Categories
Lung Cancer Patient Events

The Patient Exchange: Improving Diversity in Clinical Trials

The Patient Exchange: Improving Clinical Trial Diversity

Edited by: Katrina Villareal

The Patient Exchange: Improving Diversity in Clinical Trials
Hosted by The Patient Story
Take part in a transformative conversation with five Black patients as they share their personal journeys navigating clinical trials. This program tackles cultural and social barriers head-on, offering insights on starting discussions with your doctor, understanding enrollment, and overcoming mistrust and misinformation. Learn why cancer clinical trials are not so much about placebos but about “getting tomorrow’s medicine today,” and gain the knowledge to make informed decisions for your health.
Powered by
Powered by

Take part in a transformative conversation with six Black patients as they share their journeys navigating clinical trials. This program tackles cultural and social barriers head-on, offering insights on starting discussions with your doctor, understanding enrollment, and overcoming mistrust and misinformation. Learn why cancer clinical trials are not so much about placebos but about “getting tomorrow’s medicine today” and gain the knowledge to make informed decisions for your health.

Know how to bring up clinical trials with your doctor. Understand the screening and enrollment process. Listen to real patients discuss their clinical trial experiences. Help dispel the myth of placebos in cancer clinical trials. Overcome mistrust, lack of info, and other traditional cultural barriers.


Johnson & Johnson - J&J

Thank you to Johnson & Johnson for supporting our patient education program. The Patient Story retains full editorial control over all content.

This interview has been edited for clarity and length. This is not medical advice. Please consult with your healthcare provider for treatment decisions.



This great conversation is a true discussion where we can talk about barriers in the African American and Black community and the hesitation that some of us often feel when we want to go on a clinical trial.

Tiffany Drummond

Introduction

Tiffany Drummond: I’m a patient advocate with over 20 years of experience in cancer research. My journey as a care partner began when my mother was diagnosed with endometrial cancer in 2014. I quickly realized the challenges of finding reliable information to support her care, so I am committed to helping others avoid similar difficulties.

At The Patient Story, we create programs to help you figure out what comes next. Think of us as your go-to guide for navigating not only the cancer journey but your overall health journey. From diagnosis to treatment, we have you covered with real-life patient stories and educational programs with subject matter experts and inspirational patient advocates and guests. I truly am your personal cheerleader here to help you and your loved ones best communicate with your healthcare team as you go from diagnosis through treatment and survivorship.

Before we get to our speakers, we want to thank our sponsor Johnson & Johnson for its support, which helps us host more of these programs for free to our audience. The Patient Story retains full editorial control over all content as always. We also thank all of our promotional partners for their support, allowing our programs to reach the audience who needs them. I hope you’ll find this program helpful, but please keep in mind that the information provided is not a substitute for medical advice.

Tiffany Drummond

You may be wondering: what exactly is diversity in clinical research and why is this so important? Diversity in and of itself is vast in terms of what it means in specific settings. We’re going to focus on the experiences of Black patients. For instance, when we look at cancer and chronic conditions that increase the risk of developing cancer, Black people, who make up 14% of the US population, have a higher incidence and mortality rate.

Research is going to be paramount in understanding and eliminating this disparity, yet only 5 to 7% of Black patients are clinical trial participants. The panel you’re about to meet is representative of those who go on clinical trials. The conversation is going to be one that I hope resonates with everyone within and outside the Black and African-American community to help move research and development forward and be made accessible to all.

This great conversation is a true discussion where we can talk about barriers in the African American and Black community and the hesitation that some of us often feel when we want to go on a clinical trial. This conversation is going to resonate with us, especially in the Black and African American community because we don’t often talk about it, except when we’re thinking about the mistrust and other things that we’re going to get into throughout this conversation.

I had a bad taste in my mouth about clinical trials because my dad joined them and they didn’t work for him.

Gwen
Cayla

I have with me current and former clinical trial participants, incredible panelists, and patient advocates. I also have with me Tony Williams, who is with The Patient Story as our head of diversity and inclusion and also a diffuse large B-cell lymphoma survivor. We also have Gwendolyn, a cervical cancer survivor, and Shyreece, a non-small cell lung cancer survivor. Because not all clinical trials are cancer-based, I have LaTisha, Latasha, and Cayla who were on clinical trials or at least screened for clinical trials for uterine fibroids, a chronic condition.

Clinical Trials Knowledge

Tiffany: If you’re familiar with The Patient Story, often we talk about the medical aspect of the patient story and experience, but what I want to talk about is getting to the point of clinical trials.

Cayla, how did you first learn about clinical trials? Was it through a healthcare provider or were you already well-versed in this space? What was that experience like for you?

Cayla: My mom was diagnosed with uterine fibroids and she learned from her gynecologist about a clinical trial that was going on. I didn’t even know I had fibroids. I was diagnosed at the trial and followed up with my healthcare provider, so it opened my eyes to my diagnosis.

The Patient Exchange - Improving Diversity in Clinical Trials

Tiffany: Tony, what about you? Were you familiar with clinical trials before you started this journey?

Tony Williams: I’ve always been familiar with clinical trials, stemming back to the Tuskegee experiment and Henrietta Lacks.

When I was diagnosed in 2021 with stage 4 DLBCL, my front-line treatment was R-CHOP, which wasn’t as successful as we needed it to be so I relapsed. At the time, CAR T-cell therapy was being developed, but it wasn’t available for my type of cancer, so I waited about 4 or 5 months before CAR T-cell therapy became available for me. Participating in that clinical trial was a giving back and a next stage for me. My first and second line of treatments failed and that’s how I fell into it.

The Patient Exchange - Improving Diversity in Clinical Trials

Tiffany: Shyreece, what about you? Were you always familiar with clinical trials or was this something that happened when you started your cancer journey?

Shyreece: I was ignorant about what cancer was and what clinical trials were. It wasn’t my world when I was first diagnosed in 2014, but I’m happy to be living now for over 10 years with active cancer.

I first heard about the clinical trial through a team of doctors when I was initially diagnosed. One oncologist said you need resources to have clinical trials in your local clinic. She didn’t have access to it. I needed to accept my diagnosis and the intravenous chemo that was given to me. I stayed one month with her and then decided to get a second opinion from the University of Michigan, where I had more options.

I moved to California and in 2022 at Stanford University, I had no idea that the mutations from the targeted therapy would no longer respond to any treatment, so they started popping up and growing. My doctor, whom I greatly respect and trust, said for two years that he looked out for a trial for me. They worked to get it to their hospital so that I could try it. I’m currently on it and I’m doing well. The tumors are disappearing. I’m excited to look at possibly another 10 years of living with a deadly cancer.

Shyreece

Tiffany: That is a perfect story to share because you went from not knowing what a clinical trial was to knowing medical terms and things that you didn’t know before, and that is inspirational at best. Gwen, did you know what a clinical trial was? How did this come into your purview?

Gwen: My father was diagnosed with lung cancer. I had a bad taste in my mouth about clinical trials because my dad joined them and they didn’t work for him.

Going into any treatment, you’re always going to have apprehension, but it’s the next step and you’ve come this far. Participating in a trial was a no-brainer for me.

Tony Williams
Tony W. feature profile

Clinical Trial Screening Process

Tiffany: Tony, can you share your experience about the screening process itself? Was it stressful for you? Did you feel supported?

Tony: My first two lines of treatments failed. Because I was at UNC Chapel Hill Medical Center, they offer a lot of different types of screenings and trials, so I was part of a university program that they were working on. UNC is a teaching hospital and because my oncologist was heading that up, it was easy for me to be screened. I didn’t have to go through anything. It was a matter of deciding if I wanted to participate. It was that easy.

You always have that anxiety because you never know. Whatever you’re participating in, you want to see the desired result at the end, which is to be made whole and healed. Going into any treatment, you’re always going to have apprehension, but it’s the next step and you’ve come this far. Participating in a trial was a no-brainer for me.

The Patient Exchange - Improving Diversity in Clinical Trials

Tiffany: That brings up a point about where to go to access clinical trials. Oftentimes, it is going to be a large academic research center, but not everybody has access to that. There are local sites as well. We have to get that knowledge to the community about where these sites exist. Going to a larger research center like UNC, you will get comprehensive care.

LaTisha, when you were going through the screening process, did you have any hesitancy? More importantly, were there any barriers for you, like with transportation? Did you have to travel far? What was the experience like for you?

LaTisha: I’m in the hospitality industry, so it was hard to sync my schedule. I had to wait a little longer than anticipated to go to my first appointment to get the initial information on everything I needed to do, so that was pretty hard. It was around 15 miles away and I don’t drive, so those were barriers for me when I first started the screening process.

LaTisha

Tiffany: Thank you for being transparent. Those are barriers that exist and can prevent you from going on a clinical trial. Maybe you are eligible, but you can’t get there. With trials, you tend to have to go more often than you would for your standard care because it’s more comprehensive and they’re doing a lot of data collection. I know the medical community, especially the research community, is looking into how they can build in these added costs that affect participants’ ability to join the trial.

The Patient Exchange - Improving Diversity in Clinical Trials

Receiving Treatment on a Clinical Trial

Tiffany: This conversation is specific to the Black and African American community participating in clinical trials, so hesitations and mistrust come into the intervention itself. For participants who received an investigational drug, starting with Shyreece, what can you tell me about the information you received when you were told about the clinical trial and what your treatment was going to be? Did you feel like you were a test subject or guinea pig when they were giving you the information?

Shyreece: ALKOVE-1 is a clinical trial studying NVL-655 for patients with advanced ALK-positive non-small cell lung cancer, which I’ve had for over 10 years. For someone to come and tell me after fighting that long that they’ve got something for me is incredible.

My doctor said, “I’ve been watching your cancer. I’ve been watching you and getting to know you, so I think that this is good for you.” The doctor-patient trust was already there because I trusted him along the journey through other things that he was doing. He said, “We’re going to counteract your cancer this way. We’re going to try this, slow it down, but the resistant mutations are always going to pop up, but I got something for you. We’re going to wait.”

The Patient Exchange - Improving Diversity in Clinical Trials

He was trying to get his clinic ready to receive all of the resources needed to accommodate me in that trial as much as they could. I asked about transportation and all those barriers because I would have to go every week. It was an investigational drug, but I’m a power horse, so if there’s hope attached to it, then I’m going to try it. I’m not influenced by culture. I’m influenced by my trust in God and my doctor.

I can’t speak for everybody. If you don’t have that connection and trust with your doctor, I say find another one. I had no problem with going into the NVL-655 clinical trial because it was fully explained to me. I knew what the risks were. They sent the information to me by email and I had a month before I signed the consent form. I was very well informed and I knew that he was waiting on that trial for me. When the study coordinator gave me her cell phone number, I knew I was going to be in good hands.

It was an investigational drug, but I’m a power horse, so if there’s hope attached to it, then I’m going to try it.

Shyreece

Placebo-Controlled Clinical Trials

Tiffany: Here’s the question that’s going to need some unpacking, especially in the Black and African American community. When it comes to treatment, we don’t understand placebo, especially when it comes to cancer and chronic conditions. Before I get into that, to clarify, what are your thoughts on placebo-controlled clinical trials?

Gwen

Gwen: After someone tells you that you have 15 months to live, you’re at the point where you accept whatever you can do to stay alive and to see your grandchildren grow up. You’re going to do whatever you have to do. I knew I had some more living to do. She said, “You have to trust the team. You have to trust God first and then you have to trust the medical team,” and I trusted MD Anderson.

I met my doctor at a retreat by a cervical cancer organization called Cervivor. She was a doctor at MD Anderson and I was going to another hospital at the time. I used to be a case manager, but I was having so many issues as a case manager that I needed a case manager.

At the retreat, I was crying to her. I said, “They don’t care about Black women. They don’t care about the women in my community.” She looked at me and said, “I care. Call me when you get back.” She has been true to her word. I reached out to her and said, “I need to know some things about clinical trials.” Her team reached out to me. It’s all about trust.

The Patient Exchange - Improving Diversity in Clinical Trials

Tiffany: What often happens is when you go on a clinical trial, you get more comprehensive care. They want to know if the study drug or new combination is working for you. Maybe it doesn’t, but it may work for the next person. These experiences are what this program is about because when it comes to clinical trials, we don’t often get to see that experience. We only get to read about it or hear about the bad things that happen. Cayla, do you have any thoughts on placebo-controlled clinical trials?

Please note that the use of placebos in cancer clinical trials is very uncommon. In nearly every case, cancer clinical trials compare a new treatment or combination of therapies to the existing standard of care, rather than a placebo.

The Patient Story

Cayla: Automatically, you go in and say, “I’m going to try this and I’m going to be healed.” That’s the positive aspect, but not everyone is getting the medication. You don’t understand that a placebo has to be in effect. Try to do as much research as you can and reach out to the staff or someone you have a rapport with on the team. They can’t tell you if you’re getting a placebo because you might drop out. You should go in there knowing that you might receive the placebo and the next person next to you might receive the medication. Who knows? The person may receive the treatment and yet not have it work for them.

The Patient Exchange: Improving Diversity in Clinical Trials
Hosted by The Patient Story
Take part in a transformative conversation with five Black patients as they share their personal journeys navigating clinical trials. This program tackles cultural and social barriers head-on, offering insights on starting discussions with your doctor, understanding enrollment, and overcoming mistrust and misinformation. Learn why cancer clinical trials are not so much about placebos but about “getting tomorrow’s medicine today,” and gain the knowledge to make informed decisions for your health.
Powered by
Powered by

For anyone on a clinical trial, you will never not get anything. That is unethical. If you go on a clinical trial, you are at least going to get the standard of care for your condition.

Tiffany Drummond

It’s all about research and trying to understand as much as you can. There’s a lot of information out there and it discourages everyone from trying to be a part of the trials. People use verbiage that a lot of the people in the community don’t understand. Instead of explaining in-depth, the staff members look at us wondering why we don’t know. I’m a little 50-50 with the placebo. I’m proud of the trial, but I understand why the placebo is needed.

