Oncothon: Pediatric Oncology with Godfrey Chan, Nita Radhakrishnan

Oncothon is a telethon spanning 24 hours, dedicated to gathering donations for childhood cancer research.

Our speakers are Prof. Godfrey Chan from the University of Hong Kong and Dr. Nita Radhakrishnan from Post Graduate Institute of Child Health in Noida. Prof. Godfrey Chan will tell his journey in pediatric oncology and also share his thoughts about pediatric oncology and Dr. Radhakrishnan will introduce the challenges in childhood cancer care in India.

Speakers

Godfrey Chi-fung Chan holds the position of Professor at the University of Hong Kong. Since October 2018, he has served as the Chief of Service and Service Head of Pediatric Oncology at The Hong Kong Children’s Hospital.
He contributes as an editor for several academic journals and previously served as the Chief Editor of the Hong Kong Journal of Paediatrics.

Recognized internationally, he has received numerous awards, including those from ANR, SIOP, ASPR, and the Australian Government’s Endeavor Executive Award.

Beyond his research, he has held significant leadership roles, including as the Immediate Past Chairman of St Jude-VIVA-Asia Pediatric BMT Consortium, Regional Chairman (Asia, Australia & Africa) of Advance in Neuroblastoma Research, Secretary of the Asian Pediatric Hematology-Oncology Group, and Immediate Past President of the Hong Kong Pediatric Society.

His research focuses on childhood neurogenic tumors and stem cell biology, particularly exploring the immunological aspects of stem cells, cancers, and thalassemia.

Nita Radhakrishnan is an Associate Professor and Head of the Department of Pediatric Hematology-Oncology at the Post-Graduate Institute of Child Health, Noida, India. She serves as the honorary secretary of the Pediatric Hematology-Oncology Chapter of the Indian Academy of Pediatrics, the largest body of medical care providers for children with blood diseases and cancers in India.

She is the Co-Chair of the Partnerships Working Group of SIOP Global Health and Chair of the International Pediatric Association Program Area Working Group on Childhood Cancer. Dr. Radhakrishnan is on the Editorial Board of OncoDaily.

Moderator

Ricardo García is the Co-Founder, Chief Executive Officer, and a Member of the Board of Directors at Oncoheroes Biosciences. Ricardo has a diverse background in computer engineering, management, and business administration. His journey into entrepreneurship began early, leading to the successful sale of his first company when he was just 22 years old. This led Ricardo to start and grow multiple tech-focused companies, all driven by a passion for innovation.

In 2011, his son Richi was diagnosed with a brain tumor. This challenging experience prompted Ricardo to uproot his life and relocate to Boston to support his son’s treatment journey. During this period Ricardo discovered significant gaps and challenges in the support system for childhood cancer patients and their families.

Motivated by his journey, Ricardo founded the Richi Childhood Cancer Foundation, a non-profit organization with a global outreach. The foundation aims to address the unmet needs in childhood cancer care and support, leveraging Ricardo’s passion for making a meaningful difference in the lives of children and families affected by cancer.

00:00 Introduction
2:21 The beginning of Prof Chan’s journey in the field of oncology
7:45 Nita Radhakrishnan
17:52 About the Children’s Cancer Foundation
23:05 Number of foundations dedicated to pediatric cancer research in Hong Kong
25:16 Key priorities for pediatric cancer research in the future

The transcript of Oncothon: Pediatric Oncology with Godfrey Chan, Nita Radhakrishnan

Ricardo Garcia: Hi everyone again my name is Ricardo Garcia. I’m the CEO and co-founder of Oncoheroes Bioscience. Also, Rich is a brain tumor survivor. I’m here to introduce the next guest of our next session. We’re going to talk about pediatric cancer academic research.

We have Nita Radhakrishnan, pediatric oncologist. Dr. Nita is an associate professor and head, Department of Pediatric Hematology Oncology at the Postgraduate Institute of Child Health Noida, India. She’s a co-chair at the International Society for Pediatric Oncology SIOP partnership working group.

She is also an executive council member of the Indian Society of Primary Immunodeficiencies, nodal officer of Hemophilia Thalassemia Services in Noida, and section editor of Pediatric Hematology Oncology Journal. Welcome, Nita. thank you for joining today.

Nita Radhakrishnan: Thank you.

