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Ruiz J, Kelly RK, Aplenc R, Laetsch TW, Seif AE. Absolute neutrophil count clinical trial eligibility criteria for pediatric oncology phase I and phase I/II trials by sponsorship. Pediatr Blood Cancer 2024; 71:e30925. [PMID: 38409529 DOI: 10.1002/pbc.30925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
Normal absolute neutrophil count (ANC) variations, as seen with Duffy-null associated neutrophil count (DANC), are not accounted for in trial eligibility, which may contribute to racial enrollment disparities. We describe ANC eligibility for pediatric oncology phase I/II clinical trials according to primary sponsorship from 2010 to 2023 using ClinicalTrials.gov. Out of 438 trials, 20% were industry-sponsored. Total 17% of trials required ANC ≥1500 cells/μL for enrollment; however, industry-sponsored trials were significantly more likely to require ANC ≥1500 cells/μL than non-industry-sponsored trials (odds ratio 2.53, 95% confidence interval: 1.39-4.62; p < .001). These data suggest laboratory exclusion criteria are one possible mechanism for pediatric clinical trial enrollment disparities.
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Affiliation(s)
- Jenny Ruiz
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca K Kelly
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richard Aplenc
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Theodore W Laetsch
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alix E Seif
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Huang H, Jia S, Wang X, Miao H, Fang H, He H, Wu D, Tang Y, Li N. Quantitative evaluation of the impact of relaxing eligibility criteria on the risk-benefit profile of drugs for lung cancer based on real-world data. Thorac Cancer 2024; 15:1187-1194. [PMID: 38576119 DOI: 10.1111/1759-7714.15269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Restrictive eligibility criteria in cancer drug trials result in low enrollment rates and limited population diversity. Relaxed eligibility criteria (REC) based on solid evidence is becoming necessary for stakeholders worldwide. However, the absence of high-quality, favorable evidence remains a major challenge. This study presents a protocol to quantitatively evaluate the impact of relaxing eligibility criteria in common non-small cell lung cancer (NSCLC) protocols in China, on the risk-benefit profile. This involves a detailed explanation of the rationale, framework, and design of REC. METHODS To evaluate our REC in NSCLC drug trials, we will first construct a structured, cross-dimensional real-world NSCLC database using deep learning methods. We will then establish randomized virtual cohorts and perform benefit-risk assessment using Monte Carlo simulation and propensity matching. Shapley value will be utilized to quantitatively measure the effect of the change of each eligibility criterion on patient volume, clinical efficacy and safety. DISCUSSION This study is one of the few that focuses on the problem of overly stringent eligibility criteria cancer drug clinical trials, providing quantitative evaluation of the effect of relaxing each NSCLC eligibility criterion. This study will not only provide scientific evidence for the rational design of population inclusion in lung cancer clinical trials, but also establish a data governance system, as well as a REC evaluation framework that can be generalized to other cancer studies.
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Affiliation(s)
- Huiyao Huang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuopeng Jia
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huilei Miao
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Fang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanqing He
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dawei Wu
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Fountzilas E, Tsimberidou AM, Hiep Vo H, Kurzrock R. Tumor-agnostic baskets to N-of-1 platform trials and real-world data: Transforming precision oncology clinical trial design. Cancer Treat Rev 2024; 125:102703. [PMID: 38484408 DOI: 10.1016/j.ctrv.2024.102703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 04/06/2024]
Abstract
Choosing the right drug(s) for the right patient via advanced genomic sequencing and multi-omic interrogation is the sine qua non of precision cancer medicine. Traditional cancer clinical trial designs follow well-defined protocols to evaluate the efficacy of new therapies in patient groups, usually identified by their histology/tissue of origin of their malignancy. In contrast, precision medicine seeks to optimize benefit in individual patients, i.e., to define who benefits rather than determine whether the overall group benefits. Since cancer is a disease driven by molecular alterations, innovative trial designs, including biomarker-defined tumor-agnostic basket trials, are driving ground-breaking regulatory approvals and deployment of gene- and immune-targeted drugs. Molecular interrogation further reveals the disruptive reality that advanced cancers are extraordinarily complex and individually distinct. Therefore, optimized treatment often requires drug combinations and N-of-1 customization, addressed by a new generation of N-of-1 trials. Real-world data and structured master registry trials are also providing massive datasets that are further fueling a transformation in oncology. Finally, machine learning is facilitating rapid discovery, and it is plausible that high-throughput computing, in silico modeling, and 3-dimensional printing may be exploitable in the near future to discover and design customized drugs in real time.
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Affiliation(s)
- Elena Fountzilas
- Department of Medical Oncology, St Luke's Clinic, Thessaloniki, Greece; European University Cyprus, German Oncology Center, Nicosia, Cyprus
| | - Apostolia-Maria Tsimberidou
- The University of Texas MD Anderson Cancer Center, Department of Investigational Cancer Therapeutics, Houston, TX, USA.
| | - Henry Hiep Vo
- The University of Texas MD Anderson Cancer Center, Department of Investigational Cancer Therapeutics, Houston, TX, USA
| | - Razelle Kurzrock
- WIN Consortium for Precision Medicine, France; Medical College of Wisconsin, USA
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Hoin JA, Carthon BC, Brown SJ, Durham LM, Garrot LC, Ghamande SA, Pippas AW, Rivers BM, Snyder CT, Gabram-Mendola SGA. Addressing disparities in cancer clinical trials: a roadmap to more equitable accrual. Front Health Serv 2024; 4:1254294. [PMID: 38523649 PMCID: PMC10957576 DOI: 10.3389/frhs.2024.1254294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Abstract
The Georgia Center for Oncology Research and Education (Georgia CORE) and the Georgia Society of Clinical Oncology (GASCO) held a one-day summit exploring opportunities and evidence-based interventions to address disparities in cancer clinical trials. The purpose of the summit was to identify clear and concise recommendations aimed at decreasing clinical trial accrual disparities in Georgia for rural and minority populations. The summit included expert presentations, panel discussions with leaders from provider organizations throughout Georgia, and breakout sessions to allow participants to critically discuss the information presented. Over 120 participants attended the summit. Recognizing the need for evidence-based interventions to improve clinical trial accrual among rural Georgians and persons of color, summit participants identified four key areas of focus that included: improving clinical trial design, providing navigation for all, enhancing public education and awareness of cancer clinical trials, and identifying potential policy and other opportunities. A comprehensive list of takeaways and action plans was developed in the four key areas of focus with the expectation that implementation of the strategies that emerged from the summit will enhance cancer clinical trial accrual for all Georgians.
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Affiliation(s)
- Jon A. Hoin
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Bradley C. Carthon
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Shantoria J. Brown
- Georgia Center for Oncology Research and Education, Atlanta, CO, United States
| | - Lynn M. Durham
- Georgia Center for Oncology Research and Education, Atlanta, CO, United States
| | | | - Sharad A. Ghamande
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, United States
| | | | - Brian M. Rivers
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, United States
| | - Cindy T. Snyder
- Georgia Center for Oncology Research and Education, Atlanta, CO, United States
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Lee SS, Dinicu AI, Arthurs L, Shields D, Pothuri B, Lightfoot MDS. Demographic reporting and language exclusion in gynecologic oncology clinical trials. Am J Obstet Gynecol 2024; 230:73.e1-73.e14. [PMID: 37751830 DOI: 10.1016/j.ajog.2023.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Participation in clinical trials may help mitigate disparate cancer outcomes. Thus, ensuring equitable access to clinical trials is a major priority for national cancer organizations. OBJECTIVE This study aimed to examine clinical trial eligibility criteria that may adversely affect the enrollment of underrepresented groups and assess the availability of demographic information in published gynecologic oncology studies. STUDY DESIGN ClinicalTrials.gov was searched for gynecologic oncology studies conducted between 1997 and 2021. Each study's inclusion and exclusion criteria were reviewed to determine whether demographic factors were used for enrollment screening. For published studies, demographic variables that were reported were identified. The expected clinical trial enrollment based on disease incidence and mortality was compared with the observed trial enrollment based on race. RESULTS There were 1597 gynecologic oncology studies: 883 (55%) from ovarian cancer studies, 336 (21%) from cervical cancer studies, 262 (17%) from uterine cancer studies, and 116 (7%) from multisite gynecologic oncology studies. Of the 581 published studies, 554 (95%) reported age, 363 (63%) reported race, and 171 (29%) reported ethnicities. Cervical cancer studies were most likely to report demographic information, including race (P=.026) and ethnicity (P<.001). During the study period, 189 studies (12%) excluded patients based on the language spoken. Industry-sponsored trials (odds ratio, 0.07; 95% confidence interval, 0.02-0.30) and organization-sponsored trials (odds ratio, 0.40; 95% confidence interval, 0.22-0.73) were less likely to exclude patients because of language than investigator-initiated trials. A minority of patients (37%) in cervical cancer trials were of White race, compared with 85% of patients in uterine cancer trials and 82% of patients in ovarian cancer trials. CONCLUSION Over the last 3 decades, 1 in 10 gynecologic oncology trials excluded patients because of language. Race and ethnicity were reported in more than half of the available studies. Initiatives to increase transparency in recruiting underrepresented patients and reporting demographic data are urgently needed.