Tiffany: I’m glad you said that. This is what I always drive home. For anyone on a clinical trial, you will never not get anything. That is unethical. If you go on a clinical trial, you are at least going to get the standard of care for your condition. You’re never not going to get that.

What may happen is they give you the standard treatment in addition to whatever investigational drug they’re researching or a placebo. Oftentimes in our community, we think that they’re not giving us anything. This is the last resort, so we’re getting a placebo. This isn’t true.

Cayla

You can ask. If you’re going into an office and they’re offering you a clinical trial, ask, “What’s the minimum I’m going to get? Am I going to get treated for my condition?” No matter what it is, whether it’s a headache or diabetes. “What is my alternative?” They should tell you in the consenting process what your alternatives are and the options that you’re going to be getting on the trial.

I didn’t want to have surgery. I wanted the bleeding to slow down or stop. That was what I was going to the trial for.

LaTisha
LaTisha

Measuring Expectations on a Clinical Trial

Tiffany: LaTisha, when you went on the clinical trial, what were your expectations? What were your thoughts on what you wanted to happen? Were you realistic about whether or not it will work?

LaTisha: I wanted to be more informed. I knew I had had fibroids for a long time. I was trying to figure out what my other options were. I didn’t want to do the surgery at all, so this would have been an option to not have surgery. However, they didn’t have the resources to see where my fibroids were, so she wasn’t able to see exactly where they were. I didn’t know they could be in multiple places. I didn’t want to have surgery. I wanted the bleeding to slow down or stop. That was what I was going to the trial for. I did not want to have the surgery at all.

Tiffany: Did you enroll or were you considered a screening failure?

LaTisha: I was enrolled. I had to do samples. They kept trying to do the ultrasound. They would tell me to come at different times of the month, but she could only do the vaginal ultrasound. She couldn’t send me for an MRI or anything that wasn’t part of the screening process. I probably went for about three months. When they couldn’t get the imaging that they needed to get, then that’s when I had to stop.

Tiffany: What about you, Latasha? Are you still on a clinical trial or are you done? Would you consider going on another one?

Latasha: I’m at the beginning of a clinical trial. When I started my endometriosis journey a couple of years ago, my fibroids were small. Then it got to a point where they started to bother me so much and I was hurting, so I had them removed.

I didn’t want to have surgery either, but when they say they need to remove something that’s not supposed to be there, I’m all for it. It gives me a better chance to regroup and allows the researchers to see how fast the tissue is growing or how much the lining of the uterus is accumulating each month. They’re able to start tracking what they couldn’t see before the fibroids started growing or the uterus started thickening. It’s hard to go by what everybody else says because they have some good points about the placebo.

Latasha
The Patient Exchange - Improving Diversity in Clinical Trials

Side Effects on Clinical Trials

Tiffany: Oftentimes, we’re afraid of the unknown and when I say we, I’m talking about the Black and African American community and with valid reasons. Tony, when you were on a clinical trial, did you experience any adverse effects? How did the side effects differ than when you were on standard therapy?

Tony: Anytime you’re diagnosed with cancer or any other disease, there’s a level of faith that you have to have and that will be activated during your journey. You’re going to believe in God, but you’re also going to believe in the medicine that God can work through.

Undergoing CAR T-cell therapy was terrible. I had a very aggressive chemotherapy regimen, but CAR T-cell therapy was worse because it was coming off a clinical trial and I was getting that as a second-line defense. The procedure that I had to go through was a lot of trauma to the body, with the extracting of my blood, taking it to a lab to get it re-engineered, and giving it back to me. I have received the worst chemotherapy that they have and that didn’t solve this, but I kept my faith knowing that at the end, I’m going to see this through.

One thing I never asked during my journey and until now was why. Why not me?

Tony Williams
Tony W. CAR T-cell therapy

When I did CAR T-cell therapy, that previous six-month period when I got chemo, they gave me that in three days. I felt like I was seeing death. Darkness came over me because it was so aggressive. My body was in shock. I recall the first day that happened, I was out of sorts. The second day, I passed the chapel and said, “I can’t do this,” but I knew I could and I did.

It was very hard, but one thing I never asked during my journey and until now was why. Why not me? Why can’t I be the one to help somebody get through this? I made it through the chemo on CAR T-cell therapy, but it was unknown. I was afraid, even though I didn’t admit it.

You have to exist in a reality that’s not there for you but where you’re going to exist because if you exist in the right now, you will not get through it. You have to exist in a realm that’s beyond where you are. It was very challenging and tough. Not knowing if it was going to work was even more excruciating because you knew what you had already been through.

I never felt like a guinea pig. I felt like it was necessary. The way that drugs come to the market now is not like it was back in the time of Tuskegee or Henrietta Lacks. They have to do what they can to bring the drug to the market. When you join a clinical trial, like Tiffany said, you are getting the best of what they have because they want that to succeed. You are a frontline participant of the best of what they have.

It was traumatizing. It was excruciating and painful. Parts of me wanted to doubt, but when you’ve come this far, what do you have to lose? God has already proven that He’s with you. When they give you a ticking clock and say you have one to three years left and you passed that, what do you have to lose except to continue to believe? That was my mentality.

Tiffany: As a caregiver to someone who did not go on a clinical trial but knew about clinical trials, I understand that some of these drugs are toxic, whether they come to the market or not. Gwendolyn, when you go through that on a clinical trial, does it make you doubt? Am I doing the right thing or is it like Tony said, like you know it’s going to be hard, but you’re going to push through? What was your experience?

If you want to send somebody to talk about clinical trials, send me. I’m alive today first because of God, but second because of the clinical trials.

Gwen

Gwen: So much of what Tony said is so true. Radiation and chemo kicked my butt. I had every side effect on the list. I knew I was a fighter, but I was leaning against the ropes and I wasn’t standing anymore. I want to live.

I tried everything. When you’re fighting stage 4, all of your family and friends have the remedy. Everybody called me saying, “Eat right. Don’t eat meat. Juice. Do nothing but herbs.” I was everybody’s guinea pig. In the Black community, everybody has a remedy, so I said let’s go. If you’re stage 4, you’re already getting a beating, so let’s try something new.

The crazy part about it is when I tried clinical trials, they put me on steroids too because mine was in my bones, so I gained weight and got stronger. I tell people all the time that I’m a walking billboard now. I’m alive because of a clinical trial. If you want to send somebody to talk about clinical trials, send me. I’m alive today first because of God, but second because of the clinical trials. I was dying from radiation and chemo. I had three strokes and two heart attacks. I’m on team clinical trial. You can’t tell me anything different.

Gwen

Tiffany: Experiencing side effects when you go on these trials isn’t talked about a lot, not realizing that you can have these same side effects with drugs that are on the market as well. Shyreece, I want to hear your experience as well. When you were going through your treatment on the clinical trial, did you ever reach a point when you thought about whether this was the right thing to do or you should think about going off? What was that like for you?

Shyreece

Shyreece: Muscle myalgia was big for me in the initial stage of my diagnosis. It was so bad that I had cramping and abdominal pain. I even got C. diff at one stage of my journey. It was so bad that on Christmas day, I had to go into the hospital for two weeks to be treated.

I love mustard greens. Thanksgiving was coming up and I cooked some ahead. I ate a couple of bowls and it tore me up. I had to lay down, cramped. Sometimes you have to change some of the natural things that you’ve been doing every year. The side effects can come out of the blue. You don’t even know when they’re going to hit you. I nurtured myself until I felt better. That’s how I roll when it comes to side effects.

I’m at a place where I stay surrendered. If I’m going to do the trials and treatments, I have to stay surrendered and resilient. I’ve always believed in God. I’ve always believed in Jesus. But when I got diagnosed with cancer, I thought, “What did I do wrong? Oh, I need to forgive somebody.”

The Patient Exchange - Improving Diversity in Clinical Trials

When I went to Stanford, they issued an NCCN Distress Thermometer, a survey that assesses your well-being from week to week by the time you come into your clinical appointment to see where your psychological state of mind is at. Fighting cancer is as much mental as it is physical. How did a cough turn into stage 4 lung cancer? When I cough now and clear my throat, I say, “Wait a minute.” I’ll cough and then tell myself, “Self, don’t you over cough. Self, cough just enough. Self, get you some water.” I have to talk to myself like that. It may sound crazy, but it works for me.

I also tell myself that I was created. I had to read the Word for myself. I love everybody in my faith community, but I had to get deeper into finding a purpose as to why I’m still here. I’m not going anywhere until I have done everything that my Creator has prepared for me to do.

With that being said, I take that power and mental state of mind, get to know my team, and pray. What should I be doing? Who should I be doing it with and where? I’m at Stanford. The people who I’m working with are those particular people. I am present. I am all in. If and when I do decide whatever treatment I’m going to do, I don’t attach any cultural baggage to it because I know it comes from a place of fear and I can’t live in fear. I have to trust today. I have to trust God today and the people of today. If I don’t trust who I’m around, it’s not going to work anyway.

The Patient Exchange - Improving Diversity in Clinical Trials

Tiffany: Cayla, LaTisha, and Latasha, for your clinical trials, what did they tell you was your intervention?

Cayla: They had to confirm that I had fibroids to be on the trial. They asked a set of questions to see if I qualify. I got to a certain point and they told me there was nothing they could do. They needed more resources.

An MRI confirms how big the fibroids are and their location. Fibroids can enlarge the uterus and it can be on the uterus, behind the uterus, and in different locations, so they weren’t too sure. They knew I had them, the size, and how many, but they didn’t know where they were. They told me to count how many sanitary napkins I was going through. I kept a log of how often I had to change and how often I had to take anything for pain management. They wanted to make sure before they gave an intervention.

You had to see them more. They had to collect samples. My intervention was to make sure I controlled it. With any disease, diet is important. Are you exercising? Are you a smoker? Do you drink alcohol? These have an effect. I would say they contributed to the intervention as well. I didn’t take medication to assist me. I did the non-pharmacological method.

Cayla

Tiffany: What this shows is that when we say intervention, people automatically think it’s a drug and that’s not true. They could be collecting data. Oftentimes, what we don’t understand collectively as a community is that the data that we’re looking at is not representative of the people who it affects the most. With conditions that disproportionately affect Black and African Americans in high incidence and mortality, we’re never going to find an answer about why it’s happening if we don’t get data from the people it’s happening to.

Go to where we are. Use layman’s terms, simple language in a nice brochure, and put them in common places

Shyreece
Shyreece

Bridging the Clinical Trials Gap

Tiffany: You all have been passionate in your answers and that spreads more message than someone reading something that they don’t understand. These are shared experiences. What can we do to bridge the gap to make clinical trials less fearful?

Shyreece: We’re the ones who can best spread the message. Go to where we are. Use layman’s terms, simple language in a nice brochure, and put them in common places, like supermarkets, churches, and predominantly underserved schools, where the demographic is mostly Black. Leave some literature with visual representation so they can be easily read. Include information about the screening. Don’t be afraid to speak a little faith language to get on the inside and let them know that you care.

Tiffany: I believe that our life experience is our expertise and sharing that is going to make the difference. I talk about clinical research to anyone. If they’re listening, I want to promote it. These are things that we want to understand because we’re always asking why. Why us? Why are we always getting this? No one can ever give us an answer. The only way we’re going to get that is to look at data.

I believe that we as African American people have a lack of awareness overall about our health.

Tony Williams

Tony: What I have found over my travels with The Patient Story and being the head of diversity is to stress overall health awareness. When you go to the places that Shyreece mentions — our churches and civic centers, where we gather — cancer is not the one single modality. There is always something attached to it, like high blood pressure, high cholesterol, or diabetes.

I believe that we as African American people have a lack of awareness overall about our health. Cancer manifests itself, but something else is manifesting. If we can get to the root that, we take care of ourselves overall and you will not see the manifestation of a lot of these things.

Everything is tied to what you put into your body. Limit exposure to garbage. Overall awareness and pushing that initiative is the first place to start. Cancer is one of many. We all have that in common, but that’s not the only thing. We’re being taken out by heart attacks and other health issues too. Cancer didn’t have a chance to pop up because the heart attack got you first.

Tony W. cycling

Tiffany: Usually, you’re seeing your primary care for everything and that’s the person who’s going to give you the workup that’s going to say something’s not right. How can we be more self-aware and advocate for ourselves to say, “Doc, what else is out there?” We know there will be barriers, like transportation, childcare, and having to leave work, which is a deal breaker for many people because they don’t have the means to do that.

I had to put myself out there and start a fundraiser… If I’m doing this and willing to do this, how can I encourage someone who may not have the skill set?

Shyreece
Shyreece

Shyreece: When I realized that, I had to put myself out there and start a fundraiser. It’s so humbling and so vulnerable, but I wanted to do it and I had to go first. I couldn’t wait for the reimbursement from the sponsor, so I had to put a plan together and execute the plan.

There’s so much preparation involved. If I’m doing this and willing to do this, how can I encourage someone who may not have the skill set? Let’s talk about that and be very transparent. Everybody may not have the skill set and the resources. How do you encourage them? Where can we have a list of resources? Where are these places to get support? How do you handle rejection? I powered through it. Everybody doesn’t have that support system. How do we encourage those things first?

I tell my story because this is my community and where I grew up. Start where you are.

Gwen

Gwen: Cervivor trains us. Even though I have cervical cancer, that doesn’t mean that I’m trained to speak to the community. Before I can do that, I have to know the facts and when I’m speaking, I have to give them the truth. I can’t talk off the top of my head.

Before I even knew I had cancer, I started a cancer organization in memory of my father. I go around the low-income Black and Hispanic communities. I go with MD Anderson now because now we have a relationship. I tell them to leave their white coats at home and be in jeans and tennis shoes. We want them to have a comfortable conversation where they’ll open up to you.

