Transcription:

Scott Webb (Host): Most of us are familiar with the concept of paying it forward, which in the realm of cancer care clinical trials, it means that participants not only want to help themselves, but also help others to treat and perhaps one day cure their cancers. And joining me today to tell us about cancer care clinical trials and how important they are in the efforts to defeat cancer once and for all is Dr. Rodney Rocconi. He's a Gynecologic Oncologist and an internationally renowned leader in cancer research. Welcome to LifeCast, the podcast from Infirmary Health. I'm Scott Webb. So Doctor, thanks so much for your time today. We're going to talk about clinical trials for cancer care. And I got a bunch of questions for you, and you're going to do most of the heavy lifting, but before we get rolling here, just tell us about yourself and your specialty.

Rodney Rocconi, M.D., FACOG (Guest): I'm a GYN oncologist, which basically means that I take care of patients who have cancers of the female tract. Things like the ovaries, the tubes, the uterus and the cervix. Our specialty is a little bit different because we do both surgery as well as give chemotherapy for the treatment of these cancers.

Whereas most other cancer specialties have a surgeon, you know, then medical oncologists that give the chemo. So right off the bat, one of the things that drew me to this field was the fact that I had more continuity with my patients. And we're able to do both the surgery and the chemotherapy together.

Also I guess another part of what I do is I consider myself a physician scientist. In addition to having a busy clinical practice, I also spend some time with research and clinical trials as part of that research. So we can get better answers to treat patients better. And I truly believe 100% that the standard of care for all cancer therapies should involve clinical trials.

Host: Yeah, I see what you mean. And it sounds like you're a bit of a sort of one-stop shopping. So it's great to learn more about you as you say, you're seeing patients, but you're also involved in research and the trials. So let's talk about that. Let's talk about the various clinical trials for cancer care.

Dr. Rocconi: Well, you know, I think first, particularly in cancer when patients and family members think of clinical trials, they always view that as kind of the last option or the last step. One of the things I try to do is educate and talk to my patients or anyone who's interested in the fact that clinical trials, there's all different types, but it's something we can use even at the time of diagnosis, where there are certain trials that are good for those patients where they're entering into a new cancer diagnosis, a new journey, where we might for example, say, well, this is the standard of care.

This is the best we do. We use a regimen A for patients with this type of cancer. But, you know, we have a clinical trial comparing regimen A versus regimen A plus a new agent, agent X. And so even in early diagnoses, we have trials for those patients. And then, as patients might have recurrences and setbacks, there are other studies and other trials where it might be a very new agent that is the first to be tried, you know, in patients, to see if we get any real responses in meaningful survival, in regards to successes of those treatments.

Host: Yeah, this is really interesting. And it makes me wonder, you know, what are the goals from your perspective as the physician, as the scientist and for the patients as well? What are the ultimate goals in these trials for cancer care?

Um,

Dr. Rocconi: First and foremost is to cure and I think cancer providers almost shutter at the word but, our ultimate goal with clinical trials is to completely eradicate cancer to where that was a disease of yesteryear. Obviously that's tough, you know, we don't hit a lot of home runs, to use a baseball analogy, but we do hit a lot of singles and doubles and we string those together.

We're able to, you know, move the needle forward. I think one great example of that, the Children's Oncology Group. So, basically for pediatric cancers in my mind, are the trendsetters. They've done the best job with clinical trials for cancer, so much so that up to 85% of every pediatric cancer that's diagnose right now goes onto a clinical trial.

And so I think that's the standard of care. The success of that, that the Children's Oncology Group has shown by putting the majority of patients, the pediatric patients on trial; they have moved the needle so much forward, that they have taken incurable diseases that they saw 50 years ago in pediatric patients to now the five-year survival of these patients exceed 80%. And a lot of these former, you know, non-curative cancers are now have a high cure rate and that's placed solely on the shoulders of really being aggressive about clinical trials for these, you know, unfortunate children that get cancer.

You take that to an adult population. We've got a long ways to go. I mean, across the country, only about two to 3% of cancer patients are on clinical trials, at any point in time during their cancer journey. And so, you know, if we really want to learn and get better and develop better strategies and better therapies that lead to higher response rates and better cures, we really need to start you know, doing these trials to kind of help move that needle.

Host: Yeah, as you say that using the C word, cure word is a difficult one. But it is about moving the needle and I love the baseball analogy, playing some small ball, some singles, some doubles, you know, moving the runners, moving the needle in this case. You say two to 3% of adults?

I think the natural followup is why aren't there more like, sure we're doing this podcast to try to educate and encourage, but do you have a sense of why more adults don't participate?

Dr. Rocconi: Across the board, there's a lot of obstacles. I'll say from just the institution standpoint, you know, clinical trials are tough. I mean, there's rightly so, a lot of regulatory components, a lot of oversight. It takes a lot of infrastructure to build that up. And that's one of the things that we're really working hard here at Infirmary Health System is making sure we've got that foundation to where first and foremost, what we're doing for our patients is safe.