Ricardo Garcia: We also have Professor Godfrey Chan, which is the chair of the Chan Soon-Shiong Family Foundation. Professor Chan is currently the head of the Department of Pediatrics and Adolescent Medicine at Queen Mary Hospital. He has held the Siu-Yan Chau and Chie Shun Leung Professorship of Pediatrics at the University of Hong Kong. So, thank you so much, Professor Godfrey, for joining the session today.

I think we should have another speaker coming on board. I’m not sure if I can see them. Anyway, so I think we have another speaker that was coming today and joining, Deepen Ravikar. I don’t see him on the call. All right, so let’s go. I’d like to speak first.

Maybe the first question for both of you and then maybe you can take any of you can take the question first can answer the question is if you could share the beginning of your journey in the field of pediatric oncology and child cancer research and what motivated you to dedicate your professional career to support pediatric cancer.

Godfrey Chan: So may I start first?

Ricardo Garcia: Yeah, go ahead.

Godfrey Chan: Okay, so I’m currently working at the Hong Kong University. First of all, I mean thank you Ricardo for the introduction. And a while ago, I listened to the other two speakers. The first thing came to my mind and in fact I noticed Professor Prasad actually is working in Hong Kong but I never met her and I, I don’t even know she’s working on child cancer.

So first thing we have to do is to improve our communication within the pediatric oncology community. I think that’s very important.

So a while ago Professor Ricardo asked me how did I start with this pediatric cancer research. I still remember after my fellowship training, I returned at that time I went to St Jude and then I returned back to Hong Kong. And one of the diseases that struck me is neuroblastoma and because the survival was very bad even at that time.

So I got to know there’s a monoclonal antibody called anti-GD2 and that time was developed by the Sloan-Kettering group Professor Cheung Nai-Kong. So and then I tried to get into this antibody that was in 1999 and very luckily uh Professor Cheung happened to be from Hong Kong as well.

So we were able to work together and then I was able to get that drug for our clinical trial. So I know how much actually the drug initially cost. So for the manufacturing for each patient probably you’re talking about less than $10,000 US per person per patient.

But now by the time they’re selling this drug you are talking about 200,000 US per patient. So then I would like to say what happened maybe in the later the discussion because we are talking about raising funding donation but what makes the drug so expensive.

So I want to I mean try to explore into that okay and from my limited experience with that. So that’s how I start and I got into this drug but by the time I bought this drug back to Hong Kong because this is unregistered drug so I have to pass through many processes of regulatory process.

It took me another two years and I also have to raise funding. And where did I get the funding? Actually just like today I got the funding for the newspaper, the mass media and finally I raised the funding enough for me to treat 30 patients. So that’s how I start so I can share this experience with all of you later on.

And one of the problems for pediatric oncology is a low volume high risk kind of disease so the clinical trial will be very very expensive and take a long time. And unfortunately all of us are sitting here we are from Asia.

Asia has 70% of the world population but by the time we ask ourselves how come all this structure seldom come to Asia, why? So this is something we have to think about. And many of the Asian countries when they come to this new drug import of this new drug registration of this new drug they look at the Western society as of whether they register or not.

Why don’t we Asian country our expert we are the expert we should form our I mean leaders advisory group to advise our government so how to conduct trial in Asia which and then they should recognize us and so that’s exactly the incentive or initiative of a SIOP Asia and also and other organization.

Professor Akira Nakagawara and we founded called the APO Asian Pediatric Hematology Oncology actually we have two Indian, two Chinese and then two Japanese and a panel of many other Asian countries in the board. So I welcome all of you to join us so we promote to run clinical trial for pediatric cancer in Asia to lower down the cost so the drug will be cheaper and faster to reach our patient.

So I mean I will go into that and more detail and so Nita can talk about her experience first.

Ricardo Garcia: Yeah, thank you so much Professor, Professor Chan. Nita, I think you wanted to share some slides with the audience is that correct?

Nita Radhakrishnan: Yes, sure.

Ricardo Garcia: You can go ahead and share

Nita Radhakrishnan: I don’t think these are the slides yes thank you.

So I would like to thank uh the entire team behind ONCC and JAG for conceptualizing this and taking this forward. I think we’ve never seen anything of this uh magnitude ever and I hope um we um the mission reaches its target and thanks to the entire team behind it. And um so I’ve been um asked to share my experience in working in a center which is catering to extremely um difficult scenarios especially social scenarios.