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Affiliation(s)
- Sarah S Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University Langone Health, New York, NY; Bellevue Hospital, New York, NY
| | - Andreea I Dinicu
- Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Bhavana Pothuri
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University Langone Health, New York, NY; Bellevue Hospital, New York, NY
| | - Michelle D S Lightfoot
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University Langone Health, New York, NY; Bellevue Hospital, New York, NY.
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Hartley-Brown M, Cole CE, Price P, Andreini M, Mulligan G, Young AQ, Cho HJ. Creating Equitable and Inclusive Clinical Trials for Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2024; 24:32-39. [PMID: 37783639 DOI: 10.1016/j.clml.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023]
Abstract
Black and Latino/Hispanic populations are disproportionately impacted by multiple myeloma (MM) in the United States and are underrepresented in many clinical trials. The Multiple Myeloma Research Foundation sponsored a 1-day workshop of 46 experts spanning the ecosystem of MM research and care, including government, academia, nonprofits, pharma/biotech, community partners, and retail pharmacy. Specific, tangible steps to overcome the well-documented barriers to improving the diversity and inclusivity of clinical trials were discussed, including broadening inclusion/exclusion criteria, reducing the financial and other burdens of trial participants, selecting diverse study sites, including implicit bias training, and taking steps to empower patients.
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Affiliation(s)
| | - Craig E Cole
- Michigan State University-Karmanos Cancer Institute, Lansing, MI
| | | | | | | | | | - Hearn Jay Cho
- Multiple Myeloma Research Foundation, Norwalk, CT; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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Tsimberidou AM, Kahle M, Vo HH, Baysal MA, Johnson A, Meric-Bernstam F. Molecular tumour boards - current and future considerations for precision oncology. Nat Rev Clin Oncol 2023; 20:843-863. [PMID: 37845306 DOI: 10.1038/s41571-023-00824-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
Over the past 15 years, rapid progress has been made in developmental therapeutics, especially regarding the use of matched targeted therapies against specific oncogenic molecular alterations across cancer types. Molecular tumour boards (MTBs) are panels of expert physicians, scientists, health-care providers and patient advocates who review and interpret molecular-profiling results for individual patients with cancer and match each patient to available therapies, which can include investigational drugs. Interpretation of the molecular alterations found in each patient is a complicated task that requires an understanding of their contextual functional effects and their correlations with sensitivity or resistance to specific treatments. The criteria for determining the actionability of molecular alterations and selecting matched treatments are constantly evolving. Therefore, MTBs have an increasingly necessary role in optimizing the allocation of biomarker-directed therapies and the implementation of precision oncology. Ultimately, increased MTB availability, accessibility and performance are likely to improve patient care. The challenges faced by MTBs are increasing, owing to the plethora of identifiable molecular alterations and immune markers in tumours of individual patients and their evolving clinical significance as more and more data on patient outcomes and results from clinical trials become available. Beyond next-generation sequencing, broader biomarker analyses can provide useful information. However, greater funding, resources and expertise are needed to ensure the sustainability of MTBs and expand their outreach to underserved populations. Harmonization between practice and policy will be required to optimally implement precision oncology. Herein, we discuss the evolving role of MTBs and current and future considerations for their use in precision oncology.
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Affiliation(s)
- Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Michael Kahle
- Khalifa Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry Hiep Vo
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet A Baysal
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amber Johnson
- Khalifa Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Khadraoui W, Meade CE, Backes FJ, Felix AS. Racial and Ethnic Disparities in Clinical Trial Enrollment Among Women With Gynecologic Cancer. JAMA Netw Open 2023; 6:e2346494. [PMID: 38060227 PMCID: PMC10704282 DOI: 10.1001/jamanetworkopen.2023.46494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023] Open
Abstract
Importance Racial and ethnic disparities in clinical trial enrollment are unjust and hinder development of new cancer treatments. Objective To examine the association of race and ethnicity with clinical trial enrollment among women with endometrial, ovarian, or cervical cancer. Design, Setting, and Participants This retrospective cohort study used data from the National Cancer Database, a hospital-based cancer registry, and the Surveillance, Epidemiology, and End Results Program (SEER), a population-based cancer registry. Population-based race and ethnicity-specific proportions for each cancer site were derived from SEER. Participants included women with an endometrial, ovarian, or cervical cancer diagnosed from 2004 to 2019. Analyses were performed from February 2 to June 14, 2023. Exposure Race and ethnicity were categorized as American Indian/Alaska Native, Asian, Black, Hispanic (any race), Native Hawaiian/Pacific Islander, White, and other (not defined in the National Cancer Database). Main Outcomes and Measures The primary outcomes were the odds of clinical trial enrollment and representation in clinical trials compared with the US population. Multivariable-adjusted logistic regression was used to estimate odds ratios (ORs) and 95% CIs for associations of race and ethnicity with clinical trial enrollment within the National Cancer Database sample. Participation-to-prevalence ratios (PPRs) according to diagnosis period (2004-2011 vs 2012-2019) were calculated by dividing the race and ethnicity-specific percentage of clinical trial participants in the study sample by the percentage of racial and ethnic groups in SEER. Results Among 562 592 patients with gynecologic cancer (mean [SD] age at diagnosis, 62.9 [11.3] years), 1903 were American Indian/Alaska Native, 18 680 were Asian, 56 421 were Black, 38 145 were Hispanic, 1453 were Native Hawaiian/Pacific Islander, 442 869 were White, and 3121 were other race and ethnicity. Only 548 (<1%) were enrolled in clinical trials. Compared with White women, clinical trial enrollment was lower for Asian (OR, 0.44; 95% CI, 0.25-0.78), Black (OR, 0.70; 95% CI, 0.50-0.99), and Hispanic (OR, 0.53; 95% CI, 0.33-0.83) women. Compared with the US population, White women were adequately or overrepresented for all cancer types (PPRs ≥1.1), Black women were adequately or overrepresented for endometrial and cervical cancers (PPRs ≥1.1) but underrepresented for ovarian cancer (PPR ≤0.6), and Asian and Hispanic women were underrepresented among all 3 cancer types (PPRs ≤0.6). Conclusions and Relevance In this cohort of patients with gynecologic cancer, clinical trial enrollment was lower among certain minoritized racial and ethnic groups. Continued efforts are needed to address disparate clinical trial enrollment among underrepresented groups.
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Affiliation(s)
- Wafa Khadraoui
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus
| | - Caitlin E. Meade
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
| | - Floor J. Backes
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute, Columbus
| | - Ashley S. Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
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Huml RA, Collyar D, Antonijevic Z, Beckman RA, Quek RGW, Ye J. Aiding the Adoption of Master Protocols by Optimizing Patient Engagement. Ther Innov Regul Sci 2023; 57:1136-1147. [PMID: 37615880 DOI: 10.1007/s43441-023-00570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
Master protocols (MPs) are an important addition to the clinical trial repertoire. As defined by the U.S. Food and Drug Administration (FDA), this term means "a protocol designed with multiple sub-studies, which may have different objectives (goals) and involve coordinated efforts to evaluate one or more investigational drugs in one or more disease subtypes within the overall trial structure." This means we now have a unique, scientifically based MP that describes how a clinical trial will be conducted using one or more potential candidate therapies to treat patients in one or more diseases. Patient engagement (PE) is also a critical factor that has been recognized by FDA through its Patient-Focused Drug Development (PFDD) initiative, and by the European Medicines Agency (EMA), which states on its website that it has been actively interacting with patients since the creation of the Agency in 1995. We propose that utilizing these PE principles in MPs can make them more successful for sponsors, providers, and patients. Potential benefits of MPs for patients awaiting treatment can include treatments that better fit a patient's needs; availability of more treatments; and faster access to treatments. These make it possible to develop innovative therapies (especially for rare diseases and/or unique subpopulations, e.g., pediatrics), to minimize untoward side effects through careful dose escalation practices and, by sharing a control arm, to lower the probability of being assigned to a placebo arm for clinical trial participants. This paper is authored by select members of the American Statistical Association (ASA)/DahShu Master Protocol Working Group (MPWG) People and Patient Engagement (PE) Subteam. DahShu is a 501(c)(3) non-profit organization, founded to promote research and education in data science. This manuscript does not include direct feedback from US or non-US regulators, though multiple regulatory-related references are cited to confirm our observation that improving patient engagement is supported by regulators. This manuscript represents the authors' independent perspective on the Master Protocol; it does not represent the official policy or viewpoint of FDA or any other regulatory organization or the views of the authors' employers. The objective of this manuscript is to provide drug developers, contract research organizations (CROs), third party capital investors, patient advocacy groups (PAGs), and biopharmaceutical executives with a better understanding of how including the patient voice throughout MP development and conduct creates more efficient clinical trials. The PE Subteam also plans to publish a Plain Language Summary (PLS) of this publication for clinical trial participants, patients, caregivers, and the public as they seek to understand the risks and benefits of MP clinical trial participation.