When I go out there, I bring in resources because I can’t go in there and tell you to get screening and not have help for you. I can’t leave you out there by yourself. We have to have more of that going on. We have to get out there.

I tell my story because this is my community and where I grew up. Start where you are. Cervivor told me that my story matters. They gave me confidence, so I’m out there now telling my story and we can have that conversation. I partner with schools, business owners, and churches. We need to go to the important places in the community.

Shyreece: Amen. I wrote my book for that reason. I started in my church. Start where you are.

Gwendolyn J.
The Patient Exchange - Improving Diversity in Clinical Trials

Conclusion

Tiffany: I want to thank every single one of you. You all have made an impact in this conversation. I’ve learned about things that I did not know, so thank you so much for being willing to share with me and The Patient Story. Your experiences are going to resonate with a lot of people.

If you’re in medical school, you’re seeing the same stats that we’re seeing. You’re reading it, but we’re living it. You can understand better and get a bigger picture about why it’s so important that we participate in these clinical trials that can literally save lives.

What an electric and energizing conversation for sure. It doesn’t take much for me to talk about clinical research. Sharing the room with Tony, Gwendolyn, Shyreece, LaTisha, Cayla, and Latasha was icing on the cake. It is important to be empowered so that you and your caregivers can make informed decisions about your care.

Thanks again to our sponsor, Johnson & Johnson, for its support of our independent patient program and to our promotional partners.

The Patient Exchange: Improving Diversity in Clinical Trials
Hosted by The Patient Story
Take part in a transformative conversation with five Black patients as they share their personal journeys navigating clinical trials. This program tackles cultural and social barriers head-on, offering insights on starting discussions with your doctor, understanding enrollment, and overcoming mistrust and misinformation. Learn why cancer clinical trials are not so much about placebos but about “getting tomorrow’s medicine today,” and gain the knowledge to make informed decisions for your health.
Powered by
Powered by

Johnson & Johnson - J&J

Special thanks again to Johnson & Johnson for supporting our independent patient education content. The Patient Story retains full editorial control.


Lung Cancer Patient Stories


Chris Draft



Background: Chris' wife Keasha passed away from stage 4 lung cancer one month after they married. He's been a passionate lung cancer advocate ever since.
Focus: Leading with love, making connections to grow lung cancer community, NFL liaison

Rhonda & Jeff Meckstroth



Background: Jeff was diagnosed with stage 4 lung cancer and given months to live, but his wife, Rhonda, fought for a specialist that led to biomarker testing and better treatment options
Focus: Education of biomarker testing for driver mutations, patient and caregiver self-advocacy

Terri C., Non-Small Cell Lung Cancer, KRAS+, Stage 3A



Symptoms: Respiratory problems
Treatment: Chemotherapy (cisplatin & pemetrexed), surgery (lobectomy), microwave ablation, SBRT radiation

Stephen H., Non-Small Cell, ALK+, Stage 4 (Metastatic)



Cancer details: ALK+ occurs in 1 out of 25 non-small cell lung cancer patients
1st Symptoms: Shortness of breath, jabbing pain while talking, wheezing at night
Treatment: Targeted therapy (alectinib), stereotactic body radiation therapy (SBRT)
Stephanie W. feature profile

Stephanie W., Non-Small Cell Lung Cancer, ALK+, Stage 2B



Symptoms: Persistent cough, wheezing
Treatments: Surgery (bilobectomy), chemotherapy, targeted therapy

Categories
MPNs Myelofibrosis Patient Events

Myelofibrosis Clinical Trials and Latest Treatments

Cancer Clinical Trials

The Latest in Myelofibrosis Treatments

Edited by:
Katrina Villareal

Interested in myelofibrosis clinical trials? We’ve gathered the leading experts to explain emerging clinical trials, misconceptions, and how to find the treatment best for you.

Moderated by The Patient Story founder Stephanie Chuang and myelofibrosis advocate Ruth Fein Revell, this discussion features Dr. Angela Fleischman (UC Irvine Health), Dr. Ruben Mesa (Atrium Health Wake Forest Baptist), and clinical trial nurse Melissa Melendez (The Leukemia & Lymphoma Society).

Gain invaluable insights into upcoming exciting clinical trials, the purpose and benefit of trials, and navigating trials and treatments. Optimize communication with your healthcare team and empower yourself with extra support and resources.


Brought to you in partnership with The Leukemia & Lymphoma Society

GSK

Thank you to GSK for its support of our patient education program! The Patient Story retains full editorial control over all content.

This interview has been edited for clarity and length. This is not medical advice. Please consult with your healthcare provider for treatment decisions.



Introduction

Stephanie Chuang, The Patient Story: Hi, everyone! This discussion is hosted by The Leukemia & Lymphoma Society and The Patient Story.

I am the founder of The Patient Story and I also got a blood cancer diagnosis. Mine was in non-Hodgkin lymphoma but there are so many shared experiences in what we’re all looking for and that is what The Patient Story is all about.

The Latest in Myelofibrosis Treatments - Clinical Trials

We try to help patients and their supporters navigate a diagnosis and we do this through in-depth conversations with patients, care partners, and top specialists across different cancers.

It’s important to have these educational programs, especially when it comes to topics like clinical trials, which are daunting and overwhelming, so we’re trying to humanize your options.

We’re so proud to be co-hosting this with The Leukemia & Lymphoma Society, the world’s largest non-profit health organization dedicated to funding blood cancer research as well as offering patient services and education.

They have great resources, including information specialists who are a phone call away to help answer your questions. We’ll be highlighting the Clinical Trial Support Center, a very critical free resource that offers one-on-one support to enroll in and stay in clinical trials.

We also want to say special thanks to GSK for supporting our educational program, which helps us make this available and free for our audience. The Leukemia & Lymphoma Society and The Patient Story retain full editorial control of the entire program.

This is not meant to be a substitute for medical advice. We want you to walk away and be able to ask your own doctors and medical teams questions about clinical trials in myelofibrosis.

I know how fortunate I am as many people suffer so much more than I ever have.

Ruth Fein Revell
Ruth Fein Revell, Patient Advocate

Stephanie: I’m thrilled to introduce someone who’s not only a big MPN and myelofibrosis patient voice and leader in the community but also someone I’m lucky to call a friend and who will be leading the conversation.

The Latest in Myelofibrosis Treatments - Clinical Trials

Ruth, I know that you’re going to share more about your own myelofibrosis cancer story and how you became a passionate advocate. But first, can you share more about yourself outside the cancer context? Because as we know, we are so much more than a diagnosis.

Ruth Fein Revell: Thanks so much, Stephanie. Professionally, I’m a health and science writer who now writes primarily about cancers, blood cancers in particular. I also host patient programs. I have the privilege of speaking to many of the world’s most prominent researchers and clinicians.

In many ways, I think cancer has attracted many of us because we feel we can make a real difference in a difficult disease.

Dr. Ruben Mesa
Dr. Ruben Mesa, Hematologist-Oncologist

Ruth: Dr. Ruben Mesa is a renowned hematologist-oncologist. He’s currently the president of Atrium Health Levine Cancer Institute and senior vice president of Atrium Health. He’s also the executive director of the NCI-designated Wake Forest Baptist Comprehensive Cancer Center and the vice dean for cancer programs at Wake Forest School of Medicine.

The Latest in Myelofibrosis Treatments - Clinical Trials

He’s globally recognized as a leader in the MPN space and we are so fortunate to have him with us. Our audience would love to know you beyond that white coat of yours. What drew you to work in cancer and research?

Dr. Ruben Mesa: Cancer is such a terrible disease. It impacts and steals from an individual’s length of life and quality of life. I myself have been touched by cancer as so many have. My father passed from cancer and my mother is a cancer survivor. I was able to witness the impact of cancer research, developing new therapies, and the value of really compassionate care and how important these things were.

In many ways, I think cancer has attracted many of us because we feel we can make a real difference in a difficult disease. It’s also an exciting time when scientific progress is really making a genuine impact.

There are many aspects of myeloproliferative neoplasm that I find extremely rewarding to take part in.

Dr. Angela Fleischman
The Latest in Myelofibrosis Treatments - Clinical Trials
Dr. Angela Fleischman, Hematologist-Oncologist

Ruth: Dr. Angela Fleischman is a hematologist-oncologist at UC Irvine Health, where she leads the Fleishman Lab with a special focus on MPNs and improving the options and care for patients.

As a physician-scientist, Dr. Fleischman not only treats patients but also actively researches hematological malignancies. She’s passionate about translating findings from the lab bench to the patient’s bedside.

Dr. Fleischman, we’d love to know a little more about your passions as well. What drew you to blood cancers and research?

Dr. Angela Fleischman: I have always been extremely interested in blood cell development. I started out as a Ph.D. student prior to my MD and focused on normal blood cell development and what determines whether a blood stem cell goes one direction or the other.

When I decided to go to medical school and first learned about myeloproliferative neoplasms, I was extremely fascinated by them because I felt that it was an opportunity to learn what happens when blood cell development goes awry.

Another extremely interesting aspect of myeloproliferative neoplasm that I was extremely drawn to is the ability to make connections with patients throughout the years because it’s a chronic disease. As a physician, I’m able to travel with them through their journey as a patient. There are many aspects of myeloproliferative neoplasm that I find extremely rewarding to take part in.

I help patients navigate the complicated clinical trial landscape, and provide them with education and potential treatment options to take back to their care team.

Melissa Melendez
Melissa Melendez, CTSC Nurse Navigator

Ruth: Melissa Melendez is a nurse navigator with The Leukemia & Lymphoma Society’s Clinical Trial Support Center. Melissa, what drew you to become a nurse and to the important work that you do?

Melissa Melendez: I’ve been in the oncology field for almost 20 years and it was a happy accident how it happened. While in nursing school, I started my first clinical rotation in the oncology unit. I was pretty apprehensive and concerned that I was being plunged into caring for such complex patients with extreme highs and extreme lows of treatment outcomes.

I instantly fell in love with not only helping patients on their journeys throughout their treatment but also the privilege of caring for their families who were going through the journey as well. I decided that oncology was going to be my career path.

I started as a patient care assistant then a registered nurse, a division supervisor, and currently a nurse practitioner. Working for The Leukemia & Lymphoma Society in the Clinical Trial Support Center has been such a blessing for me as a nurse and it was a pretty easy transition from my previous occupation.

The Latest in Myelofibrosis Treatments - Clinical Trials

I help patients with clinical trials and throughout their journey. Not only do I work with intelligent, caring, and selfless colleagues but also with a population of patients and families that I truly love.

On a daily basis, I get to see the impact that the LLS has on patients and families, help patients navigate the complicated clinical trial landscape, and provide them with education and potential treatment options to take back to their care team to discuss so they can make informed decisions about their care. I get to build relationships with patients and family members that last for years.

It wasn’t until I was taken off hydroxyurea before starting a clinical trial that I realized how severe my symptoms were without treatment.

Ruth Fein Revell

Ruth’s MPN Story

Ruth: What is myelofibrosis? Myelofibrosis is one of the MPNs, a myeloproliferative neoplasm, and a very personal topic for me. I’ve lived with an MPN for nearly 30 years, originally diagnosed with essential thrombocythemia or ET at age 38 while I was raising two young boys.

I was taking an aspirin a day, which was stopped because I developed an ulcer. I ended up with clots in my portal and splenic veins. After a week in the hospital, I was put on an anticoagulant or a blood thinner. Several years later, my bone marrow flipped a proverbial switch and instead of producing too many platelets, it now produced too many red blood cells.

The Latest in Myelofibrosis Treatments - Clinical Trials

The diagnosis was changed to polycythemia vera and I lived with periodic phlebotomies and daily hydroxyurea. That was part of my life, as with many people who live with polycythemia vera and the different MPNs.

In 2018, I had surgery for early colon cancer. The surgeon was so focused on avoiding any more clots that I had the opposite happen. A major bleeding episode put me in the ICU for nearly a week, followed by several months of healing.

I finally sought out an MPN specialist and began to see Dr. Ellen Ritchie at Weill Cornell in New York. I had an updated bone marrow biopsy, which confirmed a diagnosis of myelofibrosis.

I used to say I was mostly asymptomatic but I’ve lived with severe migraines, a few TIAs (transient ischemic attacks), and other constitutional symptoms my whole life. It wasn’t until I was taken off hydroxyurea before starting a clinical trial that I realized how severe my symptoms were without treatment.

I experienced both life-threatening clots and bleeding episodes. I had such extreme fatigue that I couldn’t walk up the street without stopping to lean or sit on a neighbor’s step. Of course, I also know how fortunate I am as many people suffer so much more than I ever have.

Fibrosis does not always equal the MPN myelofibrosis.

Dr. Angela Fleischman

What is Myelofibrosis?

Ruth: Let’s dig right in. Dr. Fleischman, what exactly is myelofibrosis?

Dr. Fleischman: People may interpret the word myelofibrosis as having some fibrosis in the bone marrow. What we’re talking about is the myeloproliferative neoplasm myelofibrosis, which also can have some fibrosis in the bone marrow. However, I want to emphasize that fibrosis in the bone marrow does not always equal myelofibrosis.

MPN myelofibrosis is a chronic blood cancer that stems from the proliferation of some abnormal mutant cells in the bone marrow. Exactly what causes the fibrosis is unclear. The abnormal megakaryocytes or the cells that are producing platelets have been implicated as the bad cells in myelofibrosis and causing the fibrosis.

Patients also tend to have an enlarged spleen, which can also be seen in ET and PV but is more prevalent in myelofibrosis.

The Latest in Myelofibrosis Treatments - Clinical Trials

Blood counts can look very different. There’s a wide variety of what a myelofibrosis patient’s blood counts look like, but a classic myelofibrosis patient may have some anemia. They may have a little bit of a high white blood cell count. They may also have immature cells in their blood so their bone marrow cells are not maturing fully before going into the blood, indicating that there’s some stress going on in the bone marrow.