So treating cancer in midst of all this is what I’m going to um be sharing with you. Could you advance the slide please? So these are the challenges that we face in childhood cancer management. So many of times uh children present very late to the health facility because I I’m pretty sure that in many most of the low and middle income countries we do not have pediatric cancer in as part of the medical curriculum.

So most of the primary health centers being manned by doctors who have a basic graduation who do not have awareness that even cancer exists in children and even when they have they do not know what to do many of times even the doctors are doctors counsel that there’s no treatment possible and the kids go home.

Even the lay public feel so, so for an example just just to cite an example on 4th of February we the the world’s cancer day celebrated so one of the very prominent media houses here called me up and asked me about childhood cancer outcomes and I told them and they asked me to share couple of survivors details.

So with the permission of the family we gave the numbers of a couple of survivors for that so that they could interact directly and uh release a positive media um report.

Subsequently half an hour later the journalist calls me back and saying but madam this the numbers you have shared is all blood cancer patients and my editor says blood cancer there is no survival in blood cancer. so how can you show, how can you share details of survivors who have actually being cured?

There is no survival so that is the kind of misinformation that is there out in the community and I don’t think the paper and that news item also so this is the hardcore reality that we face and we have to kind of work towards changing every single obstacle in the path to get to cure.

Even when somebody really refers a patient there is poor access to healthcare there’s poor referral pathways. Unlike in the US or the UK where there is a and in Australia many developed economies have a very good referral pathway so that the patient wherever the patient is reaching that system automatically refers the child to a higher center.

Here there is not there is no system like that. So if the patient wants to go, they will go if they want to go. They have a choice of going to whichever center they want to go so because of all this there are a lot of issues created in a lot of money is wasted.

Often by the time they reach a center which is capable to diagnose and treat there is and on top of all this there is gender bias, there is poverty, and many of times the family thinks and this is again a very stark reality that when they travel say 100 or 200 kilometers away to come and treat in a center, the family, the often the bread winner will say of the family will say okay how do I stay here and treat for six months.

Because if I don’t work every single day who will feed the rest of my family. So this is a very big reality that we face so even if we provide free access to treatment and even food for the child food for the caretaker even then the entire other family the rest of the family, A join family might be dependent on the primary caregiver and so that becomes a big issue in continuing care for these children.

Many times centers, even medical colleges, do not have facilities for diagnosis or treatment, so they get referred. The one that I’ve highlighted in red is preventable deaths. Toxicity of treatment, especially drug-resistant organisms, sepsis due to MDR organisms, is a big reality. This has increased over the years.

Ten years back, treating cancer was easier on the same protocol. Treating cancer now is more difficult because there are so many organisms out there, and most of them are drug-resistant. That actually is probably the biggest hindrance currently.

Once a child reaches the center, getting them through the treatment without losing the child to toxicity is becoming increasingly difficult. Finally, late effects and abandonment: 10 to 12 percent of children abandon treatment in this part of the world because they do not feel that cancer is treatable.

When they lose hair or start looking different, the minute you talk to them about, say, enucleation in retinoblastoma or amputation in osteosarcoma, they just run away. They would rather not treat the disease and lose the child than lose a limb. That’s again one big issue that we face.

Brain tumors are similar. They don’t even reach a healthcare facility. The minute they hear the word brain tumor, they just go home and are ready to lose the child rather than get to curative treatment. These are the issues that we see, and many times there are these magical remedies being offered by quacks who are out there. Again, because of the absence of a regulated system and no referral pathway, we lose a few patients every year to such magical remedies.

Next slide, please. So in this context, this is a few pictures of infections that we see. Fungal infections as well as drug-resistant bacterial infections are extremely common out there. Next slide, please. This is probably what is actually accounting for that inequity of care that we have been talking about, and that is probably why, even though this region, LMIC, sees more than 80% of cancer outcomes being poor. I’m sure because of all these reasons. Next slide.

We actually do not have a denominator as of now. There are cancer registries being run by the country’s premier research organization, which is the Indian Council for Medical Research.

There are two ways of reporting childhood cancer. One is through population-based cancer registries, and the second is through hospital-based cancer registries. Both of them are not specific for childhood cancer. They report childhood cancer along with all the other cancers, but again, they are not wholesome because of the huge population that we are catering to.

