RESEARCH IN GENITOURINARY ONCOLOGY: THE CANADIAN URO-ONCOLOGY GROUP MULTIDISCIPLINARY MODEL

Authors


Fred Saad, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, 1560 Rue Sherbrooke East Montréal PQ, Canada H2L 4M1.e-mail: fred.saad@ssss.gouv.qc.ca, fredsaad@videotron.ca

Abbreviations
CUOG

Canadian Uro-Oncology Group

NCIC

National Cancer Institute of Canada

GU

genitourinary

HRPC

hormone-refractory prostate cancer

DOG

disease-orientated groups.

INTRODUCTION

Research in all fields is challenging. This is no surprise to anyone who is involved in research but may surprise those on the outside looking in. Practice changing research is extremely complicated due to many factors which include budget constraints, differing ethics approval processes, health authority complexities and the biggest obstacle remains recruitment. Single-centre studies that change clinical practice are a thing of the past. Multicentre trials require coordination, commitment, and strategies to ensure success. In Canada we realized that to be competitive and to be able to lead and contribute to important clinical trials a cooperative group needed to be created. When a group of urologists decided that strength would come through structured collaboration, the Canadian Uro-Oncology Group (CUOG), was created. CUOG was founded in 1988 through the leadership of Yves Fradet as its first Chair and Larry Goldenberg as Secretary. The subsequent chairs were Laurence Klotz (1995–2001), Martin Gleave (2001–2007) and since 2007, I have assumed this position. In 2000, CUOG and the National Cancer Institute of Canada (NCIC) genitourinary (GU) group (NCIC-GU) joined forces to create a single executive. This unified executive has allowed us to play a pivotal role in all aspects of GU clinical trials in Canada. The objective of this group was to have a national multidisciplinary body that would promote and carry out high level research in urological oncology. We are proud of the multidisciplinary composition of CUOG, with membership comprising of urologists, radiation oncologists and medical oncologists as well as pathologists. The organization quickly became a true cooperative group and a vehicle to get centres involved in practice changing clinical trials. Some landmark studies have been led by CUOG such as the Neo-adjuvant hormone therapy trials in localized prostate cancer [1] and the placebo-controlled trial in metastatic RCC [2]. CUOG participation has been exemplary in international pivotal trials such as TAX 327 [3], which led to the approval of docetaxel in hormone-refractory prostate cancer (HRPC) as well as the ZOL 039 [4] study, which led to the approval of zoledronic acid in metastatic HRPC. We are very proud that the studies that led to the approval of these two new therapeutic mehods were published with CUOG members as first authors. CUOG has also taken leadership roles in developing the basis [5,6] for large multicentre trials now being run through large intergroup consortia, which include NCIC clinical trials group. Examples of this over the last year have been extremely exciting with the launch of an international randomized trial headed by CUOG-NCIC comparing active surveillance to radical therapy in localized prostate cancer (START) (n = 2000) as well as the completion of recruitment for the CUOG led PR7 trial comparing intermittent vs continuous hormone therapy in prostate cancer recurring after radiation therapy (n = 1500). CUOG is also very involved in several studies using novel therapies for HRPC in first- and second-line settings. CUOG consistently has between 15 and 20 clinical trails ongoing in most aspects of GU oncology.

More and more investigator-initiated trials are occurring through the CUOG network. With the collaboration of the disease-orientated groups (DOG) structure, ideas can be developed and matured to ensure the greatest chances of success. DOG groups include localized prostate cancer, advanced prostate cancer, kidney cancer, superficial TCC, invasive TCC and testes. This process allows everyone to come to these open meetings and submit proposals for trials that address important issues in uro-oncology.

Another facet of CUOG has been to support research with the collaboration of industry through the funding of project grants (CUOG AstraZeneca grants), as well as fellowships (NCIC-CUOG-AstraZeneca fellowships, CUOG-Bayer RCC fellowships) and CUOG-CUA-Abbott research grants in prostate cancer. CUOG has also led a surgical wait times initiative, which led to recommendations in maximum wait times for patients with urological cancers [7].

The CUOG model is being used as an example of success in clinical research, as Canadian investigators consistently perform extremely well in the quality and quantity of patients put on trials. We feel that this multidisciplinary collaboration and the creation of a network of dedicated centres across the country has allowed us to be successful in studies that our members lead, and very attractive to both cooperative group and industry led trials of importance. We think CUOG is proof of that when dedicated investigators decide to work together the likelihood of success increases tremendously.

CONFLICT OF INTEREST

None declared.

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