Pushing Boundaries

Dr. Anthony Nichols

“We are constantly pushing the boundaries of our work that has direct clinical relevance and can improve patient care for patients with head and neck and thyroid cancer,” said Dr. Anthony Nichols. “That’s our goal.”

Dr. Nichols is an associate professor with the Department of Otolaryngology – Head and Neck Surgery. When he’s not in the operating room or the clinic, he’s in the lab working alongside a team of colleagues including John Barrett, PhD, and Joe Mymryk, PhD, as well as three graduate trainees, residents and medical students.

The profound and negative impact head and neck cancers can have on patients drives their work testing the most effective treatments and identifying the least toxic therapies for patients. “Our plan is to take the findings from the lab to the clinic,” said Dr. Nichols.

And then using a stepwise approach to develop new drugs.

One project involves robotic screening of 50 cancer cell lines with thousands of drugs to determine which drug is more effective with the cell lines.

“We are trying to correlate the genetic profile of the cell lines with the response to the therapy to determine which drug is appropriate for each patient,” Dr. Nichols explained.

They aren’t stopping there, however.

Knowing that therapies can work in cell lines, but produce debilitating side effects or are ineffective in patients, they are introducing human tumours into mouse models to monitor outcomes with the top drugs identified in the cell line studies. These mouse models are much more accurate predictors of what will work in patients.

“By using a large number of mouse models we can effectively run a ‘virtual clinical trial’ in the mice, which is much cheaper than a human trial and doesn’t put patients at risk,” said Dr. Nichols.

Using this strategy, Dr. Nichols and his team are taking their first drug finding into a clinical trial in early 2016. With industry funding they will be treating 30 patients with a drug called BYL719 prior to surgery to see if it reduces the size of the tumours.

The Nichols lab is also working on a rare study focused on anaplastic thyroid cancer. A hugely aggressive form of cancer, with poor prognosis, it is considered one of the most lethal human malignancies. In most cases, there is very little that can be done in terms of treatment once it is diagnosed.

For nearly four years, Dr. Nichols has been working with collaborators at Toronto, Harvard, Johns Hopkins, MD Anderson, British Columbia and Chicago to put together a large cohort of these rare tumour samples. They are completing a comprehensive genetic analyses of the tumours to identify all the genes that can predict response to treatment. Their goal is to use the genetic findings to identify drugs for future trials.

Lastly, the dramatic rise in oropharyngeal cancer and development of transoral robotic surgery for these malignancies, has led Dr. Nichols to yet another area of research. Alongside Dr. Kevin Fung, Dr. Nichols performed the first robotic surgery to treat throat cancer in the country. The approach can be used to treat tonsil and base-of-tongue cancers.

There is a slowly growing epidemic of these forms of cancer in young people due to the rise of the human papilloma virus. Consequently, there is a growing interest and demand for the robotic procedure.

While the most common treatment remains chemotherapy and radiation, the possible side effects of feeding tubes, hearing loss, nerve toxicity and dry mouth have led to an interest to push forward with the robotic treatment.

“Despite the potential benefits of robotic surgery, it has yet to be proven that it is superior to the non-surgical options,” said Dr. Nichols, arguing that robotic surgery is still experimental.

Along with Radiation Oncologist Dr. David Palma, Dr. Nichols started a trial in 2012 to compare the effectiveness of surgery over chemotherapy and radiation. The trial has been expanded to include sites in Australia and across Canada with collaborators at the University of British Columbia, McGill University, the University of Ottawa and Princess Margaret Hospital. The study has the potential to establish a new standard of care in cancer treatment.

Dr. Nichols is driven in his research with a desire to do better for his patients. Although he receives tremendous satisfaction from his clinical work, the sometimes debilitating impact of treatments on his patients inspires him to push the boundaries of his research in order to find novel treatments with improved cure rates and less side effects.