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Carreras MJ, Renedo-Miró B, Valdivia C, Tomás-Guillén E, Farriols A, Mañós L, Vidal J, Alcalde M, De la Paz I, Jiménez-Lozano I, Palacio-Lacambra ME, Sabaté N, Felip E, Garralda E, Garau M, Gorgas MQ, Monterde J, Tabernero J. Drug Cost Avoidance Resulting from Participation in Clinical Trials: A 10-Year Retrospective Analysis of Cancer Patients with Solid Tumors. Cancers (Basel) 2024; 16:1529. [PMID: 38672610 PMCID: PMC11048575 DOI: 10.3390/cancers16081529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
The objective of this single-center retrospective study was to describe the clinical characteristics of adult patients with solid tumors enrolled in cancer clinical trials over a 10-year period (2010-2019) and to assess drug cost avoidance (DCA) associated with sponsors' contributions. The sponsors' contribution to pharmaceutical expenditure was calculated according to the actual price (for each year) of pharmaceutical specialties that the Vall d'Hebron University Hospital (HUVH) would have had to bear in the absence of sponsorship. A total of 2930 clinical trials were conducted with 10,488 participants. There were 140 trials in 2010 and 459 in 2019 (228% increase). Clinical trials of high complexity phase I and basket trials accounted for 34.3% of all trials. There has been a large variation in the pattern of clinical research over the study period, whereas, in 2010, targeted therapy accounted for 79.4% of expenditure and cytotoxic drugs for 20.6%; in 2019, immunotherapy accounted for 68.4%, targeted therapy for 24.4%, and cytotoxic drugs for only 7.1%. A total of four hundred twenty-one different antineoplastic agents were used, the variability of which increased from forty-seven agents in 2010, with only seven of them accounting for 92.8% of the overall pharmaceutical expenditure) to three hundred seventeen different antineoplastic agents in 2019, with thirty-three of them accounting for 90.6% of the overall expenditure. The overall expenditure on antineoplastic drugs in clinical care patients not included in clinical trials was EUR 120,396,096. The total cost of antineoplastic drugs supplied by sponsors in a clinical trial setting was EUR 107,306,084, with a potential DCA of EUR 92,662,609. Overall, clinical trials provide not only the best context for the progress of clinical research and healthcare but also create opportunities for reducing cancer care costs.
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Affiliation(s)
- Maria-Josep Carreras
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Berta Renedo-Miró
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Carolina Valdivia
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Elena Tomás-Guillén
- Asserta Global Healthcare Solutions, Sant Quirze del Vallés, E-08192 Barcelona, Spain
| | - Anna Farriols
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Laura Mañós
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Jana Vidal
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - María Alcalde
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Isabel De la Paz
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Inés Jiménez-Lozano
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Maria-Eugenia Palacio-Lacambra
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Nuria Sabaté
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Enriqueta Felip
- Medical Oncology Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), E-08035 Barcelona, Spain; (E.F.); (E.G.); (J.T.)
| | - Elena Garralda
- Medical Oncology Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), E-08035 Barcelona, Spain; (E.F.); (E.G.); (J.T.)
| | - Margarita Garau
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Maria-Queralt Gorgas
- Pharmacy Department, Vall d’Hebron University Hospital, E-08035 Barcelona, Spain (L.M.); (J.V.); (M.A.); (I.D.l.P.); (I.J.-L.); (M.-E.P.-L.); (N.S.); (M.-Q.G.)
| | - Josep Monterde
- Asserta Global Healthcare Solutions, Sant Quirze del Vallés, E-08192 Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), E-08035 Barcelona, Spain; (E.F.); (E.G.); (J.T.)