Myelofibrosis patients can have some significant constitutional symptoms. ET and PV can also, but in myelofibrosis, they tend to be more severe.

I do want to emphasize that because somebody has a bone marrow biopsy that says fibrosis does not necessarily always equal the MPN myelofibrosis. Other things, like autoimmune diseases, can cause some fibrosis in the marrow. Infections can cause fibrosis in the marrow. Other blood cancers can cause fibrosis in the marrow. What I want to emphasize is fibrosis does not always equal the MPN myelofibrosis.

Ruth: That’s a really good reminder and not something that people focus on much so thank you for that.

We’ve seen an explosion in many different types of therapies. Over the last three years, we’ve seen a rapid increase in FDA-approved options.

Dr. Ruben Mesa

Advances in Myelofibrosis Treatments

Ruth: The world of MPNs, in particular myelofibrosis, is changing before our eyes as clinicians, researchers, and people living with these conditions. Dr. Mesa, would you tell us how the landscape of treatments for MF patients has changed so dramatically in the last 2 to 3 years?

Dr. Mesa: I first saw patients with myelofibrosis at the beginning of my training almost 30 years ago. In the first half of those 30 years, the medicines we had for myelofibrosis were really limited because we had a very limited understanding of the biology of the disease.

What happened about 15 years ago is we identified important genetic changes, such as JAK2, CALR (calreticulin), MPL, and others that lead downstream to a patient having a myeloproliferative neoplasm.

The Latest in Myelofibrosis Treatments - Clinical Trials

With that, we’ve seen an explosion in many different types of therapies. Over the last three years, we’ve seen a rapid increase in FDA-approved options, now four different JAK2 inhibitors. They’ve made a real impact in patients with myelofibrosis regarding the enlargement of the spleen, perhaps helping to slow down the course of the disease to some degree and, for some individuals, dramatically so.

The next step we’re launching into is combinations of therapies where we use more than one drug and look at treating different aspects of the disease or different targets in terms of the biology of the disease to make a deeper impact.

Wearing my cancer center hat, as I look at how therapies are advancing in many different diseases, both blood cancers as well as non-blood cancers, most of the time we’re now using more than one therapy where medicines complement each other.

Different blood diseases, such as multiple myeloma, use up to four different drugs at a time. The explosion went from really very little understanding to multiple drugs, a much greater understanding of the biology of the disease, and hopefully a deeper and deeper impact.

For the majority of individuals, probably over 90%, based on a variety of factors, we start with medicines.

Dr. Ruben Mesa

Standard of Care: First-Line Treatment

Ruth: Dr. Mesa, what is the standard first-line treatment for myelofibrosis?

Dr. Mesa: When patients come in with a diagnosis of myelofibrosis, their doctor first gets a sense of the risk of the disease, how likely is the disease to be life-threatening, and the burden that the patient is facing from an enlarged spleen, from symptoms, or from the risk of progression.

We discuss whether we should pursue the potentially curative option of bone marrow transplant or stem cell transplant; we use those terms interchangeably. That’s a very complex therapy, but it’s something that we consider throughout for individuals up until their 70s, depending on the risk of the disease and other factors.

For the majority of individuals, probably over 90%, based on a variety of factors, we start with medicines. The only approved medicines for myelofibrosis are the JAK inhibitors. Transplant either in the near future, delayed, or we’re not going to pursue transplant and then consideration of a JAK inhibitor.

The Latest in Myelofibrosis Treatments - Clinical Trials

JAK inhibitors help to decrease the activation of JAK2. Regardless of which mutation a patient has or even if they don’t have one of the three mutations, they all seem to benefit from JAK inhibitors.

Dr. Ruben Mesa

How JAK Inhibitors Work

Ruth: We currently have four FDA-approved JAK inhibitors, including momelotinib, which was approved in September 2023. How do JAK inhibitors work? For each of the approved JAK inhibitors, would you explain what their benefits and limitations are?

Dr. Mesa: In myelofibrosis, there are three main mutations that we believe are involved with causing the disease. The JAK2 or the JAK2 V617F, the mutation in calreticulin, and the mutation in MPL. There’s even a small subset of people who do not have one of those three.

The Latest in Myelofibrosis Treatments - Clinical Trials

All of those mutations lead to the same outcome: an overactivation of the protein JAK2. JAK2 is one step. It’s an on-off switch stuck in the on position telling cells to grow.

JAK inhibitors help to decrease the activation of JAK2. Regardless of which of those mutations a patient has or even if they don’t have one of those three mutations, they all seem to benefit from JAK inhibitors.

Ruxolitinib has been approved since 2011. It improves the spleen and symptoms, may help patients who respond live longer with the disease, and in many ways has long been the standard. It’s frequently been used as the base in combination trials.

Fedratinib has been approved since 2019. It can be used to improve the spleen or symptoms. It may be used in the front-line setting instead of ruxolitinib or in the second-line setting if someone has had ruxolitinib already.

Pacritinib was approved in 2022 and this one has a little distinct profile. It’s particularly helpful for decreasing the spleen and symptoms but for individuals with a very low platelet count.

Both ruxolitinib and fedratinib are approved for individuals with a platelet count above 50,000. Pacritinib can be helpful in anyone, but its particularly unique niche is in individuals under 50,000 and we certainly will consider it for individuals with lower blood counts.

The Latest in Myelofibrosis Treatments - Clinical Trials

Momelotinib was approved in September 2023. This can improve the spleen symptoms and anemia. It showed the strongest improvement in anemia compared to the other three. Pacritinib sometimes can have an improvement in anemia. Unfortunately, both fedratinib and ruxolitinib sometimes can have anemia as a side effect or worsen anemia and rarely would improve anemia.

There are some differences among the four of them, but they overlap in many ways in terms of improving the spleen and symptoms and can be beneficial regardless of the mutation profile that a patient with myelofibrosis has.

Ruth: It’s very exciting for the MPN community to finally have so many treatment options. People often think that because they have mutations other than JAK2, a JAK inhibitor won’t help them so thanks for noting that that’s not necessarily the case.

It’s really exciting now that we have four different JAK inhibitors so we can try to tailor the best JAK inhibitor for the person upfront.

Dr. Angela Fleischman

Navigating Treatment Options

Ruth: Dr. Fleischman, here’s a loaded question. How do you know which JAK inhibitor may or may not work and which one to try first?

Dr. Fleischman: This is an evolving topic. It’s really exciting now that we have four different JAK inhibitors so we can try to tailor the best JAK inhibitor for the person upfront. Sometimes it’s a hit or miss but, as Dr. Mesa described, each JAK inhibitor has a little bit of a different profile.

The Latest in Myelofibrosis Treatments - Clinical Trials

All of the JAK inhibitors inhibit JAK2 but each one has “off-target” effects and some different proteins and that may explain why they have their own unique profile.

Each myelofibrosis patient is quite unique so they have different needs. For example, for somebody who has an enlarged spleen, with symptoms, and pretty robust blood counts, ruxolitinib would be a great option, which is also the only JAK inhibitor currently approved for PV, in which the purpose is to bring down blood counts.

If the person’s primary problem is anemia, which is unfortunately a very common problem in myelofibrosis, it’s very exciting that we have an option that’s specifically designed for patients with anemia. That’s a patient population very, very appropriate to start pacritinib first.

Many patients with anemia also have a low platelet count. What do you do for somebody who has both anemia and a very low platelet count? We’re going to have to learn how to sequence and make decisions between pacritinib and momelotinib. For a myelofibrosis patient with both anemia and thrombocytopenia or low platelet count, the two options that exist upfront are momelotinib and pacritinib.

The Latest in Myelofibrosis Treatments - Clinical Trials

Different tiers of needs as we talk about individual clinical trials.

Dr. Ruben Mesa

Combination Therapy Clinical Trials

Ruth: Some of the most exciting clinical trials for MF patients are for combination therapies. Dr. Mesa, can you explain the idea behind combination drug approaches and who might benefit?

Dr. Mesa: We think about different populations of patients. We have those who are JAK inhibitor naive or individuals who have not had a JAK inhibitor yet. This may be at the time of diagnosis or individuals who have had the disease for a while, have been observed, and now, based on spleen symptoms or changes, need to begin therapy.

The Latest in Myelofibrosis Treatments - Clinical Trials

There are individuals who have been on a JAK inhibitor and have had some benefit, but we feel that there’s an opportunity for further benefit. Some of these individuals are participating in add-on studies where you have a JAK inhibitor that they’ve been on for a while, they have a partial response, and a second drug is added.

The third type of patient is an individual who was on a JAK inhibitor and now no longer has a benefit from that medication so you are switching them to a different therapy altogether. Different tiers of needs as we talk about individual clinical trials.

Selinexor + JAK Inhibitor

Ruth: Let’s talk about some of those combination trials. There are a number of them where JAK inhibitors are given with the addition of a new agent with a different mechanism of action. Let’s talk about selinexor plus JAK inhibitor.

Dr. Mesa: There’s a whole constellation of different agents that have an impact on different mechanisms of action that are being looked at in combination with JAK inhibitors. This one is a little bit earlier in its development.

It’s an approved drug for multiple myeloma and has been approved since July 2019. It’s an anti-cancer medication. It’s a selective inhibitor of nuclear export. It works on some of the processes within the cell in a different way that we feel may be beneficial in combination.

The Latest in Myelofibrosis Treatments - Clinical Trials

Data from early studies suggest that there is benefit and it may be more with two drugs than the single drug itself. Whether this will become an option for patients with myelofibrosis, the trials will demonstrate, but it has made an important impact for individuals with myeloma so we’re hopeful that it’ll be helpful in this group of patients as well.

Ruth: It’s great to see when we borrow from different areas of research. 

The Latest in Myelofibrosis Treatments - Clinical Trials
Navitoclax + JAK Inhibitor

Dr. Mesa: This works against a process within cells called apoptosis or programmed cell death. Navitoclax is a cousin of a drug that’s approved for acute leukemia called venetoclax.

In studies with myelofibrosis, navitoclax has shown real activity for decreasing spleen symptoms and potentially impacting the disease and, in combination, to a greater degree than JAK inhibitor alone. We have had patients on large phase 3 trials who have been newly diagnosed as well as other situations so those data are anticipated with great interest.

It may take further time for us to identify which combination is a better fit for a patient. These trials are not necessarily designed to answer that itself.

Dr. Ruben Mesa
Pelabresib + JAK Inhibitor

Ruth: Let’s talk about pelabresib, a drug very close to my heart. That’s the trial I’ve been on for more than three and a half years used in combination with a JAK inhibitor. I understand the results have been very promising. At Weill Cornell, they’re calling me the poster child for this study so I’m very grateful for that. Dr. Mesa, tell us about the MANIFEST-2 trial.

Dr. Mesa: This is probably the furthest along of the combination approaches. Pelabresib is an inhibitor of another cellular process called BET. There’s reason to believe that it may have a very complementary role in inhibiting JAK2.

In the early studies, it appeared very promising in terms of having an impact, perhaps more than JAK inhibition alone or in combination when individuals had failed a JAK inhibitor.

We now have phase 3 trials of patients newly diagnosed or who are JAK inhibitor naive receiving this combination versus ruxolitinib alone. We are looking for information to see the net benefit of using the two drugs.

Are the responses more profound? Do they last longer? Are patients better off? We always weigh any downsides to being on two drugs versus one. There are multiple combinations being tested in parallel. It’s possible that multiple of them may be beneficial. It’s possible that multiple of them could become FDA-approved.

The Latest in Myelofibrosis Treatments - Clinical Trials

It may take further time for us to identify which combination is a better fit for a patient. These trials are not necessarily designed to answer that itself. They’re designed to answer if they are better than a JAK inhibitor alone.

Downstream, we’ll have a better understanding based on specific patient features or other aspects of their health whether one of these combinations may be a better choice for one patient versus the other.

Ruth: Dr. Fleischman, what should patients be asking their doctors to understand if one of these combination therapies might be best for them?

The Latest in Myelofibrosis Treatments - Clinical Trials

Dr. Fleischman: Entering into a clinical trial is a personal decision for the patient and deserves deep thought. There are many reasons why somebody may want to do a combination therapy. It’s not only because your current therapy isn’t working or that you want something “new” but also to help other people.

Clinical trials are not necessarily only supposed to be for the benefit of the patient themselves, but by participating in a clinical trial, the patient is increasing our knowledge of whether specific combinations work, the appropriate dosing, and the side effects. You’re helping other patients who will come after you.

Cancers are pretty smart that if you target one, they’re going to find a way to get themselves around that medicine you’re giving them.

Dr. Angela Fleischman

Trials Beyond JAK Inhibitors

Ruth: We go into clinical trials often because we were on Jakafi or another treatment and it wasn’t effective, caused side effects that were serious and needed to be discontinued, or maybe it worked for some time and then stopped. Dr. Fleischman, can you talk more about aiming to introduce non-JAK inhibitor treatments?

Dr. Fleischman: JAK inhibitors are very good in terms of reducing inflammation and reducing spleen size and, in some patients, can work very well for a period of time.

Patients could get “resistance.” Resistance with JAK inhibitors is very different than what we think about with other cancers. People on JAK inhibitors don’t develop new mutations that make them “resistant” to the JAK inhibitor. They start to not work as well so that would be one reason to add on and target different pathways.

Myelofibrosis is very heterogeneous. Each patient is very different. Each patient may have different mutations. They may have either JAK2, calreticulin, or MPL, but some patients will have additional mutations that make them look a little bit different than other myelofibrosis patients.

The Latest in Myelofibrosis Treatments - Clinical Trials

Trying to target multiple pathways, as Dr. Mesa had mentioned, is a very common technique. Cancers are pretty smart that if you target one, they’re going to find a way to get themselves around that medicine you’re giving them. They’re quite ingenious and able to grow despite our single treatments. Each myelofibrosis patient is very different so identifying what the appropriate second agent would be is really on a case-to-case basis.

