Terry Fox Foundation and Terry Fox Research Institute Joint Annual Report - 2017-18

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Annual Report 2017/18

A BOLD VISION “Even if I don’t finish, we need others to continue. It’s got to keep going without me.” – Terry Fox

We expect our leaders and innovators to have bold visions, to take us places where we have not been before, to make the world a better place. Terry Fox never thought of himself as a leader or innovator and yet, undoubtedly, he was. His story, and more importantly his fundraising legacy, lives on more than 39 years after his death, because Canadians and people around the world demand it, need it and are inspired by it. And we are so grateful. This past year has been another year of transformation and innovation here at The Terry Fox Foundation. So much has changed since Terry’s run in 1980 yet the drive for significant results in our cancer research projects is just as strong as ever. The Marathon of Hope Cancer Centre Network, a collaborative effort that uses the principles of precision medicine and big data, is accelerating and we hope to share some exciting news with you in the year ahead. In this report we will share with you some encouraging stories about how our EPPIC research project is bringing Susan Stewart and other pancreatic cancer patients new hope. Take a moment to meet Lauren, our inspiring 2018 Terry Fox Ambassador, a cancer survivor with a dancing spirit. We are honoured to introduce long-time supporter John Hopkins whose generosity will continue to impact others well beyond his lifetime. We are privileged to be part of the extended family that works ever so hard to keep Terry’s dream alive – volunteers, supporters, donors, staff. We are challenged everyday to emulate his determination, tenacity, and work ethic in our support of the research directed by The Terry Fox Research Institute. After 143 days and 3,339 miles, Terry was forced to stop running outside of Thunder Bay. Before returning to BC for treatment Terry said, “I’m going to do my very best. I’ll fight. I promise I won’t give up.” He never did. And neither will we.

Yours Sincerely,

Bill Pristanski Board Chair

Britt Andersen Executive Director

The Terry Fox Foundation

The Terry Fox Foundation

AN EXCITING YEAR FOR RESEARCH This has been an impressive year for cancer research with new, important advances and discoveries making headlines around the world. As scientists, we are heartened to see that decades of research on understanding the molecular basis of cancer are beginning to pay off for patients in the form of Precision Medicine. For example, the US Food and Drug Administration just approved a drug for use by adult and pediatric patients with different types of tumours carrying a common genetic defect, demonstrating a shift to treating cancers based on their molecular properties rather than their tumour site location. Also, we now know that not all women need to undergo chemotherapy when they are diagnosed with early breast cancer. In fact, we can predict, based on molecular markers, that 7 in 10 of these women do not need it at all! The recent success of immunotherapy drugs on deadly cancers such as melanoma and lung cancer is a game-changer. There is hope that immunotherapy might also work for other hardto-treat cancers. This was acknowledged recently by a Nobel Prize to immunologist Dr. Jim Allison (MD Anderson, Texas) for his fundamental research on checkpoint inhibitors, which are used today in immunotherapy. These are exciting times and Precision Medicine is moving forward. Importantly, this kind of progress is fueled by the generosity of donors and supporters like each of you. At TFRI, our funded researchers across the country are grateful for your support. Our patients and study participants are too. At 73, Yves in Quebec is enjoying life with his partner after beating melanoma cancer with an immunotherapy drug. Debbie in Ontario is making a great recovery from breast cancer with help from a medical team that is using novel imaging technology to monitor her progress. Your belief in us, evidenced by your incredible generosity over the past 38 years, drives our vision to help other Terrys, Yveses, and Debbies. We believe this will be made possible by our plan to create the Marathon of Hope Cancer Centres Network, a pan-Canadian initiative that will link our top Canadian research institutes and hospitals across the country to work together to accelerate Precision Medicine. Our plan is gaining steam, with two pilot projects launched and more coming on board in 2019. We intend to launch the Marathon of Hope Cancer Centres Network in 2019. We hope it will transform cancer research and care for Canadians diagnosed with cancer no matter where they live in Canada. We thank you for investing in TFRI over the past decade and hope your support will continue for our new vision.