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2
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Houston L, Yu P, Martin A, Probst Y. Clinical researchers' lived experiences with data quality monitoring in clinical trials: a qualitative study. BMC Med Res Methodol 2021; 21:187. [PMID: 34544365 PMCID: PMC8454069 DOI: 10.1186/s12874-021-01385-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 08/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fundamental to the success of clinical research that involves human participants is the quality of the data that is generated. To ensure data quality, clinical trials must comply with the Good Clinical Practice guideline which recommends data monitoring. To date, the guideline is broad, requires technology for enforcement, follows strict industry standards, mostly designed for drug-registration trials and based on informal consensus. It is also unknown what challenges clinical trials and researchers face in implementing data monitoring procedures. Thus, this study aimed to describe researcher experiences with data quality monitoring in clinical trials. METHODS We conducted semi-structured telephone interviews following a guided-phenomenological approach. Participants were recruited from the Australian and New Zealand Clinical Trials Registry and were researchers affiliated with a listed clinical study. Each transcript was analysed with inductive thematic analysis before thematic categorisation of themes from all transcripts. Primary, secondary and subthemes were categorised according to the emerging relationships. RESULTS Data saturation were reached after interviewing seven participants. Five primary themes, two secondary themes and 21 subthemes in relation to data quality monitoring emerged from the data. The five primary themes included: education and training, ways of working, working with technology, working with data, and working within regulatory requirements. The primary theme 'education and training' influenced the other four primary themes. While 'working with technology' influenced the 'way of working'. All other themes had reciprocal relationships. There was no relationship reported between 'working within regulatory requirements' and 'working with technology'. The researchers experienced challenges in meeting regulatory requirements, using technology and fostering working relationships for data quality monitoring. CONCLUSION Clinical trials implemented a variety of data quality monitoring procedures tailored to their situation and study context. Standardised frameworks that are accessible to all types of clinical trials are needed with an emphasis on education and training.
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Affiliation(s)
- Lauren Houston
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia.
| | - Ping Yu
- Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
- School of Computing and Information Technology, Faculty of Engineering and Information Science, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Allison Martin
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Yasmine Probst
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
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3
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Design, organisation and impact of treatment optimisation studies in breast, lung and colorectal cancer: The experience of the European Organisation for Research and Treatment of Cancer. Eur J Cancer 2021; 151:221-232. [PMID: 34023561 DOI: 10.1016/j.ejca.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/29/2021] [Accepted: 04/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment optimisation studies (TOSs) are clinical trials which aim to tackle research questions that are often left unaddressed within the current drug development paradigm due to a lack of financial and regulatory incentives to undertake them. Examples include comparative effectiveness, therapeutic sequencing and dose de-escalation studies. Trials of this nature have historically been primarily carried out by academic institutions and not-for-profit organisations such as the European Organisation for Research and Treatment of Cancer (EORTC). OBJECTIVES Our objective was to conduct an in-depth analysis of the breast, lung and colorectal cancer TOSs that have been performed by the EORTC in the past four decades. METHODS We searched the EORTC clinical trials database for relevant studies and subsequently analysed them based on a number of predefined criteria relating to their design, organisation and scientific impact. RESULTS The 113 EORTC TOSs examined in this analysis were mainly standard-sized, international, multicentre phase III trials using a relatively simple, randomised, open-label design and comparing pharmacological combination regimens against standard-of-care treatments in terms of their potential to improve overall survival of patients with cancer. Although they were typically financially and/or materially supported by the industry, their legal sponsor was nearly always an independent party that did not benefit monetarily from their outcomes. If meaningful findings were obtained, their results, regardless of whether positive or negative, were published in high-impact journals, and the corresponding articles usually received a considerable number of citations. CONCLUSIONS Our analysis provides an empirical framework for setting up future TOSs based on the EORTC experience in oncology.
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Gelardi F, Kirienko M, Sollini M. Climbing the steps of the evidence-based medicine pyramid: highlights from Annals of Nuclear Medicine 2019. Eur J Nucl Med Mol Imaging 2020; 48:1293-1301. [PMID: 33150459 DOI: 10.1007/s00259-020-05073-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
We aimed to provide an overview on research path in nuclear medicine climbing the steps of the Evidence-Based Medicine (EBM) pyramid using review of 14 subjectively selected papers out of 111 published in the Annals of Nuclear Medicine during January-December 2019. Following the structure of the EBM hierarchy, we chose at least one study for each step of the pyramid from the basis (pre-clinical research, expert opinion, case report and case series), to the middle (case-control and cohort studies, randomised controlled trials), towards the top (meta-analyses and systematic reviews). Additionally, we collected information on the promoter of each included study: investigator-initiated trials (IITs) vs industry-sponsored trials (ISTs). We found that pre-clinical studies are primarily focused on the development of novel molecular targets in cancer, with promising results. At the same time, clinical investigations deal with cardiological, neurological, infectious and oncological applications using both SPECT and PET modalities. Additionally, radionuclide therapy gained interest and is experiencing comprehensive clinical implementation. Our overview confirms the current central role of IITs as compared with ISTs. Challenges and future directions in Nuclear Medicine research are discussed.
