Imagine if you had the option of enrolling a patient in a clinical trial without them having to leave their home, or could offer a patient their choice of where to receive the latest therapy? Coupling telemedicine with clinical research has tremendous promise for bringing this efficiency and equity to cancer care. That’s part of the vision that Alex A. Adjei, MD, PhD has brought as the new chair of Cleveland Clinic Taussig Cancer Institute.
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Previously a consultant in oncology, professor of oncology and professor of pharmacology at Mayo Clinic and Mayo Clinic College of Medicine and Science, Dr. Adjei has dedicated his career to bringing life-saving medication to everyone who needs it. As a pioneer in cancer drug development, he played a lead role in developing therapies for solid tumors and hematologic malignancies, including novel treatments for non-small cell lung cancer. He has worked in the development of immunotherapies, targeted therapies as well as cancer-fighting viruses to combat lung cancer and other solid tumors. He has authored more than 300 publications focused on preclinical pharmacology, early phase trials and lung cancer.
ConsultQD recently sat down with Dr. Adjei to learn about the future he envisions for the institute and how we can break down barriers to clinical trial access.
Dr. Adjei: For me personally, the whole goal of research is about how to apply it to patient care. This is complex, particularly when it comes to oncology. You need the right culture and the right systems in place. Having the opportunity to help build research in a place where the clinical program is exceptional is a dream job.
Dr. Adjei: My PhD was in cancer pharmacology, and I was drawn to continue that work in the clinic. Often when you’re treating patients with certain types of cancer, the available therapies are limited. I’ve always been interested in working in this space to give patients hope.
Dr. Adjei: Our vision is for anyone diagnosed with cancer to have the opportunity to participate in a clinical trial in a way that’s convenient for them. We can make that possible, thanks to having a huge health system with a regional, national and international network.
We are also focusing on relatively untapped areas of research. One of these is diagnosing, understanding and developing treatments for side effects that result from cancer treatment. Patients are living longer but many treatments come with chronic side effects. We need to not just treat cancer but address issues such as diarrhea, fatigue, depression, anxiety and dysfunction of vital organs like the liver, heart, eyes, lungs and the brain that affect our patients’ quality of life. We are uniquely positioned here at Taussig because our palliative medicine teams are experts in treating side effects, including those with psychosocial impacts. Also, our institutes have experts in all organ systems of the body, so we can build multidisciplinary teams to work together to more effectively address side effects impacting the heart, lungs, kidneys and other organs.
Dr. Adjei: We plan to develop novel therapies for cancer and build on our available expertise to develop centers of excellence in unique areas of cancer. Some examples are our group studying cancer associated thrombosis. In addition to the research, there is a dedicated clinic treating blood clots associated with cancer. For instance, this group led an international study using oral anticoagulants to prevent blood clots in patients with cancer prior to starting chemotherapy. In addition, our Clonal Hematopoiesis Clinic is following a large population of cancer survivors to understand their risk of developing secondary hematologic malignancies or heart disease as a complication from their successful treatment.
We will also focus on innovations to improve care delivery.
Dr. Adjei: Telehealth is a relatively untapped innovation. We need to make it part of our practice and move things forward to reach more patients, for standard of care and for clinical trials. Otherwise, trials would exclude patients who have to travel from a distance or who have hurdles like childcare issues. We can pioneer how telehealth is used so that, for example, patients from hundreds of miles away can sign consent, enroll on a study and be monitored remotely with digital tools and virtual visits. They can get their blood drawn in their homes, or get imaging done at home and have their records uploaded on a secure server. This is the future of clinical research, which will allow us to reach patients far and wide.
Dr. Adjei: With current advancements in cancer care, we can significantly prolong the lives of patients with many cancers, but we cure very few people. Clinical trials of promising drugs and devices provide the opportunity for incrementally improving patients’ lives.
We need to get to a place in our practice where we consider trials as a continuum in their treatment. Often a trial is actually the best treatment option. When a patient first comes in, one of the first questions we should be asking ourselves is if there is an ideal trial for them. And we need educational materials to be able to explain clinical trials to patients so they have the chance to consider this option.
Dr. Adjei: One of the first initiatives has been to go into the community through health fairs and other events to meet people and build trust. We started with offering cancer screenings to vulnerable populations, and this has been very successful. One of our colonoscopy screening clinics went from having 6 patients screened a year to 374 patients through the Community Outreach and Patient navigation program.
Building on this work, our next step is to encourage patients diagnosed with cancer to come to Cleveland Clinic for treatment. From there, we can have conversations about whether a clinical trial is right for them.
Dr. Adjei: The ESMO Gender Medicine Task Force has a primary focus on providing awareness and stimulating research in the differences in cancer treatment outcomes and side effects between different sexes. This is an area that has been traditionally ignored. Ultimately, with the differences in sexual and gender identity and differences in underlying biology, it is important that we begin to study the effects of cancer medicines, which can be effective but toxic in different groups. It is an honor to have the opportunity to provide my pharmacology expertise to this unique and important initiative.
Hear our podcast with Dr. Adjei about his vision for the future of cancer care at Cleveland Clinic.