Yours Sincerely,

Dr. Victor Ling, O.C., O.B.C., PhD President and Scientific Director The Terry Fox Research Institute

“I want to try the impossible to show it can be done.�

– Terry Fox

MEET LAUREN: CANADA’S NEXT DANCE SUPERSTAR, CANCER SURVIVOR I don’t remember a lot about my cancer treatments or being in the hospital, but my mom does. She tells me that I was only 6 months old when she and my dad were told I had cancer. They wanted to run from the hospital because they were so scared but the doctors and nurses soon became like their family. I had cancer in my eyes that went away after the doctors gave me chemotherapy. When I was almost 3 the doctor suggested removing one of my eyes but lucky for me my mom and dad wouldn’t let them. We kept going back to the hospital for treatments and they worked! When I was 5 and a half the doctor finally told us that I had no more cancer! Today I have to be careful in the sun, but nothing slows me down. I like dancing and singing. I do dance classes for Ballet, Acro, Jazz and Modern but Acro dance is my favourite. I’m in French Immersion at school where we do the Terry Fox Run. We also do the Terry Fox Run every year at Wasaga Beach with my grandma and the rest of our family. It’s so much fun!

I admire Terry Fox because he was very courageous running across Canada so he could donate money for cancer research. Cancer can bring you down but to anybody fighting it I say be brave like Terry – and me too. Thank you everyone! – Lauren

EPPIC BRINGS HOPE TO PATIENTS WITH PANCREATIC CANCER “It’s really great they have this treatment where you can still function at a pretty high level with it, despite having Stage IV terminal cancer.” – Susan Stewart When Susan Stewart felt nauseous during a weekend run in November 2016, she never would have guessed she was about to be diagnosed with Stage IV terminal pancreatic cancer. Instead, the 58-year-old from North Vancouver, B.C. thought she was coming down with the flu, and rested for the remainder of the weekend. The following Monday she returned, but after a trip to the washroom, she was stunned to see her urine was extremely dark. “That was the first indication I had that I was sick. Literally I was fine, and then over a weekend I was not fine,” says Stewart, who was eventually diagnosed with metastatic pancreatic cancer on Jan. 4, 2017. “Even in hindsight I had none of the symptoms or risk factors. I run, don’t drink much, and I’ve never smoked. It shouldn’t have hit me.” Stewart’s story isn’t unique. Pancreatic cancer has few known symptoms and no early detection tests, meaning that it normally gets diagnosed in advanced stages. This, combined with the fact that it has few treatment options, makes pancreatic cancer the fourth leading cause of cancer-related death in Canada, with approximately 5,500 deaths every year.

One of these patients is Susan, who was enrolled in EPPIC and placed on a clinical trial about a week after her diagnosis. Nearly two years later, her results are promising: her pancreatic cancer tumour is no longer visible on CT scans, and the metastatic cancer on her liver has shrunk considerably. “It’s been amazing. I’ve had some really, really good results,” she says, noting treatment side-effects have been minimal. “It’s really great they have this treatment where you can still function at a pretty high level with it, despite having Stage IV terminal cancer.” While it’s impossible to know if her progress will remain steady, Stewart is happy for the extra time she has been able to spend with her family. She is also happy to know that her genetic samples will go towards informing treatment for others, allowing a glimmer of hope to radiate through their lives. “With the clinical trials and all the money going into the disease now, there’s HOPE in capital letters,” she says. “I think that’s a really great thing for people in my situation, and my push is to keep the support coming for the research. This is a disease that needs more hope.”

If that weren’t enough, pancreatic cancer is grossly underfunded, and all indications show that its on the rise. “For many years it’s been hopeless from a patient perspective,” says Dr. Daniel Renouf (BC Cancer, University of British Columbia), who co-leads a $5-million pan-Canadian, precision medicine initiative recently funded by the Terry Fox Research Institute. Officially launched in March 2018, the Enhanced Pancreatic Cancer Profiling for Individualized Care (EPPIC) is hoping to give patients with this deadly disease some much needed hope. To do this, EPPIC researchers are connecting 400 eligible patients in B.C., Quebec, Ontario, and Alberta to promising clinical trials and collecting genetic data that will help understand how they each react to experimental treatment. This information will then be stored in a knowledge bank and shared with other researchers, allowing them to improve their understanding of pancreatic cancer biology, individualize treatment strategies, and facilitate the development of new treatment options. Susan Stewart and her dog. (Mike Wakefield/North Shore News)