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Affiliation(s)
- Fabrizia Gelardi
- Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Margarita Kirienko
- Nuclear Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Martina Sollini
- Humanitas University, Pieve Emanuele, Milan, Italy.,Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
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5
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Broes S, Saesen R, Lacombe D, Huys I. Past, Current, and Future Cancer Clinical Research Collaborations: The Case of the European Organisation for Research and Treatment of Cancer. Clin Transl Sci 2020; 14:47-53. [PMID: 32799428 PMCID: PMC7877867 DOI: 10.1111/cts.12863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022] Open
Abstract
Although collaborations between academic institutions and industry have led to important scientific breakthroughs in the discovery stage of the pharmaceutical research and development process, the role of multistakeholder partnerships in the clinical development of anticancer medicines necessitates further clarification. The benefits associated with such cooperation could be undercut by the conflicting goals and motivations of the actors included. The aim of this review was to identify and characterize past, present, and future stakeholder partnership models in cancer clinical research through the lens of the European Organisation for Research and Treatment of Cancer (EORTC). Based on the analysis of several landmark EORTC trials performed across the span of three decades, four existing models of stakeholder cooperation were delineated and characterized. Additionally, a hypothetical fifth model representing a potential future collaborative framework for cancer clinical research was formulated. These models mainly differ in terms of the nature and responsibilities of the partners included and show that clinical research partnerships in oncology have evolved over time from small‐scale academia‐industry collaborations to complex interdisciplinary cooperation involving many different stakeholders.
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Affiliation(s)
- Stefanie Broes
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Robbe Saesen
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, Katholieke Universiteit Leuven, Leuven, Belgium
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6
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Buyse M, Trotta L, Saad ED, Sakamoto J. Central statistical monitoring of investigator-led clinical trials in oncology. Int J Clin Oncol 2020; 25:1207-1214. [PMID: 32577951 PMCID: PMC7308734 DOI: 10.1007/s10147-020-01726-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/14/2020] [Indexed: 01/17/2023]
Abstract
Investigator-led clinical trials are pragmatic trials that aim to investigate the benefits and harms of treatments in routine clinical practice. These much-needed trials represent the majority of all trials currently conducted. They are however threatened by the rising costs of clinical research, which are in part due to extensive trial monitoring processes that focus on unimportant details. Risk-based quality management focuses, instead, on “things that really matter”. We discuss the role of central statistical monitoring as part of risk-based quality management. We describe the principles of central statistical monitoring, provide examples of its use, and argue that it could help drive down the cost of randomized clinical trials, especially investigator-led trials, whilst improving their quality.
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Affiliation(s)
- Marc Buyse
- International Drug Development Institute (IDDI), San Francisco, CA, USA. .,Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, Hasselt, Belgium. .,CluePoints, Louvain-la-Neuve, Belgium.
| | | | - Everardo D Saad
- International Drug Development Institute (IDDI), 30 avenue provinciale, 1340, Ottignies-Louvain-la-Neuve, Belgium
| | - Junichi Sakamoto
- Tokai Central Hospital, Kakamigahara, Japan.,Epidemiological and Clinical Research Information Network (ECRIN), Kyoto, Japan
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7
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Biganzoli L, Cardoso F, Beishon M, Cameron D, Cataliotti L, Coles CE, Delgado Bolton RC, Trill MD, Erdem S, Fjell M, Geiss R, Goossens M, Kuhl C, Marotti L, Naredi P, Oberst S, Palussière J, Ponti A, Rosselli Del Turco M, Rubio IT, Sapino A, Senkus-Konefka E, Skelin M, Sousa B, Saarto T, Costa A, Poortmans P. The requirements of a specialist breast centre. Breast 2020; 51:65-84. [PMID: 32217457 PMCID: PMC7375681 DOI: 10.1016/j.breast.2020.02.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022] Open
Abstract
This article is an update of the requirements of a specialist breast centre, produced by EUSOMA and endorsed by ECCO as part of Essential Requirements for Quality Cancer Care (ERQCC) programme, and ESMO. To meet aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this article, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Laura Biganzoli
- European Society of Breast Cancer Specialists (EUSOMA); Breast Centre, AUSL Toscana Centro, Prato, Italy.