It’s impossible to have 100% reporting, and these are just sample reporting that we have, and these are the numbers that we have to go by. Next slide, please. These are the prevalence according to the population-based cancer registry reporting. Next slide. These are the differences in numbers that we see.

When we have per thousand population, if you calculate per million population, if you calculate the numbers of patients diagnosed, there should not be any difference in terms of the region, right? These are diseases which should not have that kind of difference, but if you look at India, there is a huge difference in the gap of diagnosis, especially for CNS malignancies.

Next slide. Again, gender bias in healthcare seeking is very, very important. We face that very regularly. The minute you tell them for any advanced treatment, for example, bone marrow transplant, they are not even willing to bring the sibling for HLA typing. Just because at times, if it’s a girl child, they just abandon treatment and go back home. Next slide. These are the barriers I presented, and what are the solutions that have emerged in the last few years that we have been trying to implement here.

For this late presentation, one main aspect is to start educating at every level. Everybody in the team has to speak the same language. Even inside the hospital, every cadre of healthcare has been taught how to speak to the patient and the community.

There are public health workers called Asha workers. We have been regularly involved in training them so that they pick up children in the community and refer them on time. In addition, the government of India has something called Universal Health Care, which is at present catering to probably around 20% of these children, but it’s slowly improving.

That somehow, I think with all the digital mission that is in place, will improve universal health reporting as well. Universal, something akin to a referral system that I talked about, is not yet there, but I think it will improve. Strengthening of existing facilities has to be done, and abandonment, we’ve been trying to work hard by counseling families as well as presenting survivor stories.

Even today, there is a program on the occasion of International Childhood Cancer Day where we are highlighting survivors so that the message goes out into the community that these are the children who have come out of treatment despite all hardships, and if they can do it, even you can. Of course, treatment toxicity is being handled by nursing care improvement and training and education of doctors. I think I’ll stop here. I’m happy to take any questions and discuss this further.

Ricardo Garcia: Thank you, well thank you so much for sharing this information I think that was really interesting. I have to confess, I have to me that I learned something today I was going to ask you especially about what could be done. When I heard all the things that you at the very beginning I was just you know just biting my my tongue because I wanted to ask you the questions about okay what what could be done and you already share some of the potential solutions.

I want to give some time to Dr. Chan I’m not sure about what you want to talk because but I do have a question for you is about the work you’re doing in your in your foundation. I mean how your foundation, what are the foundation supporting child cancer so what are the initiative that your foundation has taken over to support.

Godfrey Chan: So I mean as mentioned by Nita different country nation probably has a different problem so but talking about the major challenges in for example in our part in Hong Kong is even Hong Kong is a relatively well developed City.

But the problem, the drug cost the escalating drug cost is still a big issue, so if you talk about the latest advance in the treatment of child cancer like the target therapy, the CART cell, all this you are talking about like a sky-high kind of prices so.

And how can we lower down the this the drug cost and also the avail ability as I mentioned many of the patient they don’t even have money for the basic kind of investigation and treatment so how to do with it.

So in Hong Kong we have some kind of a Evolution, so first I think in order to achieve a good goal basically you have to have a win-win-win situation.

So what are this win-win-win situation, we can classify the fee party the first one is the pharmaceuticals, the second one is the PTI the I mean the patients and the parents, and the third part are the provider including the government and the medical healthcare worker.

So in order to make the medical treatments available including the diagnostic things available is the drug company should have a reason about I mean chargings in Asian country, so can they lower down the cost to a relatively affordable level so then the for the government is how much money are they willing to contribute to the child cancer. So we all believe children’s are future so and then if many just like I mentioned leukemia is very highly curable disease now.

Now day so why should we abandon those children, so we should talk to the government and so just across the Cen River in Hong Kong as Professor Garcia mentioned I also work in the Hong Kong usingin Hospital which is inside China.

Every Monday I just go there so I can see the evolution in China as well because they are a developed country so what happened is they started to reimburse the the the citizens actually contribute to this children catastrophic funding and then the government will imburse initially 60% and subsequently higher proportion but one thing is quite interesting is that initially they don’t reimburse all the child cancer but to those with a very highly curable one and the relatively affordable one.