2017-18 Funding by Cancer Site Blood











$21.8M Research Investment



Novel Therapeutics

8% *Investment in each of these cancer sites is under 5%. The percentage shown is a cumulative total and includes bone, cervix, head & neck, lung, pancreatic, cancer biology, gastrointestinal, thyroid, and sarcoma.

9% 8%


By The Numbers




Funded Researchers

Collaborative Institutions Across Canada

Funded Projects



79 cents of every dollars goes directly to research (based on 3yr average) Research Investment


Admin and Fundraising Costs

By The Numbers




Staff to Volunteer Ratio

School and Community Runs

Annual Participants




Countries World-Wide

Funded International Programs



International Cancer Research Investment

International Runs


Maple Bear Brasilia, Brazil

Beijing City International School, Beijing

Four Seasons Hotel Kyoto, Japan

SNAPSHOT OF TFRI INVESTMENT BY REGIONAL NODE 2017/2018 snapshot of TFRI and partner investment by regional node based on excellence and impact









Index: $ Invested (K=thousands, M-millions) Up to $100K

$5 – $10M

$500K – $1M

Over $10M

$1M – $5M

No current projects

– Large number indicates total projects funded (includes discovery, translational, new investigators and training) – Many of the funded projects are multiple year (e.g. 3 and 6 year) – Many projects have multiple sites participating; each site is included within its provincial project investment total ($) *Prairie Node **Atlantic Node









MAKING A DIFFERENCE A legacy of generosity that will continue for years to come John Hopkins was working in Winnipeg when he first heard about the young man running across Canada. “To know a man on one leg made it halfway was extraordinary” John shares. “And his efforts have united Canada with so many runs done in his name.” Terry’s eventual death had a strong impact on John. John began volunteering for the Terry Fox Run in Richmond, BC in 1986. Richmond is the community where he and Helen made a home, raised their son, and took part in their first Terry Fox Run. Later, it was where he also first felt personally affected by cancer. In 1999 Helen was diagnosed with lymphoma, and so began a twelve-year journey with cancer. Like many people faced with a life-threatening illness, they wanted all the information they could get. Through research and conversations with Helen’s doctors, they quickly learned how complicated and unpredictable cancer is. The number of treatment options were limited and for many cancer types, there was a “one size fits all” approach. After being treated for lymphoma, Helen underwent two operations for breast cancer and then melanoma of the eye, which metastasized to her liver. The cancer wouldn’t let up.

Helen passed away five years ago. She died in the palliative care facility she helped set up at Richmond Hospital where she worked. John and Helen were married for 49 years and loved each other deeply but unfortunately John’s cancer journey doesn’t end there. Two years ago, John was diagnosed with papillary thyroid cancer. After two successful operations, he is now a cancer survivor – and has the Terry Fox red t-shirt to prove it! He knows there were people with the same cancer who came before him and who were not as fortunate but he wants to keep the momentum alive so that people diagnosed in the future have the best chance of survival. John firmly believes that high quality research is the key to curing this disease. That is why he is a committed long-time volunteer Run Organizer, fundraiser and even left a gift in his will to the Terry Fox Foundation. He wants to ensure he is giving back to his community in a meaningful and long-term way. “My words to live by are care, share, give, and receive. At certain points in our lives, we’re the ones caring and providing for people, and during other times, we learn to receive support. I’ve been through both stages and am committed to providing hope for people with cancer for years to come,” says John.

RESEARCH HIGHLIGHTS These four summaries explain some of the significant advances and findings our researchers have made with funding investments from the Terry Fox Research Institute and The Terry Fox Foundation. Their work is helping to: advance our understanding of this complex disease; enable clinicians to detect and diagnose it earlier in patients; identify potential new treatments that can be personalized to individuals from sequencing their tumours; and bring together top scientists and clinicians to tackle challenging aspects of the disease, including engineering the body’s immune system to launch its own defense against the disease.