| | - Fatima Cardoso
- European Society of Medical Oncology (ESMO); Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal
| | | | - David Cameron
- European Cancer Concord (ECC); University of Edinburgh Cancer Centre, IGMM, Western General Hospital, Edinburgh, UK
| | - Luigi Cataliotti
- European Society of Breast Cancer Specialists (EUSOMA), Senonetwork Italia and Breast Centres Certification, Florence, Italy
| | - Charlotte E Coles
- European Society for Radiotherapy and Oncology (ESTRO); University of Cambridge, Cambridge, UK
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja, Spain
| | - Maria Die Trill
- International Psycho-Oncology Society (IPOS); ATRIUM: Psycho-Oncology & Clinical Psychology, Madrid, Spain
| | - Sema Erdem
- European Cancer Organisation Patient Advisory Committee (ECCO PAC); Europa Donna, Milan, Italy
| | - Maria Fjell
- European Oncology Nursing Society (EONS); Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Romain Geiss
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Hôpital René Huguenin - Institut Curie, St. Cloud, France
| | - Mathijs Goossens
- European Cancer League (ECL); Centre for Cancer Detection (CvKO), Brussels, Belgium
| | - Christiane Kuhl
- European Society of Radiology (ESR); Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
| | - Lorenza Marotti
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Peter Naredi
- European Cancer Organisation (ECCO); Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Oberst
- Organisation of European Cancer Institutes (OECI); Cancer Research UK Cambridge Centre, Cambridge, UK
| | - Jean Palussière
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Department of Imaging, Institut Bergonié, Bordeaux, France
| | - Antonio Ponti
- European Society of Breast Cancer Specialists (EUSOMA), Centre for Epidemiology and Prevention in Oncology (CPO) Piemonte, AOU Citta' Della Salute e Della Scienza, Turin, Italy
| | | | - Isabel T Rubio
- European Society of Surgical Oncology (ESSO); Breast Surgical Oncology, Clinica Universidad de Navarra Madrid, Spain
| | - Anna Sapino
- European Society of Pathology (ESP); Department of Medical Sciences, University of Turin, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Elzbieta Senkus-Konefka
- European Organisation for Research and Treatment of Cancer (EORTC); Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Marko Skelin
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, General Hospital Sibenik, Sibenik, Croatia
| | - Berta Sousa
- European Society of Oncology Pharmacy (ESOP); Pharmacy Department, General Hospital Sibenik, Sibenik, Croatia
| | - Tiina Saarto
- Flims Alumni Club (FAC); Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal
| | | | - Philip Poortmans
- Iridium Kankernetwerk, University of Antwerp, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Wilrijk-Antwerp, Belgium
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Perez-Gracia JL, Awada A, Calvo E, Amaral T, Arkenau HT, Gruenwald V, Bodoky G, Lolkema MP, Di Nicola M, Penel N, Vera R, Sanmamed MF, Douillard JY. ESMO Clinical Research Observatory (ECRO): improving the efficiency of clinical research through rationalisation of bureaucracy. ESMO Open 2020; 5:e000662. [PMID: 32393574 PMCID: PMC7223268 DOI: 10.1136/esmoopen-2019-000662] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/04/2022] Open
Abstract
During the last years, there has been a dramatic increase in the administrative and bureaucratic burden associated with clinical research, which has clearly had an impact on its overall efficiency and on the activity of clinical investigators and research teams. Indeed, the supervision of the adherence of clinical research to Good Clinical Practice (GCP) guidelines and legal regulations is of the utmost importance. Yet, while such regulations have remained largely unchanged during recent years, the number of administrative tasks and their complexity have grown markedly, as supported by the results of a survey performed among 940 clinical investigators that we report in this manuscript. Therefore, many investigators believe that it has become necessary to undertake a rigorous analysis of the causes and consequences of this issue, and to create a conduit to channel the advice from experienced investigators regarding clinical research procedures, in order to improve them. Based on these premises, ESMO has launched the ESMO Clinical Research Observatory (ECRO), a task force that will analyse different aspects of clinical research. ECRO will aim to provide the views of ESMO on clinical research procedures based on the feedback from clinical investigators, under complete adherence to the Declaration of Helsinki, the GCP guidelines and any other applicable legal regulations, while at the same time showing profound respect for all the stakeholders involved in clinical research. This manuscript provides the background and rationale for the creation of ECRO, its planned activity and an analysis of the current administrative burden in clinical research with recommendations to rationalise it. Indeed, we expect that this effort shall lead to a relevant improvement in the care of patients and in the development of clinical research.