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Affiliation(s)
| | | | | | - Robert A Beckman
- Departments of Oncology and of Biostatistics, Bioinformatics, & Biomathematics, Lombardi Comprehensive Cancer Center and Innovation Center for Biomedical Informatics, Georgetown University Medical Center, District of Columbia (DC), Washington, USA
| | - Ruben G W Quek
- Health Economics & Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Jingjing Ye
- Data Science and Operational Excellent, Global Statistics and Data Sciences, BeiGene, Ltd., Washington, DC, USA
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Zhang S, Zhang J, Liu S, Pang H, Stinchcombe TE, Wang X. Enrollment Success, Factors, and Prediction Models in Cancer Trials (2008-2019). JCO Oncol Pract 2023; 19:1058-1068. [PMID: 37793091 PMCID: PMC10667018 DOI: 10.1200/op.23.00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/15/2023] [Accepted: 08/15/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE To investigate the enrollment success rate of cancer clinical trials conducted in 2008-2019 and various factors lowering the enrollment success rate. METHODS This is a cross-sectional study with clinical trial information from the largest registration database ClinicalTrials.gov. Enrollment success rate was defined as actual enrollment greater or equal to 85% of the estimated enrollment goal. The association between trial characteristics and enrollment success was evaluated using the multivariable logistic regression. RESULTS A total of 4,004 trials in breast, lung, and colorectal cancers were included. The overall enrollment success rate was 49.1%. Compared with 2008-2010 (51.5%) and 2011-2013 (52.1%), the enrollment success rate is lower in 2014-2016 (46.5%) and 2017-2019 (36.4%). Regression analyses found trial activation year, phase I, phase I/phase II, and phase II (v phase III), sponsor agency of government (v industry), not requiring healthy volunteers, and estimated enrollment of 50-100, 100-200, 200, and >500 (v 0-50) were associated with a lower enrollment success rate (P < .05). However, trials with placebo comparator, ≥5 locations (v 1 location), and a higher number of secondary end points (eg, ≥5 v 0) were associated with a higher enrollment success rate (P < .05). The AUC for prediction of the final logistic regression models for all trials and specific trial groups ranged from 0.69 to 0.76. CONCLUSION This large-scale study supports a lower enrollment success rate over years in cancer clinical trials. Identified factors for enrollment success can be used to develop and improve recruitment strategies for future cancer trials.
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Affiliation(s)
- Siqi Zhang
- Duke Cancer Institute, Duke University, Durham, NC
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jianrong Zhang
- Centre for Cancer Research & Department of General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Sida Liu
- Department of Statistics, Florida State University, Tallahassee, FL
| | - Herbert Pang
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Thomas E. Stinchcombe
- Duke Cancer Institute, Duke University, Durham, NC
- Duke University Medical Center, Durham, NC
| | - Xiaofei Wang
- Duke Cancer Institute, Duke University, Durham, NC
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC
- Alliance Statistics and Data Management Center, Duke University, Durham, NC
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11
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Cho Y, Shang S, Zhou W. Comorbidities were associated with cancer clinical trial discussion and participation: findings from the Health Information National Trends Survey-Surveillance, Epidemiology, and End Results Program (2021). J Clin Epidemiol 2023; 163:62-69. [PMID: 37783400 DOI: 10.1016/j.jclinepi.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/21/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES Oncology clinical trials are recommended to better reflect real-world cancer patient populations and to increase patient access to new treatments in trials. The influence of comorbidities on trial participation is unclear. This study examined the association of having comorbidities and patients' experiences with clinical trial discussion or actual participation. STUDY DESIGN AND SETTING We included 958 cancer survivors from Health Information National Trends Survey-Surveillance, Epidemiology, and End Results Program. Trial discussion was defined as whether their medical team discussed cancer clinical trials, and trial participation was defined as whether they participated. Comorbidities included diabetes, hypertension, heart condition, chronic lung disease, and depression/anxiety disorder. Design-based logistic regression results were conducted. RESULTS Seventy-five percent of patients had one or more comorbidities, commonly having hypertension (56%) and diabetes (26%). Only 15% of participants reported trial discussion and 8% reported trial participation. Having one or more comorbidities was significantly associated with lower rates of trial discussion in univariate analysis (22.9% vs. 12.1%, odds ratio = 0.46, P = 0.001), and such association was pertained in adjusted logistic regression (20.5% vs. 12.8%, adjusted odds ratio = 0.54, P = 0.02). CONCLUSION Findings suggest patients with comorbidities were underrepresented in cancer clinical trials, implying a potential lack of representativeness among trial participants.
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Affiliation(s)
- Youmin Cho
- College of Nursing, Chungnam National University College of Nursing, Daejeon, South Korea; School of Biomedical Informatics, The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, TX, USA
| | - Shaomei Shang
- School of Nursing, Peking University School of Nursing, Beijing, China
| | - Weijiao Zhou
- School of Nursing, Peking University School of Nursing, Beijing, China.
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12
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Corrigan KL, Rooney MK, Kouzy R, Manzar G, Thomas CR, Ludmir EB. Selection and Prejudice: Addressing Clinical Trial Disparities With a Review of Current Shortcomings and Future Directions. Semin Radiat Oncol 2023; 33:367-373. [PMID: 37684066 DOI: 10.1016/j.semradonc.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Growing evidence has demonstrated significant, persistent, and widespread disparities in cancer clinical trial enrollment across myriad disease sites and target populations. Although mechanisms underlying such disparities are complex and multifactorial, clinical trial eligibility criteria may serve as a key structural barrier to equitable and diverse trial enrollment. In this review, we provide an overview of the data describing historical and current disparities in cancer clinical trial enrollment and subsequently describe several patient-, institution-, and trial-related factors which appear to be key drivers of enrollment inequity, with specific discussion regarding the impact of eligibility criteria. We further describe the landscape of ongoing professional efforts aimed at eliminating clinical trial disparities through various medical, professional, and advocacy groups. The review concludes with a practical discussion of how modernization of eligibility criteria in clinical trials may decrease or eliminate trial disparities, including specific actionable recommendations aimed at improving the quality of future eligibility criteria.
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Affiliation(s)
- Kelsey L Corrigan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael K Rooney
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ramez Kouzy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gohar Manzar
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles R Thomas
- Department of Radiation Oncology, Dartmouth-Hitchcock Norris Cotton Center, Lebanon, NH
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX..
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13
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Fayyaz F, Carvajal RD, Devoe CE. Diversifying Eligibility to Enhance Real-World Results. J Clin Oncol 2023; 41:3895-3898. [PMID: 37307516 DOI: 10.1200/jco.23.00836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 06/14/2023] Open
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14
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Grant MJ, Goldberg SB. Precise, pragmatic and inclusive: the modern era of oncology clinical trials. Nat Med 2023; 29:1908-1909. [PMID: 37524954 DOI: 10.1038/s41591-023-02466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Michael J Grant
- Department of Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Sarah B Goldberg
- Department of Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA.