So with this initiative I can see in 30 years actually there’s a drastic improvement in the survival especially in those good those cancer with good prognosis like Al um and a while ago I mentioned about brain tumor why the diagnosis is low because they all kept by adult neurosurgeon in China I think in India probably that’s the case and then that understanding is towards adult brain tumor because 85% of the adult brain tumor are high grade esoca or Goma which is incurable.

So if your mindset is like like this it’s very bad for the patient so I think the government has to have recogniz so this one the Oncodaily is a very good platform for the Asian pediatric oncology could come together and I mean we we can mix some produce some I mean information material that we can present to the different government.

Ricardo Garcia: I have a question, Jesus, this is curiosity and is there any information available about the number of Foundations in your country dedicated to support pediatric cancer research.

Godfrey Chan: So in fact we have a Hong Kong Childhood Cancer Foundation, Children’s Cancer Foundation, that was founded in the 80s. Usually, these are from cancer patients’ parents, so they support treatments and also research, as you mentioned. We’re talking about one foundation. Is that you said there is one foundation in Hong Kong dedicated to supporting cancer research? Yes, one specific foundation.

And there was a time, but that one gradually phased off, called the Childhood Catastrophic Fund, also catered. So there are initially some different foundations, and there’s also, I think in many Asian countries, that we also have is the Ronald McDonald House.

So I mean, even if not actually for treatment, but they provide a sanitary environment for the poor patient as a midway home. As a little mention, a lot of time children after treatment may be immunocompromised. They may suffer from serious infection, so this kind of Ronald McDonald House can provide some kind of central site for these patients as a midway home.

Ricardo Garcia: I know very well about Ronald McDonald House because when you know my personal story is that my son was diagnosed with a high-risk medulloblastoma brain cancer, and then we were living in Spain, and then we had to move to the US for better expertise to save his life. And then we stayed for 60 days, yeah, at a Ronald McDonald House in Boston, and they treated us, you know, like it’s a home away from home resource, which is awesome.

I really love this organization. Just one question before we go, just I’d like to get from you, if it’s possible, a short statement, just like a very short, I would say one minute for each of you. Why, what are, in your opinion, the key priorities and areas of focus for future research on pediatric cancer? I know it’s a very wide question, but can you just, you share kind of just one idea that sells your mind?

Godfrey Chan: So if you only give me one minute, my personal belief is that in the future, cancer treatment may be 100% reliant on immunotherapy because that’s the basic, but many people understand immunotherapy as checkpoint inhibitors or CAR-T cells. But actually, immunotherapy is a whole concept, so you have monoclonal antibodies and even bone marrow transplant is immunotherapy.

So the future, mostly, will be immunotherapy. So how we can cut the cost for the immunotherapy of different types of immunotherapy will be our answer. Because, like now, in leukemia, can we start with, I mean, bispecific antibodies with low-intensity chemo or even CAR-T therapy so we can minimize chemo?

So this is the direction that we have to go to. And then I think even in children, therapy would be the key. So if in case we raise funding, we should raise funding to support immunotherapy.

Nita Radhakrishnan: Okay, surprisingly I agree with you, and so I think for Childhood Cancer treatment on the whole, we should all be working with the government closely because I think the maximum funding is finally going to come from the government. With government support, only the government has the capability of any country to bring organizations together, bring people together, build networks which will help. So that is an area where we should focus.

Second, definitely, a risk-adapted treatment for every region, and in that risk adaptation, I think immunotherapy plays a big role. Professor Sh, like with the way we are treating diseases where we are treating with targeted treatment, it’s become so much easier over the years to treat such children.

So getting a relapsed childhood leukemia into remission with immunotherapy is so much easier than getting them with conventional treatment. So if there is access to these drugs for these patients at a cost which they can afford, of course, that will be the way forward.

And all the efforts should be directed towards collaborative research and building new models in discovering molecules and bringing these molecules to the reach of these children. Thank you.

Godfrey Chan: Quick I mean follow up statement with a lest because there something called a bio simula so we should I mean make it faster in the regulatory process so and cheaper.

Ricardo Garcia: That’s definitely a good end for the discussion. Thank you so much, both of you, for joining today.

I remind the audience that we are doing this because we want to educate and share the truth about childhood cancer but also want to raise funds to support an immediate trial we want to open to test a compound for different types of pediatric indications. So, if you have the chance to support pediatric cancer research today, this is the day. So donate and see you in the next session. Thank you so much.