Leukemia: Clinical Trials with Dr. Rob Stuart

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Guest: Dr. Robert K. Stuart - Professor of medicine.

Host: Dr. Linda Austin - Psychiatrist.

Dr. Linda Austin: I am Dr. Linda Austin. I am talking with Dr. Robert K. Stuart, who is professor of medicine and is a hematologist/oncologist at Hollings Cancer Center. Dr. Stuart let’s talk today about new treatments for the adult leukemias. What’s been going on here at Hollings and why is there reason for new hope for patients?

Dr. Robert K. Stuart: Well, the most common leukemia that we see here partly because we are a referral center part is adult acute myeloid leukemia. This is a really devastating disease. Untreated patients can only expect to survive weeks to a few months; however, treatment has improved dramatically in 30 years or so that that this has been a special interest of mine beginning in my early days, back at Johns Hopkins University and treatment involves chemotherapy. We have a good backbone of chemotherapy that has stood the test of time now for over twenty years and we are attempting to modify that backbone by adding additional agents, by modifying doses, and schedules and so forth. All the progress that has been made in the treatment of this leukemia comes from clinical trials. In clinical trials, there is a sort of the final common pathway for the development of a new drug or medical treatment and it is the point at which human testing is carried out to make sure that the promising treatment is not something that just happens in the test tube or is only good in mice or rats. So, clinical trials are very, very important. Most of the clinical trials that I am involved with is a special type of clinical trial called a phase 3 or randomized clinical trial. In this setting, every patient gets the best standard treatment known, but half the patients get in addition an additional drug or a slightly different schedule and then we see whether that tweak actually improves the results compared to the best standard treatment. No patients; however, are ever - get less than the best standard treatment and that’s one of the things that I want people to know about clinical trials. Clinical trials represent a heavy investment by our government, by our funding agencies, and by the people that carry them out. All of the clinical trials are reviewed by multiple specialist and committees that include even members of the public to make sure that they are ethical and scientifically promising enough to carry out.

Dr. Linda Austin: If I had leukemia, AML, let say I might be thinking, Gee you know it will be wonderful to help science march forward, but I am sacred to death for myself. I am just thinking about me and my family right now. Why might it be in my interest or not for that matter to participate in a clinical trial?

Dr. Robert K. Stuart: Well, I have been conducting and participating in clinical trials for thirty years and I am firmly convinced that people actually get better care on clinical trials than they do off clinical trials even if it seems like it’s the same treatment. Part of the reason is that with the clinical trial there is a whole team that’s monitoring the patient to make sure that you know every T is crossed and every eye is dotted and nothing is omitted, nothing is done at the wrong time and so the precession that goes into that I think gets people better care.

Dr. Linda Austin: So you are VIP patient really. I mean every patient is very important, but you are VVIP patient if you are in a clinical trial.

Dr. Robert K. Stuart: Yeah. I certainly go out of my way to make people feel that way that they are special, they are doing something not only that’s good for themselves, but it’s good for their children, good for my children, and I want them to feel good about them.

Dr. Linda Austin: Share with us a success story of someone, who participated in a clinical trial.

Dr. Robert K. Stuart: I sure can. I have a lovely woman, who is 80 years old with AML. Now, a lot of doctors in this country don’t even treat the disease. They simply give the patient pain medicine and transfusions and you know the death occurs in few weeks or months, but because of my interest in the older patient with this disease we have a clinical trial for such patients. This is a drug that’s not available in the market, so this is a different type of clinical trial. This is a ? what’s called a phase 2 clinical trial and what was really remarkable about this case was that in this patient the total treatment time was a single one hour infusion of an experimental drug. She spend virtually no time hospitalized, where as the standard therapy for this disease even in somebody four years old is about a month in the hospital. She promptly went into remission. She received to follow-up treatments entirely in the clinic, never was admitted, had no major complications, and is currently alive and well and free of disease and at 80 I have to say she is a remarkable, functional, spry, wonderful person, and her daughter helped her with this and to me that’s a very gratifying success story.

Dr. Linda Austin: Well, we need to have an interview with her. I think of cancer in general in this way. When I think about HIV AIDS, there was a period of time that most of us remember well when AIDS was a certain death sentence. Now it’s not. Now, we know that there is effective treatment for AIDS, but there is a period of time in the interim when various agents were being tested in clinical trials that actually proved to get those participants a life and that’s where we are with many of these illnesses in clinical trials now don’t you think?

Dr. Robert K. Stuart: There is no question about it and it really has been a remarkable turn around with AIDS and actually one of the advances in AIDS therapy came from the experience in cancer therapy and that was the idea that if you combine these different agents at lower doses you reduce the side effects from each agent, but the multiple agents actually had a even greater effect on the virus and that’s a trick you know that we have been doing in cancer therapy from decades now and I well remember when the infectious disease specialist began doing that and I thought to myself this could be a big break through. Well it turned out it was.

Dr. Linda Austin: Dr. Robert K. Stuart, you are doing incredibly important and exciting work. Wish you well.

Dr. Robert K. Stuart: Thank you very much.

Dr. Linda Austin: Thank you.

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