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15
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Pothuri B, Blank SV, Myers TK, Hines JF, Randall LM, O'Cearbhaill RE, Slomovitz BM, Eskander RN, Alvarez Secord A, Coleman RL, Walker JL, Monk BJ, Moore KN, O'Malley DM, Copeland LJ, Herzog TJ. Inclusion, diversity, equity, and access (IDEA) in gynecologic cancer clinical trials: A joint statement from GOG foundation and Society of Gynecologic Oncology (SGO). Gynecol Oncol 2023; 174:278-287. [PMID: 37315373 DOI: 10.1016/j.ygyno.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Affiliation(s)
- B Pothuri
- NYU Langone Health and Laura & Isaac Perlmutter Cancer Center, New York, NY, USA.
| | - S V Blank
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, Blavatnik Family Women's Health Research Institute, New York, MY, USA
| | - T K Myers
- University of Massachusetts-Baystate, Springfield, MA, USA
| | - J F Hines
- University of Connecticut Health System, Farmington, CT, USA
| | - L M Randall
- Virginia Commonwealth University, Richmond, VA, USA
| | - R E O'Cearbhaill
- Memorial Sloan Kettering Cancer Center; Weill Cornell Medical College, New York, NY, USA
| | | | - R N Eskander
- University of California, San Diego Moores Cancer Center, La Jolla, CA, USA
| | - A Alvarez Secord
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - R L Coleman
- Texas Oncology, US Oncology Network, The Woodlands, TX, USA
| | - J L Walker
- Stephenson Cancer Center, Oklahoma City, OK, USA
| | - B J Monk
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - K N Moore
- Stephenson Cancer Center, Oklahoma City, OK, USA
| | - D M O'Malley
- The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus, OH, USA
| | - L J Copeland
- The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus, OH, USA
| | - T J Herzog
- University of Cincinnati Cancer Center, University of Cincinnati, Cincinnati, OH, USA
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16
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Shinder BM, Kim S, Srivastava A, Patel HV, Jang TL, Mayer TM, Saraiya B, Ghodoussipour SB, Singer EA. Factors associated with clinical trial participation for patients with renal cell carcinoma. Urol Oncol 2023; 41:208.e1-208.e8. [PMID: 36868881 PMCID: PMC10106382 DOI: 10.1016/j.urolonc.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/04/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE Recruitment of a diverse and representative study population is critical to the external validity of oncology clinical trials. The primary objective of this study was to characterize the factors associated with clinical trial participation for patients with renal cell carcinoma and the secondary objective was to examine differences in survival outcomes. MATERIALS AND METHODS We used a matched case-control design by querying the National Cancer Database for patients with renal cell carcinoma who were coded as having enrolled in a clinical trial. Trial patients were matched in a 1:5 ratio to the control cohort based on clinical stage and then sociodemographic variables were compared between the 2 groups. Multivariable conditional logistic regression models evaluated factors associated with clinical trial participation. The trial patient cohort was then matched again in a 1:10 ratio based on age, clinical stage, and comorbidities. Log-rank test was used to compare overall survival (OS) between these groups. RESULTS From 2004 to 2014, 681 patients enrolled in clinical trials were identified. Clinical trial patients were significantly younger and had a lower Charlson-Deyo comorbidity score. On multivariate analysis, male patients and white patients were more likely to participate compared to their Black counterparts. Having Medicaid or Medicare negatively associated with trial participation. Median OS was greater among clinical trial participants. CONCLUSION Patient sociodemographic factors remain significantly associated with clinical trial participation and trial participants experienced superior OS to their matched counterparts.
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Affiliation(s)
- Brian M Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sinae Kim
- Section of Biometrics, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Tina M Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Saum B Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Division of Urologic Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH.
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Chang SK, Liu D, Mitchem J, Papageorgiou C, Kaifi J, Shyu CR. Understanding common key indicators of successful and unsuccessful cancer drug trials using a contrast mining framework on ClinicalTrials.gov. J Biomed Inform 2023; 139:104321. [PMID: 36806327 DOI: 10.1016/j.jbi.2023.104321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 02/04/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
Clinical trials are essential to the process of new drug development. As clinical trials involve significant investments of time and money, it is crucial for trial designers to carefully investigate trial settings prior to designing a trial. Utilizing trial documents from ClinicalTrials.gov, we aim to understand the common characteristics of successful and unsuccessful cancer drug trials to provide insights about what to learn and what to avoid. In this research, we first computationally classified cancer drug trials into successful and unsuccessful cases and then utilized natural language processing to extract eligibility criteria information from the trial documents. To provide explainable and potentially modifiable recommendations for new trial design, contrast mining was applied to discoverhighly contrasted patterns with a significant difference in prevalence between successful (completion with advancement to the next phase) and unsuccessful (suspended, withdrawn, or terminated) groups. Our method identified contrast patterns consisting of combinations of drug categories, eligibility criteria, study organization, and study design for nine major cancers. In addition to a literature review for the qualitative validation of mined contrast patterns, we found that contrast-pattern-based classifiers using the top 200 contrast patterns as feature representations can achieve approximately 80% F1 score for eight out of ten cancer types in our experiments. In summary, aligning with the modernization efforts of ClinicalTrials.gov, our study demonstrates that understanding the contrast characteristics of successful and unsuccessful cancer trials may provide insights into the decision-making process for trial investigators and therefore facilitate improved cancer drug trial design.
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Affiliation(s)
- Shu-Kai Chang
- Institute for Data Science & Informatics, University of Missouri, Columbia, MO 65211, USA
| | - Danlu Liu
- Electrical Engineering and Computer Science Department, University of Missouri, Columbia, MO 65211, USA
| | - Jonathan Mitchem
- Institute for Data Science & Informatics, University of Missouri, Columbia, MO 65211, USA; Department of Surgery, School of Medicine, University of Missouri, Columbia, MO 65212, USA; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201, USA
| | - Christos Papageorgiou
- Department of Surgery, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Jussuf Kaifi
- Department of Surgery, School of Medicine, University of Missouri, Columbia, MO 65212, USA; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201, USA
| | - Chi-Ren Shyu
- Institute for Data Science & Informatics, University of Missouri, Columbia, MO 65211, USA; Electrical Engineering and Computer Science Department, University of Missouri, Columbia, MO 65211, USA; Department of Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA.
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18
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Martin AN, Snyder RA. Racial disparities in pancreatic cancer clinical trials: Defining the problem and identifying solutions. Adv Cancer Res 2023. [DOI: 10.1016/bs.acr.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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19
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Kwee SA, Wong LL, Ludema C, Deng CK, Taira D, Seto T, Landsittel D. Target Trial Emulation: A Design Tool for Cancer Clinical Trials. JCO Clin Cancer Inform 2023; 7:e2200140. [PMID: 36608311 PMCID: PMC10166475 DOI: 10.1200/cci.22.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To apply target trial emulation to explore the potential impact of eligibility criteria on the primary outcome of a randomized controlled trial. METHODS Simulations of a real-world explanatory trial of transarterial radioembolization for advanced unresectable hepatocellular carcinoma with portal vein invasion were performed to examine the effects of cohort specification on survival outcomes and patient sample size. Simulations comprised 24 different permutations of the trial varied on three disease nonspecific eligibility parameters. Treatment and control arms for these emulated trials were drawn from the National Cancer Database and matched by treatment propensity. Target trial emulation served as the causal framework for this analysis, allowing the architecture of a true controlled experiment to address forms of bias routinely encountered in comparative effectiveness studies involving real-world observational data. RESULTS Twenty-four propensity score-matched cohorts comprising a wider clinical spectrum of patients than specified by the original target trial were successfully generated using the National Cancer Database. The arms for each of the emulated trials demonstrated exchangeability across all eligibility criteria and other clinical covariates. Significant treatment benefits were associated with only a narrow range of eligibility criteria, indicating that the original target trial was well specified. CONCLUSION The impact of patient selection on treatment outcomes can be studied using target trial emulation. This analytical framework can furthermore serve to leverage existing real-world data to inform the task of cohort specification for a randomized controlled trial, facilitating a more data-driven approach for this important step in clinical trial design.
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Affiliation(s)
- Sandi A. Kwee
- The Queen's Medical Center, Honolulu, HI
- University of Hawai`i Cancer Center, Clinical and Translational Sciences Program, University of Hawaii at Manoa, Honolulu, HI
| | - Linda L. Wong
- University of Hawai`i Cancer Center, Clinical and Translational Sciences Program, University of Hawaii at Manoa, Honolulu, HI
- Department of Surgery, The John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | | | - Chris K. Deng
- University of Hawai`i Cancer Center, Clinical and Translational Sciences Program, University of Hawaii at Manoa, Honolulu, HI
| | - Deborah Taira
- The Daniel K. Inouye College of Pharmacy, University of Hawaii at Hilo, Hilo, HI
| | - Todd Seto
- The Queen's Medical Center, Honolulu, HI
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20
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BrintzenhofeSzoc K, Canin B, Casas-Silva E, Denicoff A, Braun-Inglis C, Okado I, Bakos A. Through the Lens of Patient Partners: Challenges in Accrual of Older Adults to NCI Clinical Trials. J Natl Cancer Inst Monogr 2022; 2022:125-134. [PMID: 36519817 PMCID: PMC9949584 DOI: 10.1093/jncimonographs/lgac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/15/2022] [Accepted: 09/11/2022] [Indexed: 12/23/2022] Open
Abstract
The workshop "Engaging Older Adults in Cancer Clinical Trials Conducted in the NCI Clinical Trials Network: Challenges and Opportunities" included a Patient Stakeholder Workgroup that explored the needs and concerns of older adults with cancer regarding clinical trials. To accomplish this, the workgroup conducted patient focus groups in which participants were interviewed, recorded conversations were analyzed and coded, and salient themes were identified. The focus groups identified general barriers to accrual such as complex consent forms, general communication, restrictive eligibility, nonreferrals, patient costs, cultural insensitivity, limited accessibility in community settings, and transportation issues. They also identified the influence of knowledgeable information presenters, improved care, family or caregiver support, and the desire to help others as drivers or reasons to participate in clinical trials. The workshop concluded that multi-level interventions could be used to increase the accrual of older adults to National Cancer Institute clinical trials as well as others.