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Affiliation(s)
- Jose Luis Perez-Gracia
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, SpainPamplona, Spain.
| | - Ahmad Awada
- Department of Oncology Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Emiliano Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Teresa Amaral
- Interdisciplinary Skin Cancer Center, University Medical Center, Tuebingen, Germany
| | | | - Viktor Gruenwald
- Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, University Hospital Essen, Essen, Germany
| | - Gyorgy Bodoky
- Department of Oncology, St László Teaching Hospital, Budapest, Hungary
| | - Martijn P Lolkema
- Department of Medical Oncology, Erasmus Medical Center Cancer Center. Erasmus Medical Center, Rotterdam, The Netherlands
| | - Massimo Di Nicola
- Immunotherapy and Innovative Therapeutic Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret and Lille University, Lille, France
| | - Ruth Vera
- Department of Medical Oncology, Complejo Hospitalario de Navarra and Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Miguel F Sanmamed
- Department of Oncology, University Clinic of Navarra and Health Research Institute of Navarra (IdiSNA), Pamplona, SpainPamplona, Spain
| | - Jean-Yves Douillard
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
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9
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Stahel RA, Lacombe D, Cardoso F, Casali PG, Negrouk A, Marais R, Hiltbrunner A, Vyas M. Current models, challenges and best practices for work conducted between European academic cooperative groups and industry. ESMO Open 2020; 5:e000628. [PMID: 32213534 PMCID: PMC7103800 DOI: 10.1136/esmoopen-2019-000628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The academia-industry interface is important, and, despite challenges that inevitably occur, bears the potential for positive synergies to emerge. Perceived barriers to wider collaboration in academia-industry oncology research in Europe need to be addressed, current academic cooperative group and industry models for collaboration need to be discussed, and a common terminology to facilitate understanding of both sectors' concerns needs to be established with an eye towards improving academia-industry partnerships on clinical trials for the benefit of patients with cancer. METHODOLOGY CAREFOR (Clinical Academic Cancer Research Forum), a multi-stakeholder platform formed to improve the direction for academic clinical trials in the field of oncology in Europe, formed the CAREFOR-Industry Working Group comprised of experienced professionals from European academic cooperative groups joined by industry representatives selected based on their activities in the area of medical oncology. They jointly discussed academic cooperative groups, clinical trials conducted between academic cooperative groups and industry, examples of successful collaborative models, common legal negotiation points in clinical trial contracts, data access, and principles of interaction. RESULTS Four principles of interaction between the academia and industry are proposed: (1) clarify the roles and responsibilities of all partners involved in the study, (2) involve legal teams from an early stage; (3) acknowledge that data is an important output of the study, (4) agree on the intent of the trial prior to its start. CONCLUSIONS The CAREFOR-Industry Working Group describes current models, challenges, and effective strategies for academia-industry research in Europe with an eye towards improving academia-industry partnerships on clinical trials for patients with cancer. Current perceived challenges are explained, and future opportunities/recommendations for improvement are described for the areas of most significant impact. Challenges are addressed from both the academic and industry perspectives, and principles of interaction for the optimal alignment between academia and industry in selected areas are proposed.