Part of the challenge that we have with medicines against blood cancers or cancers is finding ways to deliver medicines solely to the cells affected by the disease without harming normal cells.

Dr. Ruben Mesa

Ruth: What’s exciting to see is that we’re more forward-thinking in our endpoints of clinical trials so we’re looking more at survival and not just symptom relief.

All of the clinical trials that we’ve talked about so far are exploring new drug treatments. There are also trials that look at lifestyle issues like exercise or the benefits of yoga and meditation.

Dr. Fleischman is renowned for her work studying inflammation and diet. She and her collaborators recently published the results of a clinical trial that tested the feasibility of the Mediterranean diet for MPN patients.

For those of us living with an MPN, anything we can do ourselves to potentially control our symptoms is very welcome. In fact, it helps us feel in control of our own blood disorder. Even if it’s only a little bit, it’s important.

Dr. Mesa, let’s move on to an area of treatment that the MPN community is very excited about exploring, which is a novel therapy targeting calreticulin, the CALR mutation, one of the most common drivers of essential thrombocythemia and myelofibrosis. People are calling this a potential vaccine. What can you tell us about this that explains it best?

Dr. Mesa: About a third or more of patients with myelofibrosis have a mutation in the protein called calreticulin. This is a little different from JAK2 and MPL because calreticulin might be on the surface of the affected cells and we may be able to target the abnormal calreticulin in a specific way.

Part of the challenge that we have with medicines against blood cancers or cancers is finding ways to deliver medicines solely to the cells affected by the disease without harming normal cells. In the bone marrow, that’s particularly important.

There has been a great interest in seeing if we can target calreticulin in a specific way. A vaccine trial has been done in Europe and is in its infancy.

There’s a theme of multiple different approaches being developed, both cellular-based therapies, such as CAR T or vaccines, or a monoclonal antibody against calreticulin. That is creating great interest but has not yet started in human trials. In the laboratory, it appears to be a very promising medicine.

We’re very hopeful, but we also recognize that until we’ve started treating patients, we never know how good a fit it’s going to be, if there’s going to be an unexpected side effect, or if it will have the benefit that we hope that it has.

I certainly hope that this medication is successful. Even if it is not, I suspect there will be others behind it that hopefully will be. We learn from trials whether they end up being a home run or not. This theme of us trying to selectively target the cells involved is really key.

As we think about anemia, there are JAK inhibitors that can have an impact on the spleen and symptoms, but they may either worsen anemia or not improve anemia.

Dr. Ruben Mesa

Treatment for Patients Who Suffer From Anemia

Ruth: Dr. Mesa, as we know, anemia is very common in myelofibrosis and many people need regular transfusions so this isn’t something that’s likely to go unnoticed. There can be severe fatigue associated and MF patients will have regular blood tests so in theory, it should be seen and diagnosed early on. Tell us about some of the new hopeful treatment options for MF patients who suffer from anemia.

Dr. Mesa: Anemia is when an individual has fewer red blood cells than they’re supposed to. Red blood cells carry oxygen from our lungs to the rest of the body so that’s key for us in terms of our muscles to work well and for us to feel well. That’s why we can have issues in terms of anemia.

Myelofibrosis anemia has multiple aspects. There can be baseline anemia because the bone marrow is not producing enough red blood cells. There can be other contributors if they’ve had baseline iron deficiency that contributes to that. If the spleen is very enlarged, it can hold on to many red blood cells.

Historically, we’ve had a range of options. None of them have been overly dramatic in terms of their impact, but they can help. Injections such as erythropoietin-stimulating agents and androgens like testosterone help to produce red blood cells in both men and women.

There are medicines that are in development. Luspatercept, a medicine that can help with anemia, is currently in phase 3 clinical trials for patients with myelofibrosis. Momelotinib, which was most recently in September 2023, is a JAK inhibitor that can also help to improve anemia.

The Latest in Myelofibrosis Treatments - Clinical Trials

We look for that medicine to improve both spleen symptoms and anemia. As we think about anemia, there are JAK inhibitors that can have an impact on the spleen and symptoms, but they may either worsen anemia or not improve anemia. Both things can be present.

Momelotinib is an important advance. I hope that as we see other combination therapies, we may see broader improvement in spleen symptoms and anemia.

Should momelotinib or those agents that are more helpful with anemia, perhaps even pacritinib, be that JAK inhibitor to be used with other medications in combination? That has yet to be answered with some of these combinations.

Some real progress in anemia and improving anemia can clearly have a benefit, in terms of the patient’s quality of life and their ability to have enough energy to do their daily activities or things they enjoy, as well as being easier on the body.

One area that we’re intensely working on is trying to identify surrogates for survival or something that we can capture with data amenable to a clinical trial that will be a marker for disease impact.

Dr. Angela Fleischman

Symptom Control While Being on Treatment

Ruth: Dr. Fleischman, what I find very exciting in today’s clinical trials is that we’re moving beyond symptom management and moving more toward progression-free survival, living longer with a high quality of life. When evaluating clinical trials, it’s important to understand the goal of the study. Where do you think we are with this?

Dr. Fleischman: That’s a very important point. For a clinical trial, you need to have an endpoint, a defined thing that you’re going to test. Ideally, something that you anticipate that your drug of interest is going to achieve better than the comparator.

The Latest in Myelofibrosis Treatments - Clinical Trials

Classically, in myelofibrosis, we’ve focused on spleen volume reduction and symptom burden because those are two things that we can quantify and expect to see a change in a short period of time. Although spleen size reduction and symptom burden are extremely important, they just don’t capture the whole picture of myelofibrosis.

The endpoint of survival obviously is extremely important to myelofibrosis patients. Survival is extremely important to everybody. But because, in general, myelofibrosis patients live a long time, it’s not a feasible outcome for clinical trials.

One area that we’re intensely working on is trying to identify surrogates for survival or something that we can capture with data amenable to a clinical trial that will be a marker for disease impact.

There are some clinical trials such as the imetelstat clinical trial in which survival is the actual endpoint, which is a unique and forward-thinking endpoint. One of the key areas of need in myelofibrosis is identifying markers that can be used in clinical trials that indicate a significant impact on the disease that goes beyond reducing spleen size and symptoms.

Ruth: We’re definitely getting into a very exciting time that will make such a difference therapeutically once we have those answers.

A transplant itself is an extremely risky procedure that can lead to significant side effects or even death.

Dr. Angela Fleischman

The Best Time to Get a Stem Cell Transplant

Ruth: When is the best time to get a stem cell transplant? I know there isn’t a black-and-white answer, but Dr. Fleischman, how do you answer this common question?

Dr. Fleischman: That is another million-dollar question in myelofibrosis and I think the most difficult decision for a myelofibrosis patient as well as for the physician.

As we know, at this point in time, a bone marrow transplant is the only curative option for patients with myelofibrosis. You may say, “If it’s curative, why doesn’t everybody just get a transplant?”

Transplants themselves can be quite risky. The media may miscommunicate transplants. You always see on the news that somebody’s looking for a donor so it may seem that the only problem with transplants is you can’t find a donor. That’s not necessarily the case.

A transplant itself is an extremely risky procedure that can lead to significant side effects or even death. We don’t want to give somebody a transplant if the transplant is going to make them sicker or potentially lead to their death earlier than would be the case if they just treated their myelofibrosis through other means.

The Latest in Myelofibrosis Treatments - Clinical Trials

The ideal time to transplant is when you get clues from this myelofibrosis patient that with standard treatments, they are very likely going to have an extremely bad outcome or will have an outcome that will lead to their death very quickly. That’s the time going forward with a transplant is worth the significant risk.

The safer the transplant becomes, the greater the consideration of when it is used.

Dr. Ruben Mesa

Dr. Mesa: There is a balance between a patient undergoing a stem cell transplant and a medical treatment. They have very different dynamics. A stem cell transplant can potentially be curative but can come with significant risks, including upfront risk.

The benefits of medication depend on many things, like how much benefit, how long is that benefit, and the impact on the patient. I would certainly view it as a success if we are able to have medicines that are sufficiently impactful that it leads us to either be able to skip a bone marrow transplant or delay it further.

The Latest in Myelofibrosis Treatments - Clinical Trials

We have precedent in other areas and the most successful example is in chronic myeloid leukemia. At the beginning of my career, most young patients had a stem cell transplant. Now, with the impact of medications, it is rare for patients to have a stem cell transplant because of the effectiveness of medications.

Currently, we are not there yet. A patient who clearly needs a transplant still will go for a transplant. Over time, there may be more combinations of both. Can the medicines help to decrease the burden of the disease and make the likelihood of success with the stem cell transplant greater? That is also a win.

In parallel, there’s tremendous research from our colleagues who do stem cell transplants to try to make that process safer. The safer the transplant becomes, the greater the consideration of when it is used.

It continues to evolve. We reevaluate every option we have. Does that change the dynamic in terms of transplantation as well as how the two things work together? With our current medicines, we are not changing our decisions for transplant, but increasingly, almost all patients that go to transplant have had at least one or more of the JAK inhibitors ahead of time.

The data would suggest that the outcomes with transplant are better in part because of JAK inhibitors but also because of improvements in the processes, antibiotics, other medications, and expertise of our colleagues who run transplant centers.

Asking About Clinical Trials

Ruth: When should a patient ask about clinical trials? How and when do you introduce the idea of considering a clinical trial to your patients?

Dr. Mesa: Clinical trials may exist in any aspect of the disease, from diagnosis to initial treatment to treatment downstream. It’s always a fair question for patients to ask. Is there a clinical trial that may be appropriate for me? It is not limited to one segment of the disease.

Clinical trials are how we make progress. They are highly regulated and always have the needs of the patient front and center. At a minimum, a patient is always getting the option that is at least as good as the standard of care.

It’s a fair question to ask at any point along the way. Truly, all the options we currently have have only been possible because of patients’ willingness to participate in clinical trials.

The Latest in Myelofibrosis Treatments - Clinical Trials

As physicians, we are happy to have another set of eyes look at the patient and hear another person’s thoughts. That is in no way hurting your physician’s feelings by seeking out a second opinion.

Dr. Angela Fleischman

Dr. Fleischman: This may be a different answer than one may get in a community practice. When I approach a new patient and we talk about treatments, I’ll always talk about standard-of-care treatments first and give people their options, and the pros and cons of each of the standard treatments.

Afterward, we’ll discuss potential clinical trials that the patient might be eligible for. I talk about clinical trials at my own university or elsewhere that I think would be appropriate for the patient. If there was something specific that I thought the patient would be ideal for, we’d talk about that trial first.

The Latest in Myelofibrosis Treatments - Clinical Trials

Because I want to give the patient all of the information, I would talk about other clinical trials that the person may be eligible for. I would give them reasons why they might be a good idea but also why I don’t think that clinical trial would be ideal for them and give them specific reasons why.

I highly recommend second opinions or even third opinions. Sometimes patients feel bad going for a second opinion. Their primary oncologist may think that they are not happy with their approach. That is not the case.

As physicians, we are happy to have another set of eyes look at the patient and hear another person’s thoughts. That is in no way hurting your physician’s feelings by seeking out a second opinion.

I highly recommend a second opinion or a third opinion, even if it’s just, “I want to learn more about my disease. I’m happy with my treatment now, but I want to get somebody else’s point of view, learn about my future, and what might the options be if this happens or that happens.”

All drugs must move through the steps or phases to ultimately be approved by the FDA.

Melissa Melendez

Trial Knowledge #1: Phases of Clinical Trials

Ruth: Melissa, clinical trials try to see if we can improve the standard of care and give more and better options to more people.

There are different phases of a clinical trial. What are they and what do they mean?

Melissa: I like to think of clinical trials as steps to drug approval. All drugs must move through the steps or phases to ultimately be approved by the FDA. If drugs are studied in new combinations or in diseases outside of their approved indication, they still need to go through all the phases.

The Latest in Myelofibrosis Treatments - Clinical Trials

For phase 1 trials, the treatment is tested in a very small number of patients. It could range from 20 to 40 patients. We’re testing dosage and looking at the safety and side effects.

Phase 2 trials typically build on phase 1 results. They try to determine the effectiveness and safety of the drug in a specific population. We’re trying to answer the questions of whether a treatment works and how well it works.

For example, there may be a phase 1 trial that tests a drug in blood cancer patients or MPN patients. After the phase 1 results, they determined that myelofibrosis patients showed the best response to the drug. The phase 2 trial now might only include myelofibrosis patients and they’ll be testing it in a larger subset, like 100 to 300 patients.

Researchers continue to monitor patient safety throughout the phase 2 trial and phase 2 studies with positive results will then move into the phase 3 trial.

Phase 3 trials are often referred to as randomized trials, comparing a new treatment against the best standard treatment. These trials can be done with anywhere from 300 to 3,000 participants. Researchers are trying to see if a new treatment has better survival outcomes and fewer side effects.

When a trial is completed and shows that the drug is in fact better than the standard of care or the best standard treatment, that’s when the newly investigated drug becomes a standard of care and will become FDA-approved.

By the time a clinical trial enters phase 4, the FDA has already approved the treatment. These trials are done in thousands of patients and they usually go on for many years.

Placebos are not typically used with patients in cancer clinical trials. But if a placebo is used, the person will also receive the standard treatment for their specific cancer.

Melissa Melendez

Trial Knowledge #2: Use of Placebos in Clinical Trials

Ruth: This one needs myth-busting. A lot of patients and care partners say, “I wouldn’t want to risk getting a placebo.” Are placebos used in myelofibrosis clinical trials?

Melissa: Ruth, I’m really glad you asked that because federal regulations require patients to know if a placebo, which is an inactive substance that looks the same as the one used as treatment, will be incorporated into a trial. An example of a placebo could be a sugar pill.

The Latest in Myelofibrosis Treatments - Clinical Trials

Placebos are not typically used with patients in cancer clinical trials. But if a placebo is used, the person will also receive the standard treatment for their specific cancer. In our case for myelofibrosis patients, the placebo will be in combination with active drugs so patients are receiving at least the standard of care. No one with active cancer would be treated with only a placebo because that is unethical.