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Affiliation(s)
- Karlynn BrintzenhofeSzoc
- Correspondence to: Karlynn BrintzenhofeSzoc, PhD, MSW, FAOSW, University of Louisville, 2301 S. 3rd St, Louisville, KY 40292, USA (e-mail: )
| | - Beverly Canin
- SCOREboard Patient Advocate Board, The Cancer and Aging Research Group, USA
| | - Esmeralda Casas-Silva
- Center for Biomedical Informatics and Information Technology, Informatics and Data Science Program, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
| | - Andrea Denicoff
- Division of Cancer Treatment and Diagnosis, Cancer Therapy and Evaluation Program, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
| | - Christa Braun-Inglis
- Clinical Faculty, UH Nancy Atmospera-Walch School of Nursing, University of Hawaii Cancer Center/Hawaii M/U NCORP, Honolulu, HI, USA
| | - Izumi Okado
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Alexis Bakos
- Division of Cancer Prevention, Community Oncology and Prevention Trials Research Group, National Institutes of Health, National Cancer Institute, Rockville, MD, USA
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21
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Denicoff AM, Ivy SP, Tamashiro TT, Zhao J, Worthington KH, Mooney MM, Little RF. Implementing Modernized Eligibility Criteria in US National Cancer Institute Clinical Trials. J Natl Cancer Inst 2022; 114:1437-1440. [PMID: 36047830 PMCID: PMC9664179 DOI: 10.1093/jnci/djac152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/19/2022] [Accepted: 06/03/2022] [Indexed: 01/04/2023] Open
Abstract
In 2018, the Cancer Therapy Evaluation Program (CTEP) at the US National Cancer Institute published new protocol template language that focused on organ function and prior and concurrent cancers in an effort to modernize eligibility criteria for cancer treatment trials. We conducted an analysis of CTEP-supported trials to evaluate the uptake and incorporation of the new language. The analysis included evaluation of 122 protocols approved in the years 2018-2020 for inclusion of the modernized eligibility criteria and consistency with new protocol template language related to 7 major eligibility criteria. These were cardiac function, liver function, kidney function, HIV status, prior and/or concurrent malignancies, treated and/or stable brain metastasis, and new and/or progressive brain metastases. Overall, CTEP trials evaluated in this period demonstrated that eligibility criteria were implemented to a relatively high degree ranging from a low of 54.1% for prior and/or concurrent malignancies to a high of 93.4% for eligibility criteria related to HIV infection. The findings demonstrate that modernized eligibility criteria can be successfully implemented but that consistent implementation requires sustained focused effort. As a result of these findings, CTEP began a new initiative in January 2022 that incorporates a specific review of eligibility criteria for new protocols to promote and improve consistency with the modernization effort.
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Affiliation(s)
- Andrea M Denicoff
- Division of Cancer Treatment & Diagnosis, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | - S Percy Ivy
- Division of Cancer Treatment & Diagnosis, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | - Margaret M Mooney
- Division of Cancer Treatment & Diagnosis, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | - Richard F Little
- Division of Cancer Treatment & Diagnosis, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
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22
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O’Dwyer PJ. Modified Eligibility Criteria: Patient Access and Subpopulation Applicability vs Efficiency in Drug Development. J Natl Cancer Inst 2022; 114:1429-1430. [PMID: 36047853 PMCID: PMC9664182 DOI: 10.1093/jnci/djac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Peter J O’Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA, USA
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23
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Lewis D, Salmi L, Staley A, Harlow J. From Individuals to Systems and Contributions to Creations: Novel Framework for Mapping the Efforts of Individuals by Convening The Center of Health and Health Care. J Particip Med 2022; 14:e39339. [DOI: 10.2196/39339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/05/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background
People with lived health care experiences (often referred to as “patients”) are increasingly contributing to health care and are most effective when they are involved as partners who can contribute complementary knowledge alongside other stakeholders in health care.
Objective
Convening The Center aimed to bring together “people known as patients”—the center of health care—to address priorities as they defined them.
Methods
According to the original project design, an in-person gathering was to be conducted; however, as a result of the COVID-19 pandemic, the in-person gathering was transformed into a series of digital gatherings, including an in-depth interview phase, small-group gatherings, and a collective convening of 25 participants (22 women and 3 men from the United States, India, Costa Rica, Sweden, and Pakistan). Each participant was interviewed on Zoom (Zoom Video Communications Inc), and the interview data were thematically analyzed to design a subsequent small group and then full cohort Zoom sessions. Visual note-taking was used to reinforce a shared understanding of each individual- and group-level conversation.
Results
The interviews and gatherings for Convening The Center offered unique perspectives on patient activities in research, health innovation, and problem-solving. This project further developed a novel, two-spectrum framework for assessing different experiences that patients may have or seek to gain, based on what patients actually do, and different levels of patients’ involvement, ranging from individual to community to systemic involvement.
Conclusions
The descriptors of patients in academic literature typically focus on what health care providers think patients “are” rather than on what patients “do.” The primary result of this project is a framework for mapping what patients “do” and “where” they do their work along two spectra: from creating their own projects to contributing to work initiated by others and from working at levels ranging from individual to community to systems. A better understanding of these spectra may enable researchers to more effectively engage and leverage patient expertise in health care research and innovation.
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Caston NE, Lalor F, Wall J, Sussell J, Patel S, Williams CP, Azuero A, Arend R, Liang MI, Rocque GB. Ineligible, Unaware, or Uninterested? Associations Between Underrepresented Patient Populations and Retention in the Pathway to Cancer Clinical Trial Enrollment. JCO Oncol Pract 2022; 18:e1854-e1865. [PMID: 36178922 PMCID: PMC9653198 DOI: 10.1200/op.22.00359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/07/2022] [Accepted: 08/15/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Cancer clinical trials can benefit current and future patients; however, Black patients, rural residents, and patients living in disadvantaged areas are often underrepresented. Using an adapted version of Unger and colleagues' model of the process of clinical trial enrollment, we evaluated the relationship between underrepresented patient populations and trial end points. METHODS This retrospective study included 512 patients with breast or ovarian cancer who were prescribed a therapeutic drug at the University of Alabama at Birmingham from January 2017 to February 2020. Patient eligibility was assessed using open clinical trials. We estimated odds ratios and 95% CIs using logistic regression models to examine the relationship between underrepresented patient populations and trial enrollment end points: eligibility, interest, offer, enrollment, and declining enrollment. RESULTS Of the patients in our sample, 27% were Black, 18% were rural residents, and 19% lived in higher disadvantaged neighborhoods. In adjusted models, each comparison group had similar odds of being eligible for a clinical trial. Black versus White patients had 0.40 times the odds of interest in clinical trials and 0.56 times the odds of enrollment. Patients living in areas of higher versus lower disadvantage had 0.46 times the odds of enrolling and 3.40 times the odds of declining enrollment when offered. CONCLUSION Eligibility did not drive clinical trial enrollment disparities in our sample; however, retention in the clinical trial enrollment process appears to vary by group. Additional work is needed to understand how interventions can be tailored to each population's specific needs.
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Affiliation(s)
- Nicole E. Caston
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Fallon Lalor
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jaclyn Wall
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Courtney P. Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Rebecca Arend
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Margaret I. Liang
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gabrielle B. Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- O'Neal Comprehensive Cancer Center, Birmingham, AL
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25
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Hamann HA, Gerber DE. Placing a Cancer Diagnosis in Clinical Context: Applying Functional Trajectories to Advanced NSCLC. JTO Clin Res Rep 2022; 3:100366. [PMID: 36176486 PMCID: PMC9513545 DOI: 10.1016/j.jtocrr.2022.100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Heidi A. Hamann
- Department of Psychology, University of Arizona, Tucson, Arizona
- Department of Family and Community Medicine, University of Arizona Health Sciences, Tucson, Arizona
- The University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
- Corresponding author. Address for correspondence: Heidi A. Hamann, PhD, Department of Psychology, University of Arizona, 1513 East University Boulevard, Tucson, AZ 85721.
| | - David E. Gerber
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
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26
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Wieland ML, Grover M. Inclusive Clinical Trials for Disorders of Gut-Brain Interactions. Gastroenterology 2022; 163:583-585. [PMID: 35780870 DOI: 10.1053/j.gastro.2022.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Mark L Wieland
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, Minnesota.