Helping surgeons to see and treat tumours with minimally invasive procedures A long-funded Terry Fox research team is hoping to improve outcomes for patients with prostate and thyroid cancers by developing new technologies that allow doctors to see and treat tumours more effectively. The team lead by Dr. Gang Zheng (Princess Margaret Cancer Centre) is developing a wide-range of nanoparticles that interact with light to improve photoacoustic imaging techniques while also playing a role in photodynamic therapy (PDT), a promising treatment against cancer that uses light-activated drugs to kill cancer cells. These nanoparticles – which range from biomimetic chlorosomes to porphysomes – will serve as theranostic agents, meaning that they will help diagnose and treat tumours. “We envision these agents will improve current surgical procedures by helping surgeons view tumours they are operating on in real-time, while also providing minimally invasive and curable PDT for surgically inaccessible tumours or tumours that are close to anatomical structures,” said Dr. Zheng, adding that in some cases the nanoparticles will also help doctors diagnose cancers more precisely, helping them avoid the harsh side-effects associated with overtreatment. “Specialists and experts from a wide range of fields have come together for the project. This is a purely Canadian innovation. I really think this technology will be a major winner down the road – we are very, very excited about this.”


Team identifies best method to sequence gene mutations for precision medicine approach to lymphoid cancer A Terry Fox research team is moving closer towards making precision medicine a reality for patients with lymphoid cancer after identifying the best way to discover gene mutations associated with the disease. In a paper published in March 2018, the team led by Dr. Christian Steidl (BC Cancer) announced that it had discovered that a DNA sequencing method known as “hybrid-capture sequencing” is the best way to identify gene mutations in three forms of lymphoma: diffuse large B-cell lymphoma, follicular lymphoma, and chronic lymphocytic leukemia. According to Dr. Steidl, the new sequencing method has a higher sensitivity for variant calling (the process used to identify variants from sequence data), which allowed it to identify at least one actionable mutation in 91 per cent of tumours from 219 patients. The discovery offers renewed hope for patients with this disease, as it means that doctors will be able to act more precisely against specific mutations associated with the disease, something they couldn’t do until now. This is much needed. A type of blood cancer, lymphoid cancers are the fourth most common cancers in Canada and incidence rates have been steadily increasing over the last 50 years.



Metabolism team’s work provides clearer understanding of enzyme’s role in prostate cancer development and growth

Collaborators hope to bring immunotherapy trials to more ovarian cancer patients

Research by a TFRI-funded group studying cancer metabolism has shed light on how prostate cancer develops, survives and grows. It also provides a possible reason for why some drugs have not been an effective therapy for the disease.

Ovarian cancer patients across Canada may soon have access to promising immunotherapy trials thanks to a new collaboration led by the Terry Fox Research Institute.

Led by Dr. Vincent Giguère (McGill University, Montrèal), the team has found that nuclear mTOR, a regulator of cellular metabolism, also works in the nucleus to directly affect the expression of metabolic genes. Their findings underscore a shift in scientists’ understanding of the androgen receptor (AR) as the master transcriptional regulator of metabolism in prostate cancer. Their 2017 paper suggests mTOR co-operates directly with the androgen receptor to regulate the expression of these genes. Together, the combined action of nuclear mTOR and the AR reprograms the metabolism of prostate cancer cells to favour their growth and proliferation. This knowledge will benefit the development of future combinatorial therapies against both mTOR and AR to treat prostate cancer. Currently, drugs targeting mTOR have not been an effective therapy for prostate cancer. The research team suggests this could be because they target the cytoplasmic function of mTOR instead of the nuclear function. The team also successfully identified an mTOR-dependent gene signature which could help predict recurrence in prostate cancer patients. Prostate cancer is the third leading cause of cancer-related death in Canadian men, and one of the most common cancers for this demographic. Illustration above: cancer of the prostate