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Affiliation(s)
- Rolf A Stahel
- Medical Oncology and Hematology, University Hospital Zürich, Zurich, Switzerland
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Paolo G Casali
- Medical Oncology Unit 2, National Cancer Institute: Fondazione IRCCS, Milano, Italy
| | | | - Richard Marais
- Molecular Oncology, Cancer Research UK Manchester Institute, Greater Manchester, United Kingdom
| | | | - Malvika Vyas
- Public Policy, European Society for Medical Oncology, Lugano, Switzerland
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10
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Phase III evaluating the addition of fulvestrant (F) to anastrozole (A) as adjuvant therapy in postmenopausal women with hormone receptor-positive HER2-negative (HR+/HER2−) early breast cancer (EBC): results from the GEICAM/2006–10 study. Breast Cancer Res Treat 2019; 177:115-125. [DOI: 10.1007/s10549-019-05296-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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11
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Calin A, Martin M, Lopez-Tarruella S. Simulation modeling approaches to answer clinically relevant questions in breast cancer low-risk populations. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S80. [PMID: 30613655 DOI: 10.21037/atm.2018.10.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ana Calin
- Radiation Oncology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Miguel Martin
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, Spain
| | - Sara Lopez-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, CiberOnc, GEICAM, Madrid, Spain
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12
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Barrios CH, Reinert T, Werutsky G. Global Breast Cancer Research: Moving Forward. Am Soc Clin Oncol Educ Book 2018; 38:441-450. [PMID: 30231347 DOI: 10.1200/edbk_209183] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Breast cancer is a major global health problem and major cause of mortality. Although mortality trends are declining in high-income countries, trends are increasing in low- and middle-income countries (LMICs). Addressing global breast cancer research is a challenging endeavor, as notable disparities and extremely heterogeneous realities exist in different regions across the world. Basic global cancer health care needs have been addressed by the World Health Organization's (WHO) proposed list of essential medicines and by resource-stratified guidelines for screening and treatment. However, specific strategies are needed to address disparities in access to health care, particularly access to new therapies. Discussions about global research in breast cancer should take into account the ongoing globalization of clinical trials. Collaboration fostered by well-established research organizations in North America and Europe is essential for the development of infrastructure and human resources in LMICs so that researchers in these countries can begin to address regional questions. Specific challenges that impact the future of global breast cancer research include increasing the availability of trials in LMICs, developing strategies to increase patient participation in clinical trials, and creation of clear guidelines for the development of real-world evidence-based research. The main objective of this review is to encourage the discussion of challenges in global breast cancer research with the hope that collectively we will be able to generate workable proposals to advance the field.
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Affiliation(s)
- Carlos H Barrios
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Tomás Reinert
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Gustavo Werutsky
- From the Latin American Cooperative Oncology Group, Porto Alegre, Brazil
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13
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Oosting SF, Fehrmann RS, de Vries EGE. Indispensable benefit of independent investigator-driven research in a changing clinical trial landscape. ESMO Open 2017; 2:e000272. [PMID: 29226919 PMCID: PMC5640100 DOI: 10.1136/esmoopen-2017-000272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/09/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sjoukje F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Rudolf S Fehrmann
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Fox L, Toms C, Kernaghan S, Snowdon C, Bliss JM. Conducting non-commercial international clinical trials: the ICR-CTSU experience. Trials 2017; 18:440. [PMID: 28950887 PMCID: PMC5615436 DOI: 10.1186/s13063-017-2176-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/11/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Academic clinical trials play a fundamental role in the development of new treatments, the repurposing of existing treatments and in addressing areas of unmet clinical need. With cancer treatments increasingly targeted at molecular subtypes, and with priority placed on developing new treatments for rare tumour types, the need for international trial participation to access sufficient patient numbers for successful trial conduct is growing. However, lack of harmonisation of international legal, ethical and financial systems can make this challenging and the cost and effort of conducting trials internationally can be considered prohibitive, particularly where the sample size is comparatively small. METHODS The Institute of Cancer Research - Clinical Trials and Statistics Unit (ICR-CTSU) is a UK-based academic clinical trials unit that specialises in the design, conduct and analysis of clinical trials of cancer treatments with an expanding portfolio of trials in molecular subtypes of breast and urological cancers and in other rare cancer types. Implementing appropriate mechanisms to enable international participation has therefore been imperative. In this article, we explain how we have approached the challenges involved and describe examples of successful international trial conduct, achieved through robust collaborations with academic and industry partners. CONCLUSION Conducting academic trials internationally is challenging but can and should be achieved through appropriate governance mechanisms and strong collaborations.
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Affiliation(s)
- Lisa Fox
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
| | - Christy Toms
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
| | - Sarah Kernaghan
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
| | - Claire Snowdon
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
| | - Judith M. Bliss
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
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