| | - Madhusudan Grover
- Division of Gastroenterology and Hepatology, Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota
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Cooper RA, Chai Y, Nieva J. Effect of sponsor on enrollment criteria in non-small cell lung cancer clinical trials. J Cancer Policy 2022; 33:100336. [PMID: 35605888 PMCID: PMC10226152 DOI: 10.1016/j.jcpo.2022.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inclusion and exclusion criteria in clinical trials are used to mitigate the effects of confounding variables on study outcomes. In 2017 and 2021, ASCO and the Friends of Cancer Research published recommendations to loosen enrollment criteria in cancer clinical trials to improve generalizability. The purpose of this study is to determine if the source of funding influences the degree of transparency and selection of inclusion and exclusion criteria. METHODS Phase 2 and 3 non-small cell lung cancer (NSCLC) drug trials on clinicaltrials.gov were grouped into one of three sponsor categories: industry, government/cooperative group, and academic. Strictness of specific criteria and the level of transparency in listing organ function requirements were analyzed using Fisher Exact tests. Independent sample t-tests were used to assess the variability in total number of criteria. RESULTS Organ function requirements listed on clinicaltrials.gov are more often vague or incomplete in industry sponsored trials compared to government/cooperative group (p = 2.3 × 10-10, α = 0.01) and academic (p = 1.8 × 10-4, α = 0.01) sponsored trials. Industry sponsored trials more often excluded patients with worse performance status scores compared to government/cooperative group sponsored trials (p = 5.7 × 10-6, α = 0.01). CONCLUSION Industry sponsored NSCLC drug trials are more likely to exclude patients with worse performance status and are less transparent in listing complete study requirements on clinicaltrials.gov. POLICY SUMMARY Unnecessarily strict enrollment criteria are increasingly seen in clinical trials sponsored by industry. Regulators responsible for drug approvals should note when studies deviate from ASCO and Friends of Cancer Research framework and question the external validity of study findings with overly narrow enrollment criteria when making decisions on drug approvals.
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Affiliation(s)
- Ryan A Cooper
- University of Southern California Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
| | - Yan Chai
- Biostatistics Core, The Saban Research Institute and Southern California Clinical and Translational Science Institute, Children's Hospital Los Angeles Los Angeles, 4551 Sunset Blvd, Rm. 102 MS 142, Los Angeles, CA 90027, USA.
| | - Jorge Nieva
- University of Southern California/Norris Cancer Center, 1441 Eastlake Ave, Los Angeles, CA 90033, USA.
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Abstract
Recent rapid biotechnological breakthroughs have led to the identification of complex and unique molecular features that drive malignancies. Precision medicine has exploited next-generation sequencing and matched targeted therapy/immunotherapy deployment to successfully transform the outlook for several fatal cancers. Tumor and liquid biopsy genomic profiling and transcriptomic, immunomic, and proteomic interrogation can now all be leveraged to optimize therapy. Multiple new trial designs, including basket and umbrella trials, master platform trials, and N-of-1 patient-centric studies, are beginning to supplant standard phase I, II, and III protocols, allowing for accelerated drug evaluation and approval and molecular-based individualized treatment. Furthermore, real-world data, as well as exploitation of digital apps and structured observational registries, and the utilization of machine learning and/or artificial intelligence, may further accelerate knowledge acquisition. Overall, clinical trials have evolved, shifting from tumor type-centered to gene-directed and histology-agnostic trials, with innovative adaptive designs and personalized combination treatment strategies tailored to individual biomarker profiles. Some, but not all, novel trials now demonstrate that matched therapy correlates with superior outcomes compared to non-matched therapy across tumor types and in specific cancers. To further improve the precision medicine paradigm, the strategy of matching drugs to patients based on molecular features should be implemented earlier in the disease course, and cancers should have comprehensive multi-omic (genomics, transcriptomics, proteomics, immunomic) tumor profiling. To overcome cancer complexity, moving from drug-centric to patient-centric individualized combination therapy is critical. This review focuses on the design, advantages, limitations, and challenges of a spectrum of clinical trial designs in the era of precision oncology.
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Affiliation(s)
- Elena Fountzilas
- Department of Medical Oncology, St. Lukes's Hospital, Thessaloniki, Greece.,European University Cyprus, Limassol, Cyprus
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Henry Hiep Vo
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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29
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Stensland KD, Richesson RL, Vince RA, Skolarus TA, Sales AE. Evolving a national clinical trials learning health system. Learn Health Syst 2022; 7:e10327. [PMID: 37066100 PMCID: PMC10091198 DOI: 10.1002/lrh2.10327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/26/2022] [Accepted: 06/28/2022] [Indexed: 11/07/2022] Open
Abstract
Clinical trials generate key evidence to inform decision making, and also benefit participants directly. However, clinical trials frequently fail, often struggle to enroll participants, and are expensive. Part of the problem with trial conduct may be the disconnected nature of clinical trials, preventing rapid data sharing, generation of insights and targeted improvement interventions, and identification of knowledge gaps. In other areas of healthcare, a learning health system (LHS) has been proposed as a model to facilitate continuous learning and improvement. We propose that an LHS approach could greatly benefit clinical trials, allowing for continuous improvements to trial conduct and efficiency. A robust trial data sharing system, continuous analysis of trial enrollment and other success metrics, and development of targeted trial improvement interventions are potentially key components of a Trials LHS reflecting the learning cycle and allowing for continuous trial improvement. Through the development and use of a Trials LHS, clinical trials could be treated as a system, producing benefits to patients, advancing care, and decreasing costs for stakeholders.
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Affiliation(s)
| | - Rachel L. Richesson
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - Randy A. Vince
- Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
| | - Ted A. Skolarus
- Department of UrologyUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Anne E. Sales
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Sinclair School of NursingUniversity of MissouriColumbiaMissouriUSA
- Department of Family and Community MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
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30
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Luong VTT, Ho C, Aedo-Lopez V, Segelov E. Gender profile of principal investigators in a large academic clinical trials group. Front Surg 2022; 9:962120. [PMID: 35923437 PMCID: PMC9339678 DOI: 10.3389/fsurg.2022.962120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Gender equity in medicine has become a significant topic of discussion due to consistently low female representation in academia and leadership roles. Gender imbalance directly affects patient care. This study examined the gender and craft group of the Principal Investigators (PI) of clinical trials run by the Australasian Gastro-Intestinal Trials Group (AGITG) Methods Publicly available data was obtained from the AGITG website. Trials were divided into upper, lower gastrointestinal cancer, miscellaneous (neuroendocrine and gastrointestinal stromal tumours). Where multiple PIs were listed, all were counted. Craft group was assigned as surgical, medical, radiation oncology or other. Results There were 69 trials with 89 PI, where 52 trials were represented exclusively by male PIs. Of all PIs, 18 were women (20.2%); all were medical oncologists. Prior to 2005, all PIs were male. The craft group distribution of PIs was: 79% medical oncologists, 12% surgical oncologists, 8% radiation oncologist, 1% nuclear medicine physicians. Regarding trials with multiple PI's, there were 19 in total. Of these, 11 had only male PIs, which included 5 surgeons. Females were more likely to be a co-PI (42%) as opposed to sole PI (18%). There was no gender policy publicly available on the AGITG website. Conclusions There is a low percentage of female PIs in academic oncology trials in the portfolio of this large international trials group. No trial was led by a female surgical or radiation oncologist. There is a need to understand the reasons driving the disparity so that specific strategies can be put in place.
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Affiliation(s)
- Vi Thi Thao Luong
- Oncology Department, Monash Health, Melbourne VICAustralia
- Correspondence: Dr Vi Thi Thao Luong
| | - Cindy Ho
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Eva Segelov
- Oncology Department, Monash Health, Melbourne VICAustralia
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
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31
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Orvain C, Othus M, Johal G, Hunault-Berger M, Appelbaum FR, Walter RB. Evolution of eligibility criteria for non-transplant randomized controlled trials in adults with acute myeloid leukemia. Leukemia 2022; 36:2002-2008. [PMID: 35660798 DOI: 10.1038/s41375-022-01624-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022]
Abstract
Eligibility criteria for clinical trials are intended to select suitable study subjects but can limit trial participation and generalization of results. While reported for other cancers, non-enrollment rates and evolution of eligibility criteria over time have so far not been studied for randomized controlled trials (RCTs) involving adults with acute myeloid leukemia (AML). Among 3698 studies published between 2010 and 2020, including 447 involving prospective clinical trials, we identified 75 phase three RCTs testing non-transplant therapies for adults with AML. Only 31 studies (41%) provided information on non-enrollment; in these studies, the median non-enrollment rate was 23%, primarily attributed to restrictive eligibility criteria. In 95% of trials, eligibility criteria were reported with the total number per trial increasing over time (P < 0.001), particularly in industry-funded trials. A total of 27 eligibility criteria were used across trials, mostly concerning comorbidities or performance status, with eight of them becoming more common over time. The concordance with recent ASCO - Friends of Cancer Research eligibility criteria recommendations greatly varied, from 35% to 99%. Together, our analyses suggest that the ability to generalize results from non-transplant RCTs may be increasingly limited because of high non-enrollment rates and increasingly restrictive eligibility criteria.