The collaboration brings together researchers from two top Canadian immunotherapy labs to harmonize how they create T-cells, a type of white blood cell with cancer-fighting potential used in immunotherapy treatments. “Harmonizing our processes opens doors for fascinating new collaborations between the two teams that could have a real impact on patients,” said Dr. Brad Nelson (BC Cancer), a Victoria-based immunologist who co-leads the project with Dr. Pamela Ohashi (Princess Margaret Cancer Centre) in Toronto. According to Dr. Nelson, harmonizing T-cell production will let investigators from both centres administer clinical trials together, meaning they will be able to reach more patients in more places. “Until now, we were pretty much siloed, which meant that trials could only occur in one centre,” said Dr. Nelson. “Our vision is that we will soon be able to do immunotherapy trials at different centres and generate data that is comparing apples to apples from centre to centre.” Launched in early 2017, the project is part of The Terry Fox Canadian Comprehensive Cancer Centres Network (TF4CN) initiative, a two-year precision medicine pilot led by the TFRI that brings together investigators from Vancouver’s BC Cancer and Toronto’s Princess Margaret Cancer Centre.

BRINGING GREAT MINDS AND TEAMS TOGETHER TO TACKLE BRAIN CANCER Winnipeg resident Lawrence Traa, 56, was watching television when he realized that the names of everyone he knew had suddenly faded from his memory. He immediately called his doctor and after a few tests received a daunting diagnosis: glioblastoma multiforme (GBM), the same brain cancer that claimed Tragically Hip band member Gord Downie and U.S. Senator John McCain. Although he was quickly put on a treatment plan that included surgery, chemotherapy and radiation, his doctors were clear: Traa would be lucky to live more than two years. Impending death pushed Traa to live his life to the fullest, and between motorcycle trips, fishing excursions and hikes, something strange happened — six whole years went by! This extreme response to treatment grabbed the attention of DNA repair biologist Dr. Sachin Katyal (CancerCare Manitoba, University of Manitoba) who connected with Traa and began studying his response to treatment, with the hopes of understanding how he has survived so long. Dr. Katyal is a TFRI New Investigator who is trying to understand how GBM interacts with different drugs. “Hearing that research like this is being done in Manitoba brings hope,” says Traa. “When people help fund research it buys me and future patients more time. The research is being sped up in such a good way, and that is very exciting!”

Two Ontario-based teams are studying the disease under Terry Fox New Frontiers Program Project grants:

• At McMaster University, Dr. Sheila Singh’s team, with co-investigators at the University of Toronto, is focused on recurrent GBM – studying GBM tumours that pop up after the initial tumours are removed.

• At the Hospital for Sick Children, a project focused on metastatic cancer contains a large brain cancer component. Neurosurgeon Dr. Michael Taylor is using genomics to pave the way for the development of treatments that could improve outcomes and quality of life for children with metastatic medulloblastoma, the most common form of brain cancer in children. A third project in Alberta, led by Dr. Greg Cairncross (University of Calgary) is nearing the end of its work in successfully identifying potential new drugs for clinical trials for patients with genetically divergent primary tumours. In Canada, an estimated 3,000 people are annually diagnosed with brain cancer. These cancers often have low survival rates, and in many cases, those who survive brain tumours are left with long-term physical and cognitive side-effects. Funds from the Terry Fox Foundation are enabling the Institute’s investigators to tackle this disease from many directions – to increase survival and quality of life for these patients.

Dr. Katyal’s research is part of a larger $1.9-million investment in brain cancer by the Terry Fox Research Institute during the 2017-18 fiscal year.

Mr. Lawrence Traa

Dr. Sachin Katyal

“I’ve said to people before that I’m going to do my very best to make it, I’m not going to give up. But I might not make it… If I don’t, the Marathon of Hope better continue.”

– Terry Fox

THANK YOU to all of our generous & amazing Terry Fox supporters. Including those who contributed by: • Giving a monthly gift • Participating in or donating to a Run • Volunteering your time • Making a donation • Leaving a Legacy gift in your will • Donating stocks or investments Anyone who has donated continues to be a part of helping to keep Terry’s dream alive. Without you this would not be possible.

The Terry Fox Foundation 150-8960 University High St. Burnaby, BC V5A 4Y6


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