When researchers do use a placebo, they must tell the patient that they have a chance of getting a placebo and that they will receive an experimental treatment at some point in the clinical trial, if not right away. For example, you may be assigned to the placebo group, but if your cancer gets worse, researchers will switch you to a study drug or new treatment.

The more you ask and open up the lines of communication with your team about potential treatment options, the more you learn.

Melissa Melendez

Trial Knowledge #3: Finding Clinical Trials

Ruth: For people who want to explore clinical trials, what can they do to find one for themselves? The ClinicalTrials.gov site isn’t the most user-friendly and that’s why the LLS Clinical Trial Support Center is in existence and is so important. Tell us about that.

Melissa: I agree that ClinicalTrials.gov isn’t the most user-friendly and can be difficult to use. ClinicalTrials.gov is a searchable registry and database of clinical trials conducted in the United States and around the world. It can be overwhelming and this is where the patient’s healthcare team and the CTSC can come into play.

Patients can talk to their doctors and learn more about clinical trials done at their home institution or outside of it. The more you ask and open up the lines of communication with your team about potential treatment options, the more you learn. This can help you better understand what options are available to you and feel more comfortable moving forward with a treatment plan.

The LLS created the Clinical Trial Support Center to arm patients with information to take back to their healthcare team. The CTSC provides a free service to patients. It usually takes under five minutes to fill out a form online. Don’t get overwhelmed. If you’re worried that you haven’t filled out enough information, please submit it anyway.

We reach out to patients within 1 to 2 business days; typically, on the same business day that we receive the referral. When you connect with one of the nurses, you can expect a teammate who will join you on your cancer journey.

The Latest in Myelofibrosis Treatments - Clinical Trials

We take your individual needs into account. We learn about your treatment goals. We educate the patient about trials and conduct a clinical trial assessment. This includes addressing barriers, such as travel, and discussing financial assistance through LLS or even outside organizations.

We search for trials and go through each one individually, which is a little bit different than other online services. We take an individualized approach and only send trials to patients that they’re likely eligible for. We send the results to the patient and encourage them to take them back to their doctors to discuss the results.

We provide patients with a non-biased, patient-friendly list of appropriate clinical trials. Ultimately, we work in collaboration with the patient’s healthcare team to decide if a clinical trial is right for them. We offer to reach out to the trial sites if there’s anything on the trial list that they would like to learn more about.

The Latest in Myelofibrosis Treatments - Clinical Trials

We have many patients that we’ve worked with for several years and developed a personal connection with them. We really strive to provide continuity of care throughout their journey. I always tell my patients that I’m just a phone call away and they can always reach out to me at any point with questions or if their disease or treatment changes.

Over time, trials may change. Additional trials may open up or some may have closed so I want to make sure that I can provide them with an updated search any time.

Our services are available to myelofibrosis patients as well as other blood cancers ranging from pediatric patients to adult patients. We even encourage healthcare providers to reach out to us. We do clinical trial searches for physicians in large centers and smaller community centers where they don’t have as many resources or staff.

The clinical trial landscape is pretty complicated. CTSC nurse navigators are here to break down the barriers to clinical trials that patients face to help them make informed decisions. We’re here to help and welcome any patient referrals.

We learn about each patient and take a personal approach to find out their treatment goals, their physician’s goals, and what they’re looking for in a trial.

Melissa Melendez

Trial Knowledge #4: Staying in a Clinical Trial

Ruth: What are the top three things that you do at LLS to help people stay in a trial? Talk about the challenges and the solutions.

Melissa: We learn about each patient and take a personal approach to find out their treatment goals, their physician’s goals, and what they’re looking for in a trial.

Barriers are the first challenge. Nurse navigators are proactive during those conversations on breaking down barriers that patients might face. Are these barriers financial? Will they have to travel if we find one that they’re interested in? Our solution to these issues is to find out if a trial offers financial assistance in addition to what we may offer at LLS.

We email trial coordinators and principal investigators and inquire about the treatment schedule. How many visits may the patient expect? Can they get labs at their home institution?

The Latest in Myelofibrosis Treatments - Clinical Trials

This is also dependent on what phase the trial is in. This may not be possible for phase 1 trials, but more possible for phase 2 or phase 3 trials. Can any of the long-term follow-up visits be virtual?

Communication is also another challenge. Our solution in the CTSC is to help break down the intimidating medical language or trial jargon. We try to use the simplest explanations and if patients want more in-depth or complex information, we can definitely adjust and provide that as well.

We always check on a patient’s understanding. When we’ve explained something or provided information, we may ask the patient to repeat what they understood and listen as they walk through that process with us. The more they understand, the more comfortable they feel when they’re making the decision.

Trial awareness is a challenge and we can help raise awareness through programs like this. We talk about trial myths and help patients understand the clinical trial landscape better. We help patients be more well-informed about trials that may be available to them and about personalized trial services like ours and the Clinical Trial Support Center at LLS.

The Latest in Myelofibrosis Treatments - Clinical Trials

At the LLS, our main hub is our information resource center through our information resource specialists, nurses, and social workers. You can call the 1-800 number Monday through Friday, 9 a.m. to 9 p.m. Eastern Standard Time.

We also have a chat option where you can do a live chat online, and that’s Monday through Friday, 10 a.m. to 7 p.m. Eastern Standard Time.

If for some reason you reach out to us outside of our business hours, you can always leave a message 24/7 and we’ll give you a call back.

We’re in a very exciting time for myelofibrosis… We can personalize FDA-approved JAK inhibitors for each myelofibrosis patient.

Dr. Angela Fleischman

Final Takeaways

Ruth: If you could leave people with just one message, what would that be?

Dr. Mesa: I would leave them with a message of hope. We have made a tremendous amount of impact and a much greater understanding of the biology of the disease, the genetic mutations, and why people progress. We are building on a base of very good medicines that have made an impact with the JAK inhibitors but to a new era of multiple different approaches.

I would heavily encourage patients to consider clinical trials where appropriate. Clinical trials will build on the base of these medications to try to drive progress further and further. We need your help and together we will continue to improve the therapy of diseases like myelofibrosis.

Dr. Fleischman: We’re in a very exciting time for myelofibrosis. In the past few years, we’ve moved from a single FDA-approved JAK inhibitor to four JAK inhibitors. We can personalize FDA-approved JAK inhibitors for each myelofibrosis patient.

There are a lot of opportunities for combination treatments that are moving forward in clinical trials as well as going beyond JAK inhibitors, trying to identify other key pathways to target myelofibrosis.

The Latest in Myelofibrosis Treatments - Clinical Trials

Melissa: In the CTSC, we educate, support, and empower myelofibrosis patients as well as other blood cancer patients to be active participants and have control over their treatment decisions with their healthcare team.

The Leukemia & Lymphoma Society wants to make a difference in patients’ lives through research, advocacy, education, support, and financial assistance. We want to see a future without blood cancers. We have a lot of free information for patients, caregivers, and healthcare providers to check out.

We’re a phone call away and we are here to help make clinical trials less overwhelming for patients and to help healthcare providers.

Ruth: We have covered an awful lot of information and invaluable insight from our experts. I know I speak for people living with ET, PV, and MF, their loved ones, and care partners when I offer our very sincere gratitude to you all for everything you do for our community.

Stephanie: Thank you so much, Ruth. I always appreciate the way you bridge the conversation for us.

The Latest in Myelofibrosis Treatments - Clinical Trials

Thanks so much to Drs. Mesa and Fleischman for the work that you do in the clinic and in research to help patients and families who are trying to navigate a myelofibrosis diagnosis and treatment, and all the decisions that come in between.

Thank you to our LLS clinical trial nurse Melissa Melendez for being there day to day and helping people who are overwhelmed by the topic of clinical trials.

We really hope that you walk away with a greater understanding of clinical trials in myelofibrosis. We hope to see you at a future program.


GSK

Special thanks again to GSK for its support of our independent patient education content. The Patient Story retains full editorial control.


More Medical Expert Interviews

Dr. Lecia Sequist

Using AI to Detect Lung Cancer Risks With Dr. Lecia Sequist

Using AI to Detect Lung Cancer Risks Dr. Lecia Sequist discusses using AI to detect lung...
Dr. Mark Lewis, Dr. Kerry Rogers, Dr. Ruben Mesa

Trends in Cancer Research 2022

Learn from three of the top cancer specialists about cancer treatment trends, including precision medicine...
Jack Aiello and Dr. Alfred Garfall feature profile

The Role of Bispecific Antibodies in the Treatment of Multiple Myeloma

The Role of Bispecific Antibodies in the Treatment of Multiple Myeloma Hematologist Alfred Garfall, MD, MS...
ASH 2023 multiple myeloma

The Latest in Multiple Myeloma: Understanding Promising Treatment Options

The Latest in Multiple Myeloma: Understanding Promising Treatment Options Patient advocates Cindy Chmielewski and Jack Aiello...

The Latest in Multiple Myeloma with Caitlin Costello, MD

Dr. Costello discusses the latest in multiple myeloma treatment from ASH 2022, including the MAIA...
Categories
Colorectal Patient Events

Colorectal Cancer Clinical Trials

The Latest in Colorectal Cancer Clinical Trials

What to Know about Common Misconceptions, Emerging Trials, and Biomarkers

Edited by:
Katrina Villareal

What is it really like to find and participate in clinical trials as a colorectal cancer patient? Learn how to navigate the complex world of clinical trials from patients and experts who have been there.

Hear from Dr. Andrea Cercek of Memorial Sloan Kettering, David Fenstermacher, Senior Director of Research and Medical Affairs at the Colorectal Cancer Alliance, and patient advocates Allison Rosen, Julie Clauer, and Kelly Spill as they share the barriers, risks, and results from real-life clinical trial experiences.

*Watch the full video below!


Colorectal Cancer Alliance
Colon Cancer Coalition
COLONTOWN

Brought to you in partnership with Colorectal Cancer Alliance, Colon Cancer Coalition, and COLONTOWN.

This interview has been edited for clarity. This is not medical advice. Please consult with your healthcare provider to make treatment decisions.



Full Video Conversation

Introduction

Allison Rosen: We’re going to talk about the latest in colorectal cancer trials, what to know, and what to ask. We’re going to hear from some experts in the field and some amazing patient advocates who have participated in clinical trials.

This discussion is hosted by The Patient Story, a platform where you can find hope, guidance, and supportive communities, explore insights on navigating life after a cancer diagnosis, discover promising treatments, and connect with people who truly understand what you’re experiencing.

I’m very, very excited to introduce the partners that help make this happen: Colorectal Cancer Alliance, Colon Cancer Coalition, and COLONTOWN. I’ve had the opportunity to volunteer with each and every one of them in one shape or form.

The mission of Colorectal Cancer Alliance is to empower a nation of allies and to provide support for patients and families, caregivers, and survivors. Their goal is to raise awareness of preventative measures and inspire efforts to fund critical research.

The mission of the Colon Cancer Coalition is to improve health outcomes by reducing barriers to complete colorectal cancer screening and educating the public to advocate for their own health through tailored, local, and grassroots solutions.

COLONTOWN is an online community of more than 120 private Facebook groups that provide education and peer support for colorectal cancer patient survivors and care partners on every aspect of living with colorectal cancer and beyond, including clinical trial understanding and experiences.

COLONTOWN has an amazing university that’s a public education resource with content created by patients and caregivers for patients and caregivers. It’s a library of original content where experts talk about various topics, including clinical trials.

The purpose of this conversation is to have a conversation. We want to humanize colorectal cancer clinical trials by hearing from people who have been through them and are now dedicated to advocating for others. We’re also going to answer questions and break myths that surround clinical trials in general but especially colorectal cancer clinical trials.

Colorectal Cancer Clinical Trials
Allison Rosen

Allison: I’m a stage 2 colorectal cancer survivor and a very, very passionate advocate. I’ve worked in the field of oncology for about 17 years and have been an advocate ever since I was in remission.

David Fenstermacher

David Fenstermacher: I’m the senior director of research and medical affairs with the Colorectal Cancer Alliance. My role is to oversee our grant portfolio. I also work with the community to develop some patient-focused projects around biomarkers and equity. The other thing in my purview is a national survey, which we will be releasing later in 2023, for colorectal cancer patients and caregivers.

Dr. Andrea Cercek

Dr. Andrea Cercek: I’m a medical oncologist at Memorial Sloan Kettering Cancer Center. I’m very passionate about clinical trials and the hope for the future that they give us.

Kelly Spill

Kelly Spill: I was diagnosed with stage 3 colorectal cancer at age 28. At that time, I had an ulcerated 5 cm tumor and I received nine infusions of immunotherapy from March to August 2020. I was declared in remission that same August.

Julie Clauer

Julie Clauer: I’m a stage 4 colorectal cancer patient. I was diagnosed in March 2018 with liver mets and since then, I’ve had cancer jump throughout pretty much everywhere — lung, liver, lymph nodes, bone.

I’ve had an active disease since then and started participating in a clinical trial in July 2020. I was on the trial for two and a half years and it completely changed the trajectory of my disease. I might actually have my first scans with no evidence of disease. We’re hoping that after all these years, I’m finally NED.

All the drugs that we have now were at one point in a clinical trial and had to be tested on people in order to get approval.

Dr. Andrea Cercek

Misconceptions about clinical trials

Allison: I’m very, very excited because this is such an important conversation. People have all sorts of knowledge about clinical trials when they go in. When we talk about clinical trials, there are a lot of misconceptions.

Dr. Cercek, what are some misconceptions you’ve heard? When people reach out to me, one that I’ve heard is they think clinical trials are a last resort, only for the very sickest patients. But they aren’t, are they?

