Partnerships propel kidney research forward
After joining Hamilton Health Sciences (HHS) in 2018, medical oncologist and researcher Dr. Aly-Khan Lalani was quick to establish a reputation as a relationship builder.
Lalani was deeply interested in the connection between immunotherapy – a fairly new cancer treatment back then — and gut health, but in order to get research projects off the ground he needed to forge new partnerships locally, nationally and worldwide.
“The evolution of this work shows how researchers leave pebbles along a path as they build relationships that allow studies to expand,” says Lalani, who treats kidney cancer patients at HHS Juravinski Hospital and Cancer Centre (JHCC), where he’s also chair of the genitourinary cancers disease site team. Genitourinary cancers include prostate, kidney, bladder, and testicular cancer.
“I come to work every day curious about understanding human beings diagnosed with cancer, how to prolong their lives and provide good quality of life through both direct treatment and research.”
Lalani is a scientist with the Escarpment Cancer Research Institute, a joint research institute of HHS and McMaster University, located at JHCC. He’s also an associate professor and an associate member of the Centre for Discovery in Cancer Research at McMaster. He’s passionate about translational research, which bridges the gap between research that happens in a lab and direct patient care.
A pebble in the path
With funding from the HHS Foundation, Lalani launched a feasibility study involving JHCC kidney cancer patients undergoing immunotherapy — a treatment that ramps up the immune system to fight cancer. “My aim was to collect stool samples from these patients in order to better understand the relationship between immunotherapy and the gut’s microbiome,” says Lalani.
To make this study a reality, Lalani formed a new partnership with McMaster’s Surette Lab, which specializes in microbiome research. Results are expected to be published later this year.
The next step
This study laid the groundwork for much larger undertaking – the global CYTOSHRINK trial that Lalani led with co-investigator and HHS radiation oncologist Dr. Anand Swaminath, and the Ontario Clinical Oncology Group (OCOG). Patient recruitment ended in the spring of 2024 and study results are expected later this year.
CYTOSHRINK involved patients with newly-diagnosed with stage 4 kidney cancer. This study received a federal-funding grant from BioCanRX, Canada’s immunotherapy network.
“I think this trial could be very impactful when results are available, hopefully later this year,” predicts Lalani, adding that the trial was made possible through partnerships he established with McMaster’s Surette Lab and the Human Immune Testing Suite, as well as cancer centres in Ottawa, Kitchener-Waterloo, London, Toronto, Edmonton and Australia.
“Launching this trial didn’t involve a yellow brick road that was already laid out for me to follow,” says Lalani. “It was something that had to be established, and as an early career investigator I’ve learned so much along the way.”
All patients in this phase 2 randomized trial received immunotherapy and provided stool, blood and tissue samples before, during and after their treatment for comparison. But the experimental group also received stereotactic body radiation therapy (SRBT), which delivers precisely targeted high doses of radiation to tumors in fewer sessions, in this case targeting the kidney tumor at the main disease site.
“Historically, kidney cancer was felt to be radiation resistant,” says Lalani. “But we now know that radiation can shrink a kidney tumor, and may even allow immunotherapy to work more effectively. This is what we sought out to test in a randomized trial.”
Lalani and his team compared the two groups, based on patients’ symptoms, CT scans and how long they live after treatment. There were lessons to be learned by comparing blood using a cutting-edge blood test, as well as stool and tissue samples of two groups before, during and after treatment, to see how they were influenced by immunotherapy versus immunotherapy combined with targeted radiation.
“We’re not only learning if the combination of immunotherapy and radiation helps patients live longer,” says Lalani. “For example, we can also look at changes in blood and the gut microbiome before, during and after treatment to better understand why some patients do better with treatment and some don’t.” Given that this trial is unique, sample collections will also create a one-of-a-kind biomarker repository.
Inspiration from patients
Lalani views research, and partnerships built through studies, as powerful tools in improving outcomes for cancer patients locally and globally.
“I come to work every day curious about understanding human beings diagnosed with cancer, how to prolong their lives and provide good quality of life through both direct treatment and research,” says Lalani. “That’s the spark I wake up with every day. You’ve got to feel that at the end of the day, your understanding will help people, and make a ripple somewhere in this world.”
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