells use to send signals to T-cells. When the signal is blocked, T-cells may be better able to differentiate a cancer cell from a healthy cell and launch an attack.
- We continue to be involved in the design and execution of immunotherapy trials, often including combinations of these CPIs with more novel immunotherapy approaches, including innovations involving cell and gene therapies. In the case of cell therapies the cells themselves are the basis of the treatment and can be autologous (using the patient’s own cells) or allogeneic (cells from donors or other sources). Most gene therapies address the abnormal genetic code solution by inserting new DNA to replace, silence or remove the existing genetic coding causing the disease.