Dr. Cercek: No, definitely not. Clinical trials come in all shapes and sizes and in all stages so that’s a really, really important point. People often feel it’s a last resort. “I’m a guinea pig. Why should I do this? Will this matter at this point?”

Trials happen in early-stage disease. They can be as a first-line treatment, when someone is first diagnosed, and also with advanced disease, where the goal of the trial is how to improve the standard treatment either by adding new medication or changing medications completely based on data from studies in advanced disease.

Colorectal Cancer Clinical Trials

It’s important to run these trials in all stages to find out which drugs work and at what stage they work best. That’s a really, really important point that we need to instill. It’s critical for people to consider clinical trials because that’s really what helps move science forward. That’s really what makes advances.

All the drugs that we have now were at one point in a clinical trial and had to be tested on people in order to get approval. We have super strict approvals for all drugs but especially for oncology drugs. We get approval through clinical trials.

Patients are afraid they’re going to be given a placebo. In oncology, that’s not true.

David Fenstermacher

Allison: That last point is one of the things that most people have no idea about. David, you speak to patients all the time. What are some of the questions and misconceptions about clinical trials that you hear?

Colorectal Cancer Clinical Trials

David: The one I hear the most is patients are afraid they’re going to be given a placebo. In oncology, that’s not true. The care that you would get would be the standard of care for your disease at your particular stage and biomarker. That’s really important to understand.

There are all sorts of concerns that patients have. How do I find a trial? Is there a trial near me? What are the costs of a trial and who pays for the different aspects of that? If you participate, how is that going to alter the schedule of when you have to go to the doctor or the site where the clinical trial is being conducted? Do you need more tests? Do you need more imaging?

A lot of people don’t truly understand that when you go in, it’s very regimented. You will learn exactly what’s going to happen. You can ask questions of your doctor so that you can understand exactly what you’re getting yourself into by possibly participating in a trial.

Everything is your decision. You can withdraw from a clinical trial at any time. This is really about you and the care that you can get through these new therapies or new combinations that are being developed.

Allison: This is great information. If someone is in North Carolina, they want to go to Houston or New York for a trial. They want to go to the trial that’s best for them. They want to know about cost, lodging, parenting — all the different things.

I said, ‘You know what? I have nothing to lose. The side effects sound a lot less worse than chemo, radiation, and surgery. Let’s give it a shot.’

Kelly Spill

Kelly’s clinical trial story

Allison: Kelly, we want to hear about your clinical trial experience. What were your first treatment options and how did you end up hearing about clinical trials? Did your doctor bring this up or did you?

Kelly: My original treatment option was chemo, radiation, and surgery, which would have led me to have a colostomy bag for the rest of my life and likely not be able to carry another baby again.

I didn’t know anything about clinical trials. I’m actually still learning to this day and it’s very exciting to learn now that I’m in remission. I’m in a big learning era right now.

At the time, I was going to Memorial Sloan Kettering. If I didn’t go there, I would have never known about this clinical trial.

I was planning on checking out a couple of cancer centers at the time and once I hit Sloan, I felt like I was at home. I felt like a family member there. I felt very comfortable. They were very informative with everything that was going on and that I needed to know.

Colorectal Cancer Clinical Trials

Thankfully, I had a research nurse come into my room right before we were about to set an appointment to start chemo. She said, “We may have another option for you. Would you like to hear it?” I said, “Of course, I want to hear another option.”

I had this other option specifically because my tumor type was an MMRD, mismatch repair-deficient, so it allowed me to be on this clinical trial.

I had my mom with me and I don’t know what I would do without her. It was really nice having someone with me who was able to understand what I was being told. Being so sick, not feeling well, and being young, I had no idea what a lot of these big words meant and what was going on at the time.

After I heard the pros and cons of the side effects, I looked at my mom and asked, “Should we do this?” She asked, “How do you feel about it?” I weighed out my options.

I said, “You know what? I have nothing to lose. The side effects sound a lot less worse than chemo, radiation, and surgery. Let’s give it a shot.” If that didn’t work for me, then I would have gone back and did the chemo, chemo-radiation, and surgery. I still had a backup.

Allison: Having a caregiver there is so important, someone you trust and know. We’re in a nervous state and going through something very, very traumatic so having someone else there to help guide you is so important. Thank you so much for sharing and letting everyone know how you came to that decision because it’s personal and hearing different viewpoints is so important for others.

Dr. Cercek, you co-led the trial that Kelly was on and know her well. Can you tell us a little bit more about this trial?

Our trial was specifically asking the question, ‘Can it work even better when the tumor is in an early stage when it’s localized before it spreads?’

Dr. Andrea Cercek
Colorectal Cancer Clinical Trials

Dr. Cercek: This study is still open. It’s for patients with mismatch repair-deficient, a specific subtype in early-stage rectal cancer.

Normally, for early-stage rectal cancer, the treatment is chemotherapy, radiation, and surgery. Because it’s located down in the pelvis at the end of the large intestine, there are a lot of important organs that are affected by our normal treatment, like the ovaries and the uterus.

Although it’s a good treatment and it’s curative, people are left with a lot of toxicity from treatment, including not being able to have babies, bowel/bladder dysfunction, and potentially even a permanent bag in about a third of patients or so because of where the tumors are.

The idea of the study in this subset of patients with mismatch repair-deficient or MSI-high tumors is to try immunotherapy. We knew that in stage 4 disease, immunotherapy works very well for mismatch repair-deficient colon and rectal cancer. This was accomplished in a clinical trial where it was the same idea.

We have a good biomarker. Our trial was specifically asking the question, “Can it work even better when the tumor is in an early stage when it’s localized before it spreads?” The way that we designed it is that because the standard treatment was curative, we didn’t want to compromise the cure.

We gave immunotherapy first, watched the patients really closely, and then if the tumor didn’t completely go away, they would simply jump onto the normal standard of care regimen with chemotherapy, chemo-radiation, and surgery, depending on the clinical situation. Everyone would be offered a complete package.

Thankfully, we saw that immunotherapy alone is able to get rid of these tumors so it’s been really amazing. Now we’re treating all different early-stage cancers, including the esophagus and stomach that have mismatch repair deficiency or MSI High. As I mentioned, the rectal study is still ongoing.

Allison: It’s important to note that that trial was for that specific gene. It’s important to know your genes and your mutation so that you can figure out what trial works best for you. Talk to your doctor about that so you have that knowledge. I’ve heard about your research and now meeting Kelly and seeing the human side of it is just amazing. Thank you so much for doing what you’re doing and continue doing what you’re doing.

I’d had over 60 chemo treatments, five open surgeries, and multiple radiation therapies. My body was worn out.

Julie Clauer

Julie’s clinical trial story

Allison: Julie, we want to hear about your clinical trial experience. How did you learn about it and how much did you know before?

Julie: In my first appointment before I started treatment, I was told about a clinical trial. I thought that was just what happens is that you get offered clinical trials. I found out later that that’s not actually how it works.

At that time, I decided not to do the clinical trial. I knew with stage 4 and as extensive as the disease I had, I knew that the first line of treatment wasn’t going to work forever and I knew that this wasn’t going to be a one-shot deal for me.

I’m a planner by nature so I wanted to know what the options were before I needed them. It was actually while I was doing well in treatment that I did the most research on clinical trials. I felt like that was extremely helpful because I wasn’t in a panicked state. You’re looking at it very objectively. You’re not making a major life decision at that point.

Colorectal Cancer Clinical Trials

Sometimes I’d find out about clinical trials from COLONTOWN. I’d hear about something from another patient or my doctor would tell me about something he was working on that was really exciting.

We dribbled the clinical trial conversation in which I’d bring something to an appointment and say, “I heard about this trial. What do you think?” I’d get his opinion. It was like talking and learning about clinical trials two minutes at a time over a long period of time.

Anytime I got news of progression and needed a treatment change, we’d already have a set of what would be next. I always wanted to have a few options. The clinical trial I ended up going on was always on that shortlist.

When I would come in with the results of a scan that wasn’t good, we’d say, “Given what we see now, are all those still options? How do we want to move forward?” We had already made the decision before I needed the decision.

This trial was one that was on the docket for a long time so I learned a lot about it. I learned how the early results were going. I learned almost too much because, by the time it was time to go on it, the trial was not looking very good in terms of the results. From a research perspective, it didn’t meet its endpoint.

But I had progression and I was really exhausted. I’d had over 60 chemo treatments, five open surgeries, and multiple radiation therapies. My body was worn out.

When it came time to decide what was next, I could have gone on the last line of the standard-of-care chemotherapy, a third-line treatment that was available, or two trials that were in the mix.

This trial was one that was on the docket for a long time so I learned a lot about it.

Julie Clauer

When I went to my doctor, we were talking about the trial that I ended up going on. It was a better option for me than the standard of care at the time. We talked about the fact that it wasn’t going to change the trajectory of my disease. I wasn’t going to be cured, but the short-term stability was pretty good.

He said, “It’s immunotherapy-based. The toxicity is less. It could give you a few months to regroup, have a chemo break, and hopefully get you to stability so we could figure out what’s next.” It was intended to be a bridge.

I said, “Okay, I think I want to do this, but we have that other trial that I’m more interested in so I want to go talk to that primary investigator.” He was at a different institution. I made an appointment with him, talked to him about the trial, was excited about it, but he said, “It’s not open for another six weeks and when I look at your counts, you’re not going to be able to wait that long.”

Colorectal Cancer Clinical Trials

There’s also an element of having options because you don’t know what will be available and what will work for you. I was looking for a range of stability and I ended up being stable on it for two and a half years.

It opened up a lot. I was able to get surgery. It was much better than stable, in my opinion. In terms of the actual results of the trial, it was stable. It goes to show that you have to know what you’re looking for and have some options.

Those moments are scary. Having somebody else who can help talk you through it is fantastic. Not having all the information thrown at you at a time when you’re really scared and trying to figure out the logistics while you’re in the moment was key for me.

My clinical trial experience was fantastic. It out-delivered. I actually went off the trial to get surgery, which wasn’t an option before. My side effects were significantly better.

I’ve since gone on an off-label treatment because of how I responded to the trial. It became an option because of how I did. It really changed everything about my disease, but it definitely was not the cure.

Allison: It’s always very complicated. It’s never, “I’m going to do this then this and this.” You need to figure out what’s best for you at that time. Sometimes you have to wait or make a difficult choice about where to go next if one trial doesn’t open for a certain amount of time. Someone asked, “What exactly do you mean by stability? No tumor growth?”

Julie: No tumor growth. Technically, on a clinical trial, if you have between 30% shrinkage and 20% growth on certain tumors that they’re measuring, that means stability. Technically, I had stability. However, I had 29.4% shrinkage so I was right on the cusp. I had 11 mets and went down to four. I was nonsurgical and became surgical.

Those outcomes are so important for researchers to look at, to see the whole population and how people do to move medicine forward. But when you’re an individual patient, I think all that matters is what it means to you.

Deciding to join a clinical trial

Allison: You can see between these women that their stories are different. Trials are different and they’re happening all over the US. There’s a process and some people might not know the process. How do I find what’s best for me? What might go through the mind of someone thinking about a trial?

Kelly, what was the process like for you before deciding to join the trial? Did you have any concerns? What were some of the questions that you asked your doctor?

Kelly: To be honest, I was so sick sitting there that I was weighing out the side effects. I was so concerned about not being able to have another baby. I was so concerned about radiation.

I remember sitting and listening to what I would have experienced as side effects. My sex life would have never been the same. It really scared me. Radiation and surgery scared me a lot more than chemo at that time.

After hearing the side effects of this clinical trial, I said, “Why wouldn’t I try this?” I had a backup plan of chemo, radiation, and surgery. My mom and I looked at each other, I said, “Let’s go for it.”

Colorectal Cancer Clinical Trials

I’m the only one in my family who has been diagnosed with colorectal cancer. No one in my family has cancer so I haven’t been surrounded by it. I didn’t know anything. In our eyes, it was more of a chance of should we do it or not.

Coming out of this, I want to be that advocate because so many young people are being diagnosed with colorectal cancer. If you don’t know anyone who goes through it, you don’t even know that there are any of these options or resources.

Keep an open line of communication at every point. Make sure everyone is informed that these are the possibilities that we might be thinking about at some point.

Dr. Andrea Cercek

Clinical trials for young-onset patients

Allison: We know early-onset colorectal cancer is on the rise. I was an adolescent young adult patient when I was diagnosed. I wouldn’t say epidemic, but there’s something going on. Researchers and oncologists are trying to figure out why.

There are a lot of young onset programs now. How do oncologists proactively counsel their patients about trials given most young-onset patients want to do trials before failing the second line?

Dr. Cercek: Epidemic is actually a really good word. It’s rising worldwide. We don’t know why it’s happening, but there’s a steady rise from year to year.

Colorectal Cancer Clinical Trials

We opened centers dedicated to young people under the age of 50 with colorectal cancer for two reasons. First is for research to try to get data to figure out why this is happening and second is to help patients navigate this disease from diagnosis through treatment and into survivorship. Each stage is critically important and has different and unique challenges in our young patients, as everyone here is well aware.

We believe that this disease, as best as we can tell, is the same disease once someone has it. There might be slight nuanced differences, but in terms of available treatment, our chemotherapy and our trials are for all ages. There’s nothing specifically for early-onset colorectal cancer because the disease, once it’s present in any stage, behaves very similarly.

Young patients themselves are more motivated, perhaps more eager to participate in trials and think about the next steps. It depends on the person very much, but that’s probably true as a group.

Although someone is motivated, it’s not always easy to offer trials because sometimes the standard of care is better, which is an important thing to acknowledge and think about, too. We have certain good treatments that are already accepted as the standard of care.

There are trials for every stage so it’s an important thing to keep in mind, especially with our young patients. Often, people come armed with information.

It’s incredibly overwhelming how many trials there are out there so that’s a challenge in and of itself. It’s important to educate our patients at any age, but especially our young patients in terms of biomarkers, which are potential targets in the future.