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Affiliation(s)
- Corentin Orvain
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA.,Maladies du Sang, CHU d'Angers, Angers, France.,Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL, Angers, France.,Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, F-49000, Angers, France
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Gurleen Johal
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA
| | - Mathilde Hunault-Berger
- Maladies du Sang, CHU d'Angers, Angers, France.,Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL, Angers, France.,Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, F-49000, Angers, France
| | - Frederick R Appelbaum
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.,Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Roland B Walter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA. .,Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA. .,Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
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Sprangers B, Perazella MA, Lichtman SM, Rosner MH, Jhaveri KD. Improving Cancer Care for Patients With CKD: The Need for Changes in Clinical Trials. Kidney Int Rep 2022; 7:1939-1950. [PMID: 36090489 PMCID: PMC9458993 DOI: 10.1016/j.ekir.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022] Open
Abstract
Chemotherapeutic agents used to treat cancer generally have narrow therapeutic indices along with potentially serious adverse toxicities. Many cancer drugs are at least partially excreted through the kidney and, thus, the availability of accurate data on safe and effective dosing of these drugs in patients with chronic kidney disease (CKD) is essential to guide treatment decisions. Typically, during drug development, initial clinical studies only include patients with normal or only mildly impaired kidney function. In subsequent preregistration studies, a limited number of patients with more severe kidney dysfunction are included. Data obtained from patients with either severe kidney dysfunction (here defined as an estimated glomerular filtration rate [eGFR] < 30 ml/min or stage 4G CKD) or end-stage kidney disease (ESKD) requiring kidney replacement treatment are particularly limited before drug registration and only a minority of new drug applications to the US Food and Drug Administration (FDA) include data from this population. Unfortunately, limited data and/or other safety concerns may result in a manufacturer statement that the drug is contraindicated in patients with advanced kidney disease, which hinders access to potentially beneficial drugs for these patients. This systemic exclusion of patients with CKD from cancer drug trials remains an unsolved problem, which prevents provision of optimal clinical care for these patients, raises questions of inclusion, diversity, and equity. In addition, with the aging of the population, there are increasing numbers of patients with CKD and cancer who face these issues. In this review, we evaluate the scientific basis to exclude patients with CKD from cancer trials and propose a comprehensive strategy to address this problem.
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Oyer RA, Hurley P, Boehmer L, Bruinooge SS, Levit K, Barrett N, Benson A, Bernick LA, Byatt L, Charlot M, Crews J, DeLeon K, Fashoyin-Aje L, Garrett-Mayer E, Gralow JR, Green S, Guerra CE, Hamroun L, Hardy CM, Hempstead B, Jeames S, Mann M, Matin K, McCaskill-Stevens W, Merrill J, Nowakowski GS, Patel MI, Pressman A, Ramirez AG, Segura J, Segarra-Vasquez B, Hanley Williams J, Williams JE, Winkfield KM, Yang ES, Zwicker V, Pierce LJ. Increasing Racial and Ethnic Diversity in Cancer Clinical Trials: An American Society of Clinical Oncology and Association of Community Cancer Centers Joint Research Statement. J Clin Oncol 2022; 40:2163-2171. [PMID: 35588469 DOI: 10.1200/jco.22.00754] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A concerted commitment across research stakeholders is necessary to increase equity, diversity, and inclusion (EDI) and address barriers to cancer clinical trial recruitment and participation. Racial and ethnic diversity among trial participants is key to understanding intrinsic and extrinsic factors that may affect patient response to cancer treatments. This ASCO and Association of Community Cancer Centers (ACCC) Research Statement presents specific recommendations and strategies for the research community to improve EDI in cancer clinical trials. There are six overarching recommendations: (1) clinical trials are an integral component of high-quality cancer care, and every person with cancer should have the opportunity to participate; (2) trial sponsors and investigators should design and implement trials with a focus on reducing barriers and enhancing EDI, and work with sites to conduct trials in ways that increase participation of under-represented populations; (3) trial sponsors, researchers, and sites should form long-standing partnerships with patients, patient advocacy groups, and community leaders and groups; (4) anyone designing or conducting trials should complete recurring education, training, and evaluation to demonstrate and maintain cross-cultural competencies, mitigation of bias, effective communication, and a commitment to achieving EDI; (5) research stakeholders should invest in programs and policies that increase EDI in trials and in the research workforce; and (6) research stakeholders should collect and publish aggregate data on racial and ethnic diversity of trial participants when reporting results of trials, programs, and interventions to increase EDI. The recommendations are intended to serve as a guide for the research community to improve participation rates among people from racial and ethnic minority populations historically under-represented in cancer clinical trials. ASCO and ACCC will work at all levels to advance the recommendations in this publication.
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Affiliation(s)
- Randall A Oyer
- Penn Medicine Lancaster General Health Ann B Barshinger Cancer Institute, Lancaster, PA
| | | | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, MD
| | | | - Kathryn Levit
- American Society of Clinical Oncology, Alexandria, VA
| | - Nadine Barrett
- Duke Clinical and Translational Science Institute, Raleigh, NC
| | - Al Benson
- Northwestern University, Evanston, IL
| | | | - Leslie Byatt
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | | | - Kyle DeLeon
- American Cancer Society Cancer Action Network, Washington, DC
| | - Lola Fashoyin-Aje
- US Food and Drug Administration Oncology Center of Excellence, Silver Spring, MD
| | | | | | - Sybil Green
- American Society of Clinical Oncology, Alexandria, VA
| | - Carmen E Guerra
- University of Pennsylvania Raymond and Ruth Perelman School of Medicine, Philadelphia, PA
| | - Leila Hamroun
- ChristianaCare Oncology Patient Advocates for Clinical Trials, Newark, DE
| | - Claudia M Hardy
- University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, AL
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eddy S Yang
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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Benbow JH, Rivera DR, Lund JL, Feldman JE, Kim ES. Increasing Inclusiveness of Patient-Centric Clinical Evidence Generation in Oncology: Real-World Data and Clinical Trials. Am Soc Clin Oncol Educ Book 2022; 42:1-11. [PMID: 35561304 DOI: 10.1200/edbk_350574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rapid advancements in cancer discovery, diagnosis, and treatment options available to patients with cancer have highlighted the need for enhancements in clinical trial design. The drug development process is costly, with more than 80% of trials failing to reach recruitment targets. Historical approaches to trial design are increasingly burdensome and lack real-world application in the intent-to-treat patient population. Equitable access to clinical trials combined with increased availability of real-world data are creating new opportunities for inclusiveness, improved outcomes, and evidence-based advances in therapies that will generate more generalizable data to better inform clinical decision-making. Clinical trials need to be inclusive if lifesaving data are not to be missed and investigational therapies are to be more accessible to a broader patient base. Real-world data can facilitate the conduct of studies that are identifying and understanding where disparities exist and developing new interventions to improve patient care. The clinical trial design process should be a multistakeholder and consensus- and evidence-driven process in which stakeholders are working together across the health care industry to close the care gap and ensure elimination of barriers that prevent equal access to specialized cancer care and advanced therapies available in clinical trials. The patient voice is essential throughout the trial process; however, it is often excluded from the design process. Integrating real-world data as well as ensuring patient involvement in early trial design during drug development can enhance enrollment and retention, leading to greater diversity.
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Affiliation(s)
| | - Donna R Rivera
- Oncology Center of Excellence, U.S. Food and Drug Administration, Silver Spring, MD
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jill E Feldman
- Lung Cancer Patient and Advocate and EGFR Resisters, Deerfield, IL
| | - Edward S Kim
- City of Hope National Medical Center, Los Angeles, CA
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35
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Haynes RM, Sirintrapun SJ, Gao J, McKenzie AJ. Using Technology to Enhance Cancer Clinical Trial Participation. Am Soc Clin Oncol Educ Book 2022; 42:1-7. [PMID: 35486887 DOI: 10.1200/edbk_349671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The COVID-19 pandemic presented many challenges to health care systems, including oncology clinical research programs. There were substantial negative effects on oncology clinical trial screening, enrollment, and study activities that forced institutions and regulatory bodies to develop innovative solutions to maintain robust and equitable participation in these trials. Digital pathology innovations at Memorial Sloan Kettering Cancer Center have streamlined the diagnostic life cycle for patients with cancer, and the seamless integration of digital pathology services with next-generation sequencing and other molecular pathology services have accelerated the time to diagnosis and receipt of molecular results. Timely access to these results, coupled with Memorial Sloan Kettering Cancer Center's knowledge engine OncoKB, enhances patient clinical trial coordination precisely and efficiently. At the Sarah Cannon Research Institute, centralized remote clinical trial matching and screening, virtual molecular tumor boards, and centralized molecular interpretation support services have empowered clinic staff to identify more efficiently potential participants in clinical research, despite the COVID-19 pandemic. In addition, the U.S. Food and Drug Administration Oncology Center of Excellence has been involved in several efforts to address challenges for patients with cancer during the COVID-19 pandemic, including writing guidance documents and participating in efforts to modernize clinical trials. The enclosed personal experience of a patient with cancer currently participating in an oncology clinical trial emphasizes the need for continued decreasing of barriers to study participation. Clinical trial advances that were accelerated by the pandemic will ultimately help patients with cancer and the greater oncology health care community.