And making sure they're on the right types of trials. There's also obstacles, you know, I think you look across the complexity of the United States, different people have different levels of access to care. A lot of our country is, you know, very rural and sometimes, patients have to travel great distances to, to get to certain cancer care.

So are a lot of obstacles to that. I'd be remiss in Alabama, not to mention things like Tuskegee. That was significant setback in regards to how clinical trials, you know, should not be run. There were some major and very important lessons learned from that. The last study report out of Tuskegee happened in 1971. You know, that's in my lifetime. And to think that that's still not something that people think about I think is not being completely truthful. And personally I have patients, black patients that I take care of and that topic comes up. We talk about clinical trials and we hit it head on and the goal and the onus of establishing that trust is on me. You know, it's on our clinicians, our physicians, we're the ones responsible to making sure a patient really trusts us when we come to them and say, this is a clinical trial.

This is why I think it is good for you. And then respecting, the patient wishes in regards to whether they do or do not want to be on the study. We're still gonna care for them and give our best care. But yes, I mean, all those things play a role in trying to improve the number of patients on clinical trials so we can get better results. And, it's not easy. If it was easy, everybody would be doing it right?

Host: Right. Absolutely. Yeah and I thought you might mention Tuskegee and that kind of transitions right into my next question. Let's talk about ethics and as a scientist, I know, and especially in Alabama and Tuskegee and everything that we're kind of talking about here, what ethics do you follow with these clinical trials and why is it so important to you?

Dr. Rocconi: You cannot perform clinical trials or take care of patients without a sound foundation in the ethics of patient care and there are, you know, national, international guidelines on ethical research and clinical trials. And there's dozens of examples of things gone wrong. And I think as long as we learn from those types of things and move forward in creating the infrastructure to do it safely and ethically, we're on the right track.

For every study that we perform there are numerous individuals and actually boards that review the study to make sure that the ethics and patient safety are upheld as the number one goal. They're called Institutional Review Boards. IRBs as we call them.

And it's a group of individuals, some of which are physicians, some of which might be cancer specialists. But there's also, you know, other people, even patient advocates, people who have previously had cancer and are survivors and are on these committees, as well as usually, other people who have some background in ethics, religious providers in the area, our pastors and priests are also serving on these boards.

And I think it's so important to have an independent group of people outside of physicians and other people who, you know, have our own inherent biases, we want to have a non-biased objective review to make sure that, hey, we're being safe. This is an ethical thing to do. And I think in addition to that, we follow a patient so closely during a clinical trial to where I think that there's so many eyes on that patient and what they're receiving, looking at labs, double checking this, that, and the other, that I do believe they get better care on a trial.

Host: Yeah, it certainly seems so. And independent review and oversight and really bringing a bunch of folks together and talking these things through and reviewing them and, you know, getting all the stakeholders involved, it really sounds ethical to me. And I can understand the importance, especially in Alabama.

So we get close to wrapping up here, and this has been really educational. I'm sure it has been for listeners as well. Why do you want patients to consider being a part of clinical trials? What's the advantage to them and others? I'll give you your chance to, you know, really sell it here Doctor.

Dr. Rocconi: To go back to the point of myself and others believe in it is the best care and it should be the standard being on a clinical trial. Every time I talked to a patient about clinical trials, I always try to talk about the benefit and there is a, I believe a benefit to the patient. You know, they are typically getting an agent that they would not receive otherwise, you know, something that's new and could be better than what we already have. I mentioned the oversight and the fact that there are a team of individuals who are solely responsible of following the patient, making sure all the I's are dotted, T's are cross and all their symptoms are being controlled for. But I would be remiss to mention that the benefit also is paying it forward a little bit.

Every discovery and every treatment that we give, not only in cancer care, but just in medicine in general, is on the shoulders of, as I tell patients, women just like then, with you know, an ovarian cancer patient, we're giving this agent or doing this trial because there've been women like them who entered into a study to show that it's better.

And I think if we can somehow get, you know, both the patient to understand that there's a benefit for them as well, in addition to that, making something maybe better for the next group of women like them. I think it's a win-win situation for all.

Host: Yeah, it certainly is. And I was thinking that exact phrase paying it forward. When you were talking about pediatric patients, participating in trials. You know, your point today about moving the needle, it's just not possible without the clinical trials, it's just such a key component. And whether you're helping yourself or that next generation really paying it forward so much value, so many benefits, and I really appreciated this today, Doctor. So thanks so much and you stay well

Dr. Rocconi: Yeah, thank you. Have a good day. I appreciate it.

Host: For more information, call 251-435-CARE. That's 251-435-2273. Or visit infirmarycancercare.org.

And if you enjoyed this podcast, please share on social media and subscribe, rate, and review on your favorite podcast apps. This is LifeCast, the podcast from Infirmary Health. I'm Scott Webb. Thanks for listening. Stay well.