If someone has a specific mutation, I’ll often say, “Listen, you have this. We’re not going to think about this now, but this might be something that we’ll think about a trial in the future,” or, “There’s an exciting new trial with combination immunotherapy. We don’t need it right now, but that’s something that we’ll think about.”

The challenge is always, “I’m ready now, I’m ready now,” and oftentimes, I’ll tell you, “Listen, you’re in a really good spot. You don’t need anything right now because we don’t have anything. The chemo that you’re on is actually working. Once, of course, we see that it’s not working, then we think about what are the next steps.”

The most important thing is to keep an open line of communication at every point. Make sure everyone is informed that these are the possibilities that we might be thinking about at some point.

Allison: Having an open line of communication is huge as well as trust. Patients can do their research but it’s shared decision making. It’s about what’s best at that time. Younger people might be eager, but we have to trust in the process.

You shouldn’t let cost, fear, or other things stop you from investigating and thinking about trials.

Allison Rosen

Costs involved in joining a clinical trial

Allison: Does insurance cover clinical trials? People can’t just pick up and go. There might be a trial down the street, but the best trial might be 500 miles away or a thousand miles away.

David: There are some things covered by the sponsor of the clinical trial. The study drug is covered. Any lab tests related to any endpoints that aren’t the primary endpoint are paid by the sponsor. Any imaging that the sponsor would ask to be done so that they can monitor the response to the therapy on the clinical trial very closely would also be covered by the sponsors.

The doctor’s visits, hospital stays, regular lab tests, and regular imaging that would be part of the standard of care, your insurance would pay for.

Some sponsors do provide support for things such as transport, housing, food, and child care. There are other resources like the Colorectal Cancer Alliance, where we also have resources where we can help patients with some of these financial needs.

Colorectal Cancer Clinical Trials

We have navigators who can help you through the process of finding a clinical trial and how you can participate in a clinical trial based on some of the challenges that you have.

Allison: You shouldn’t let cost, fear, or other things stop you from investigating and thinking about trials.

I wasn’t giving up on the idea of a cure. I saw it more as a relay race.

Julie Clauer

Switching mindsets

Allison: Everyone wants to be cured and it’s hard not to be stuck on getting to a cure. Julie, how did you change your goal to stability? What was that like?

Julie: It depends a lot on where you are in your care. That changes every point. Overall, the long-term goal and desire is always cure.

When you look at where I was in treatment, I was on the third/fourth-ish line. My body was very depleted. My blood count numbers weren’t doing so well. My platelets were low. I wasn’t necessarily in a healthy spot to do trials.

Colorectal Cancer Clinical Trials

One of the reasons why I couldn’t wait six weeks wasn’t because the cancer was out of control. It was because I probably wouldn’t be healthy enough to participate in a clinical trial. That’s another reason not to leave them as a last resort.

But at that moment, I wasn’t giving up on the idea of a cure. I saw it more as a relay race. For this segment, what I want is to get to stability, to be able to regroup, let my body recover a little bit so I can figure out the next step.

Any given treatment, if you look at it as a one-time treatment, depending on where you are in your disease, you could be cured with one treatment like Kelly was. Where I was in my disease, I knew it was going to be a series of multiple treatments.

Look at it as segments of the long race. In this segment, what I was looking for was stability so that I could be ready for the next segment. My goal would change then because if I’m stable, then my goal would be something different at the next point.

Allison: Clinical trials are a conversation and decision you make with your care team, your caregiver, and yourself. You have to think about a lot of different things. It’s not an easy decision.

Stay in contact, be honest with what’s going on, and be honest with yourself. If you have a question, ask. Don’t be scared.

Kelly Spill

Importance of advocating for yourself

Allison: Kelly, you mentioned your mom was a part of your decision making and you now strive to be an advocate to help others. What advice do you have for people as far as being their own best advocate when you’re talking to your care team?

Kelly: Before I started the trial, I was taking pictures of what was happening in the bathroom because sometimes it’s hard for me to describe what’s going on. I took pictures and showed my oncologist.

I ended up being very close with my oncologist and my research nurse. They were calling me pretty much all the time. I don’t know if that’s how it is in every hospital, but I was taken care of very closely.

We had a very open communication. I wasn’t holding anything back. I told him how I felt after every treatment, every little detail, not just physically, but mentally and emotionally. All of that plays into it.

As a mom, my mind is elsewhere, too, so I was writing in my Notes on my iPhone how I was feeling at home.

Colorectal Cancer Clinical Trials

I was constipated a lot and not doing well. After my first or second treatment, I couldn’t stop going to the bathroom. It was a completely opposite problem that I had been having. I quickly called the research nurse and told her what was going on, and she said, “That’s actually great news. Everything is being released.”

Stay in contact, be honest with what’s going on, and be honest with yourself. If you have a question, ask. Don’t be scared. It’s easy to be scared when you’re going through something like that, but putting everything out on the table is important.

Allison: I didn’t think about taking pictures. A journal can help because you go through so many things and can’t remember everything. You only have a certain amount of time with your doctor so coming prepared with a list helps expedite the conversation, help them understand, and not forget something. Be as prepared as possible. Those are great tips.

When people are first diagnosed, it’s really important to know those biomarkers right away.

Dr. Andrea Cercek

Role of biomarkers in clinical trials

Allison: Dr. Cercek, can you talk about the role of biomarkers in clinical trials and how they can guide personalized treatment?

Dr. Cercek: A biomarker, at this point, is probably one of the most important pieces of information in terms of clinical trials and general treatment of colorectal cancer. It’s definitely important in advanced disease and even in the early stage, as we saw from Kelly’s experience.

A biomarker basically is a change in the tumor, like a mutation, which we have a potential drug for. Important biomarkers in colorectal cancer are things like mismatch repair deficiency or MSI, where we can use immunotherapy or other combinations that are tested in clinical trials.

Colorectal Cancer Clinical Trials

Important biomarkers include BRAF, V600E in particular, but BRAF is good enough to remember. We’ve made progress with BRAF targeting in clinical trials. There’s an approved therapy, but we’re trying to do better. It’s a really, really important marker in terms of treatment and trials as well.

Another one, which used to be a huge challenge but now we’re making progress, is KRAS or RAS. Typically, when we hear RAS mutated, we think there’s a treatment that we can’t use, like anti-EGFR therapy.

Now, there are RAS inhibitors or RAS-targeted therapies. RAS is the biomarker and then we have a targeted therapy for different types of KRAS. You might have heard KRAS G12C; that’s the new kid on the block. We recently had very good data in terms of responses when treating this biomarker in colon cancer. A newer one is G12D that’s now in clinical trials.

That’s an important thing to think about and to test. Most importantly, it’s something that everyone should have done when they’re diagnosed so that we know what the landscape is and what we can do, not only in terms of clinical trials but also the standard of care.

Another really important one is HER2 or ERBB2. We’ve studied that a lot in breast and stomach cancer, but now we’re seeing combinations work in colon cancer as well. There are ongoing trials looking at it in advanced disease and first-line treatment.

When people are first diagnosed, it’s really important to know those biomarkers right away. We’re also looking at it in early-stage disease and rectal cancer, similar to the study that Kelly was on but with HER2 targeting because it’s a very, very good biomarker for which we have a really good drug.

There are a number of biomarkers that we need to know. We encourage the next-generation sequencing of the tumor to know the mutational landscape. You can do it from the tumor. We could even do it from the blood in what’s called circulating tumor DNA. There are different ways to get it done, but it’s important for everyone to speak with their oncologists and have that done if you don’t already know that information.

Things have changed over the past few years in such an exciting way so you can treat the specific mutation of the tumor of that person. Asking those questions is one of the most important things.

Allison Rosen

Allison: The point that you made right there is so important. Not everyone has the knowledge. Ask about biomarker testing and circulating tumor DNA. Personalized medicine is so important now. Back when I was diagnosed, the standard of care was chemo, radiation, and surgery. A lot of this was on the horizon.

Things have changed over the past few years in such an exciting way so you can treat the specific mutation of the tumor of that person. Asking those questions is one of the most important things. A few years ago, only one mutation had a trial. Now there’s all this research ongoing. There are trials ongoing for a lot of this. Have that conversation with your doctor.

If you don’t know, that’s the first question you can ask your care team. Send them a message or call their team.

If they haven’t done it or they haven’t told you about genetic testing, biomarker testing, or circulating tumor DNA testing, have that conversation. It could change the trajectory of your whole treatment. You can find a trial that would work for you.

Colorectal Cancer Clinical Trials

Julie: Biomarkers are so critical. As a vanilla girl who’s wild type with no targetable mutations, not having a mutation is valuable information as well. There are a lot of trials that are available to you, too. A lot of people will say, “I don’t have any of those mutations so I’m out of luck.” No, you are not and I’m proof of that right here.

Dr. Cercek: Julie, thank you for that point. There are many studies, many drugs, many trials, and many different ways of targeting colorectal cancer. Biomarker is just one of them. 

There are different ways that drugs can enter the cell that have nothing to do with the mutation that are also explored and making progress. That’s really critical to know your mutational landscape because even that wild type makes a big difference in the standard of care, too.

Allison: The amount of information that’s being shared here is so valuable.

There’s a wealth of tools on the Internet that can help you find a trial. It’s more about making sure you’re finding the right trial that is also going to fit your lifestyle.

David Fenstermacher

Finding clinical trials

Allison: How do you get started on a trial and/or find trials and register? How often should a patient be searching?

David: ClinicalTrials.gov was brought up, which is a website run by the government that lists all clinical trials available. That can be a little bit daunting to navigate through. It’s a fairly complicated site, but that’s the place where you’re going to get the most. You have to use different search strategies.

There are tools out there that you can use. You don’t have to necessarily do it yourself. We have a system called BlueHQ. It’s a patient portal that allows you to learn more about your disease, especially if you understand your biomarkers. We have a trial finder embedded called Leal Health. You can put data in there and they will try to match you with a clinical trial.

I’ve worked at several comprehensive cancer centers and they will have on their website what clinical trials are available. There’s a wealth of tools on the Internet that can help you find a trial. It’s more about making sure you’re finding the right trial that is also going to fit your lifestyle.

Colorectal Cancer Clinical Trials

ClinicalTrials.gov is going to be the most up-to-date because protocols have to be submitted to ClinicalTrials.gov. You don’t have to do it yourself.

We use something called Leal Health that you can get through BlueHQ that allows you to enter data into their platform and they will try to do the trial matching for you. They’ll contact you if you are eligible for a trial, talk to you about where the trial is being conducted, and then see if you’re interested.

There is so much going on right now in colorectal cancer. When you look at new types of drugs that are coming out, antibody-drug conjugates are one. Think about new immunotherapies and how to turn cold tumors, those that do not respond to immunotherapies like PD-1 and PD-L1 therapies, into hot tumors so that they would respond then to those immunotherapeutic drugs.

There are opportunities for things like oncological vaccines. If you’re in stage 2 or 3 and you have a resection done, a company will take your tumor, sequence it, and look for neoantigens. These are caused by mutations in the tumor.

The interesting thing here is is they give you a vaccine against most common neoantigens so that hopefully if you grow new tumor cells after your surgery, your immune system would already be primed to take care of them.

On a daily basis, there could be a new trial. It’s more important to work with your oncologist and let them know you’re interested so they can help with trying to find the right trial for you.

Not all oncologists are comfortable with clinical trials, especially in rural parts of the country. There are resources that you can reach out to online that would allow you to keep track of clinical trials more closely. You can work with other companies that can do clinical trial matching for you. They’re on the web so they’re available.

Work with your oncologist and let them know you’re interested so they can help with trying to find the right trial for you.

David Fenstermacher

Final takeaways

Dr. Cercek: The most important thing is you can be and should be your own advocate. Speak up for yourself. Open that line of communication.

If you’re having trouble, let your oncologist know. If you have questions, it’s okay. Ask questions. It’s not annoying. You’re in this fight together and that’s the most important way to think about this and to approach this disease.

Kelly: Ask questions. Be open. You know your body best and you know yourself best. Coming from someone who’s a big introvert, I always feel like I’m annoying people with all these questions. It’s so important to ask them. Trust your gut.

David: A clinical trial could be out there that is just right for you at your stage in your disease progress. Do not be afraid of the fact that it’s research. These are drugs that have gone through extensive pre-clinical testing. This could be the best standard of care that you could get. Keep an open mind.

Julie: There’s no perfect trial for everybody. They’re all studies. They’re all trying to learn. Know yourself and have those conversations. Understand what you’re willing to do before you need to make the decision. When you get to that point of having to make the decision, you don’t necessarily have enough time to make the best decision you can.

Allison: Thank you so much to these panelists for their time to share and educate. You will most certainly help save lives by being here to share so thank you to each and every one of you.

Colorectal Cancer Clinical Trials

More Medical Expert Interviews

Dr. Lecia Sequist

Using AI to Detect Lung Cancer Risks With Dr. Lecia Sequist

Using AI to Detect Lung Cancer Risks Dr. Lecia Sequist discusses using AI to detect lung...
Dr. Mark Lewis, Dr. Kerry Rogers, Dr. Ruben Mesa

Trends in Cancer Research 2022

Learn from three of the top cancer specialists about cancer treatment trends, including precision medicine...
Jack Aiello and Dr. Alfred Garfall feature profile

The Role of Bispecific Antibodies in the Treatment of Multiple Myeloma

The Role of Bispecific Antibodies in the Treatment of Multiple Myeloma Hematologist Alfred Garfall, MD, MS...
ASH 2023 multiple myeloma

The Latest in Multiple Myeloma: Understanding Promising Treatment Options

The Latest in Multiple Myeloma: Understanding Promising Treatment Options Patient advocates Cindy Chmielewski and Jack Aiello...

The Latest in Multiple Myeloma with Caitlin Costello, MD

Dr. Costello discusses the latest in multiple myeloma treatment from ASH 2022, including the MAIA...