In China, cancer is a major cause of childhood death.
Each year, about 40,000 children are diagnosed with the disease, about 10,000 of whom have acute lymphoblastic leukemia (ALL). Before the year 2000, fewer than 10 percent of children with cancer received treatment, with individual families required to shoulder the financial burden of therapy.
But thanks to St. Jude Children’s Research Hospital, the number of children receiving cancer treatment in China has skyrocketed.
After a 2011 Chinese medical insurance policy provided many children with access to treatment, Ching-Hon Pui, MD, St. Jude Oncology chair, proposed that Shanghai Children’s Medical Center form a study group to provide high-quality treatment for children with ALL. With his input, the Chinese Children’s Cancer Group ALL clinical trial was developed. Since 2015, that trial has enrolled 1,250 patients annually in 20 major hospitals across China.
With the Chinese government’s approval, Shanghai Children’s Medical Center and St. Jude developed a National Childhood Cancer Center and established a collaborative framework for cancer treatment and research.
“We need to go where the patients are,” says Carlos Rodriguez-Galindo, MD, St. Jude Global Pediatric Medicine chair and executive vice president. “Our mission is to advance care for all children with cancer in the world.”
I said, ‘Let’s make a deal with Beijing and Shanghai, and let’s start to save lives.’
Don’t let them go home to die
In 1991, Pui began working with Beijing Children’s Hospital and Shanghai Children’s Medical Center, teaching and training their physicians and nurses.
Twelve years later, he had a dramatic experience during a visit to one of the hospitals.
“I saw a mother screaming for help to save her child with leukemia,” he says. “And then I realized that after all these years, I might not have saved a single child with leukemia in China.”
He had assumed the government had been subsidizing cancer care, but that wasn’t the case. Pui then received assistance from St. Jude to treat a group of children. That project proved to Chinese officials that childhood ALL was curable and the treatment was affordable.
With the support of the Hope Foundation established by a St. Jude Board member, Pui collaborated with physicians at Shanghai Children’s Medical Center and Beijing Children’s Hospital to develop a clinical trial that treated 149 patients, 86 percent of whom remain in continuous complete remission. After results of the trial were published in Pediatric Blood and Cancer and the project was introduced to Chen Zhu, MD, China’s minister of health, the official selected childhood ALL as the first disease to be covered by his new national medical insurance.
Soon, more than 70 percent of children with ALL were being treated nationwide.
In 2012, Pui suggested to Zhu that China needed to develop a center like St. Jude for education, training, teaching and research.
“He agreed,” Pui says.
Today, the National Childhood Cancer Center is under construction in Shanghai.
We now have an embryo of a network that could change the landscape of childhood cancer in China.
A new model
Rodriguez-Galindo stresses the importance of sharing worldwide the techniques and processes central to the historic success of St. Jude clinical trials.
“At St. Jude, our practice, our values and our models have been evolving for more than 50 years, leaving a culture—a corporate memory—that’s invaluable,” Rodriguez-Galindo says. “We’ve constantly improved our systems, and our current results and quality of care reflect the many years of striving to achieve perfection.”
Physicians and researchers from China recently traveled to St. Jude to learn the principles behind building clinical trials, collecting data and identifying challenges.
“We reviewed principles of clinical research and analytics, and quality improvement methodology,” Rodriguez-Galindo says. “But we also discussed the importance of developing comprehensive clinical care models as well as integrating clinical research into practice.”
It’s not just helping them; we think the project is going to have an impact for everyone involved in pediatric leukemia research.
In 2015, through the leadership of James R. Downing, MD, St. Jude president and chief executive officer, St. Jude expanded its work in China and launched a collaborative research project that included whole genome sequencing of patients.
Coordinating a collaborative research project between scientists in Memphis and China means in addition to the science requirements, there are also patient protection measures, government and quality concerns, and financial and legal issues.
“As a researcher, I never thought I’d spend so much time on those things,” says Jinghui Zhang, PhD, St. Jude Computational Biology chair. “But it was a worthwhile experience.
“Our lab staff were invaluable to the successful launch of this project, and it’s taught our collaborators how to operate first-class genomic research.”
At the suggestion of Jun J. Yang, PhD, of St. Jude Pharmaceutical Sciences, the project focused on relapsed patients with ALL. Scientists and physicians at St. Jude and the National Cancer Center in Shanghai worked together to collect, process and analyze patient samples.
Their efforts are paying off.
“The preliminary data revealed specific genetic changes in patients who relapsed,” Yang says. “That provides important insight into why treatment initially failed.
“Being able to monitor the emergence of these mutations means leukemia relapse can be identified earlier and therapies can be implemented sooner,” Yang adds.
Together, we accelerate the science and advance the cure.
A global collaboration
The new St. Jude Global Alliance–China is a testament to the partnerships formed over decades. The alliance incorporates the sharing of information and technology. That effort also encompasses education as well as clinical and translational research. St. Jude shares its experience and technology, while Chinese partners share data and outcomes. With China as a blueprint, St. Jude plans to create similar partnerships with other countries in Asia.
“Our goal is to treat at least 5,000 patients in the next few years on the current ALL clinical trial in China,” Rodriguez-Galindo says. “It’s the largest trial of its kind, so we’re making sure this is done well and that it benefits these children and cancer treatment in the future.”
At its core, it’s about doing research together and helping more children.
“It’s been a lot of work, but it has been rewarding,” Pui says of his work in China. “There’s still a lot of work to do and a lot of children to help, but we now have an army of people participating.”
From Promise, Autumn 2017