By Niecole Killawee
Nova Scotia Health’s Atlantic Clinical Cancer Research Unit (ACCRU) was recently selected as the first site in Canada to open the Novartis Adjuvant WIDER study, a global clinical trial evaluating whether a medication called ribociclib can lower the risk of early-stage breast cancer returning.
Dr. Ashley Davidson, a Nova Scotia Health oncologist and division head of medical oncology at Dalhousie University, is leading the study.
“The way we increase the cure rates for early-stage breast cancer is by shrinking the number of people who experience a recurrence,” says Dr. Davidson. “Patients in Nova Scotia are the first in Canada to have the opportunity to participate in this study.”
The study focuses on treating hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer (HR+/HER2-), the most common subtype, accounting for 70 percent of breast cancer diagnoses.
Although this form of the disease is highly treatable and often curable if caught early, one-third of patients with breast cancer will eventually face a recurrence.
Ribociclib, which is already used in the treatment of advanced-stage breast cancer, was approved by Health Canada last year as a treatment in the early-stage setting to prevent the cancer from returning. In the Adjuvant WIDER trial, ribociclib is now being evaluated in a broader population to determine if the benefits seen in previous trials will be applicable across a wider range of patients who still face elevated risk after a lumpectomy or mastectomy. It’s a medication that shows promise in its ability to boost the effectiveness of endocrine therapy, a critical post-surgery treatment that starves cancer cells of the fuel they need to grow and spread.
A trusted global research partner
There are currently more than 300 clinical trials happening in Nova Scotia. Within ACCRU, a specialized program supporting cancer research, there are between 45-50 trials in start-up and 20-25 underway at any given time.
Nova Scotia Health’s capacity to run complex studies collaboratively and efficiently is attracting more clinical trials to the region, and that’s good news for Nova Scotians.
“When it comes to clinical trials, more is definitely better,” said Dr. Davidson.
A born Maritimer who returned to Nova Scotia in 2022 after working at the University of British Columbia and McGill University, he credits all the Nova Scotia Health teams involved for their commitment to expanding research strength and capacity.
“Our nurses, data managers, physicians, and the Clinical Research unit have done an exemplary job in Nova Scotia,” said Dr. Davidson. “The time it takes to open a clinical trial here has been reduced from 16 months to under six months in just two years."
Nova Scotia’s centralized referral process is another advantage. All medical oncology referrals flow through Halifax or Cape Breton, making trials accessible to patients living in smaller communities across the province.
“Providing excellent care to individual patients is immensely rewarding, but the ability to affect the care of others on a larger scale through research is the thrill that drives most clinical investigators,” said Dr. Davidson. “Impacting the patient in front of you and the whole community of patients internationally — and knowing it will all feed back to the next patient you see — is essentially the full circle of clinical cancer research.” – Dr. Davidson
Research is care
Having led or collaborated on countless clinical trials, Dr. Davidson is a firm believer in the idea that research is care.
“During my training, I was taught that the best treatment for anyone diagnosed with cancer is a clinical trial,” he said. “A patient participating in a trial has the potential to access a new and exciting treatment before it becomes widely available.”
While all new treatments developed against cancer go through clinical trials before becoming part of standard care, some people aren’t immediately comfortable with the idea of medical research.
Fears of “being experimented upon” are understandable, said Dr. Davidson, but research activity will never compromise a patient because of detailed institutional and regulatory processes that ensure it’s as safe as possible. Every clinical trial in Nova Scotia undergoes a rigorous review by Nova Scotia Health’s Research Ethics Board to ensure patient protection, safety, and ethical oversight before a single patient is enrolled.
“The very first responsibility of any physician is to provide the best possible care to the patient,” he explained. “Physicians are not permitted to offer participation in a trial unless they believe it’s in the best interest of a patient.”
Taking part in medical research is always optional. Only a patient can make the decision to participate. A patient’s routine care and standard treatment plans won’t be affected, no matter their choice.
Many of Dr. Davidson’s patients who do decide to enroll in a clinical trial tell him they’re willing to participate if it can improve care for others in the future, often raising the idea themselves. That motivation — doing it for the greater good — is humbling, said Dr. Davidson.
“A cancer diagnosis is one of the most significant events that can happen to somebody. It leads to a re-evaluation of their life, relationships, and their position in the world,” he said.
“So, in that moment, to be able to think of other people suffering from this illness is always striking to me,” said Dr. Davidson.
Patients moving cancer care forward
For decades, treatment options for HR+/HER2 breast cancer were limited to the surgical removal of tumors and a handful of additional therapies to help prevent the cancer from returning.
While those treatments remain essential in cancer care today, it was a series of international trials over many years that dramatically changed the outcomes for people affected by this disease.
Because of the compassion of patients who participated in those trials, people with HR+/HER2- breast cancer today are receiving more effective treatments that can stop or delay cancer growth and lower the risk of it returning. They’re getting more hope, more time, and more peace of mind as new studies continue to build on that progress and offer patients even stronger treatments against cancer in the years ahead.