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Affiliation(s)
- Rudene Mercer Haynes
- Breast cancer survivor, clinical trial participant, and partner at Hunton Andrews Kurth LLP, Richmond, VA
| | | | - Jennifer Gao
- U.S. Food and Drug Administration, Oncology Center of Excellence, Silver Springs, MD
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36
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Snyder RA. Clinical Trial Eligibility Criteria: A Structural Barrier to Diversity in Clinical Trial Enrollment. J Clin Oncol 2022; 40:2183-2185. [PMID: 35427183 DOI: 10.1200/jco.22.00537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rebecca A Snyder
- Brody School of Medicine at East Carolina University, Greenville, NC
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37
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Abstract
Cancer clinical trials are critical for testing new treatments, yet less than 5% of patients with cancer enroll in these trials. Minority groups, elderly individuals, and rural populations are particularly underrepresented in cancer treatment trials. Strategies for advancing equity in cancer clinical trials for these populations include (1) optimizing clinical trial matching by broadening eligibility criteria, screening all patients for trial eligibility, expanding the number of trials against which patients are screened, and following up on all patient matches with an enrollment invitation; (2) conducting site self-assessments to identify clinical-, patient-, provider-, and system-level barriers that contribute to low rates of clinical trial screening and enrollment; (3) creating a quality improvement plan that addresses the barriers to enrollment and incorporates the use of tools and strategies such as clinical trial checklists; workforce development and trainings to improve cultural competence and reduce unconscious bias; guides to promote community education, outreach and engagement with cancer clinical trials; screening and accrual logs designed to measure participation by demographics; models of informed consent that improve understanding; clinical trial designs that reduce accessibility barriers; use of cancer clinical trial patient navigators; and programs to eliminate barriers to participation and out-of-pocket expenses; and (4) working with stakeholders to develop both protocols that are inclusive of diverse populations' geographic locations, and strategies to access those trials. These actions will support greater access for populations that have remained underrepresented in cancer clinical trials and thereby increase the generalizability and efficiency of cancer research.
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Affiliation(s)
- Carmen E Guerra
- Department of Medicine, Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Mark E Fleury
- American Cancer Society Cancer Action Network, Inc., Washington, DC
| | - Leslie P Byatt
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Tyler Lian
- Department of Medicine, Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lori Pierce
- Department of Radiation Oncology, School of Medicine, University of Michigan, Ann Arbor, MI
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI
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Bagley SJ, Kothari S, Rahman R, Lee EQ, Dunn GP, Galanis E, Chang SM, Burt Nabors L, Ahluwalia MS, Stupp R, Mehta MP, Reardon DA, Grossman SA, Sulman EP, Sampson JH, Khagi S, Weller M, Cloughesy TF, Wen PY, Khasraw M. Glioblastoma Clinical Trials: Current Landscape and Opportunities for Improvement. Clin Cancer Res 2022; 28:594-602. [PMID: 34561269 PMCID: PMC9044253 DOI: 10.1158/1078-0432.ccr-21-2750] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/29/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Therapeutic advances for glioblastoma have been minimal over the past 2 decades. In light of the multitude of recent phase III trials that have failed to meet their primary endpoints following promising preclinical and early-phase programs, a Society for Neuro-Oncology Think Tank was held in November 2020 to prioritize areas for improvement in the conduct of glioblastoma clinical trials. Here, we review the literature, identify challenges related to clinical trial eligibility criteria and trial design in glioblastoma, and provide recommendations from the Think Tank. In addition, we provide a data-driven context with which to frame this discussion by analyzing key study design features of adult glioblastoma clinical trials listed on ClinicalTrials.gov as "recruiting" or "not yet recruiting" as of February 2021.
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Affiliation(s)
- Stephen J. Bagley
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Shawn Kothari
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Eudocia Q. Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gavin P. Dunn
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri
| | | | - Susan M. Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Louis Burt Nabors
- Division of Neuro-oncology, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Manmeet S. Ahluwalia
- Department of Medical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Roger Stupp
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Minesh P. Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - David A. Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stuart A. Grossman
- Department of Oncology, Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland
| | - Erik P. Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York
| | - John H. Sampson
- Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Simon Khagi
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Timothy F. Cloughesy
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mustafa Khasraw
- Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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Somayaji D, Mohedat H, Dean GE, Dickerson SS. Patients' Perceptions at Diagnosis: Lung Cancer Discovery and Provider Relationships. Cancer Nurs 2022; 45:397-405. [PMID: 35067577 DOI: 10.1097/NCC.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the United States, most lung cancer cases are diagnosed at advanced stages, limiting treatment options and impacting survival. This study presents patients' perspectives on the complexity of factors influencing a lung cancer diagnosis. Lung cancer awareness regarding risks, symptoms, smoking behaviors, family history, and environmental factors can lead to preventative and early detection measures. OBJECTIVE The aim of this study was to explore lung cancer patient perspectives on lung cancer awareness within the context of an earlier study to understand sleep-wake disturbances in adults with non-small cell lung cancer. METHODS A content analysis was used to analyze the original deidentified longitudinal interview data collected from 26 patients diagnosed with lung cancer. RESULTS Of the original 26 participants, 16 were included in this secondary data analysis. The participants were primarily females (n = 10) and Whites (n = 13), with ages ranging between 49 and 83 years. Half of the sample was diagnosed with stage IV lung cancer and most of the sample was on chemotherapy (n = 10). Two key themes were identified: the lung cancer discovery and the patient-physician relationship. CONCLUSIONS Unspecific initial symptoms, lack of knowledge and screening, as well as fear of the diagnosis delayed seeking medical care. Patient-physician relationships were hindered by smoking-associated stigma, inadequate sharing of information, and lack of coordinated, holistic care. Positive communication strategies are critical between patients and providers to meet patients' specific needs. IMPLICATIONS FOR PRACTICE Educational interventions that enhance lung cancer awareness may improve prevention and screening actions, improve timely healthcare intervention, and reduce incidence and mortality.
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Pierret T, Giaj-Levra M, Gobbini E, Toffart AC, Moro-Sibilot D. [Implication of bronchopulmonary cancer patients in thoracic oncology]. Rev Mal Respir 2021; 38:986-992. [PMID: 34782178 DOI: 10.1016/j.rmr.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
Changed relationships between patient and health care provider have given patients a greater role in their care. Nowadays, they have the opportunity to be involved in decision-making regarding any diagnostic, therapeutic or monitoring intervention related to their disease. Access to international scientific data through the web, the activity of different patient associations, and the information given by their referring physician can enrich their knowledge about their disease and its possible treatments. In addition to the objective criteria usually assessed, the role currently assumed by patient associations in clinical research helps to identify their expectations. In addition, a number of new tools allow the thoracic oncologist to better understand patients' wishes. Health authorities' use of patient-reported outcomes and patients' use of digital applications contribute to improved survival without any deleterious impact on quality of life. Web applications designed to monitor a patient's toxicities during treatment are now commercially available. To meet our patients' expectations, we are called upon to incorporate these different digital tools into our daily practice.
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Affiliation(s)
- T Pierret
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France.
| | - M Giaj-Levra
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France
| | - E Gobbini
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France
| | - A-C Toffart
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France
| | - D Moro-Sibilot
- Service de pneumologie et physiologie, unité d'oncologie thoracique, CHU Grenoble Alpes, CS10217, 38043 Grenoble cedex, France
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Sanz-Garcia E, Haibe-Kains B, Siu LL. Using real-word data to evaluate the effects of broadening eligibility criteria in oncology trials. Cancer Cell 2021; 39:750-752. [PMID: 34129820 DOI: 10.1016/j.ccell.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Eligibility criteria restrict patient enrollment in clinical trials. A Nature paper applied a machine-learning algorithm in a real-world database to show that relaxing some criteria may not jeopardize efficacy and safety. This may enable more patients to have earlier access to new therapies and make results more generalizable to clinical practice.
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Affiliation(s)
- Enrique Sanz-Garcia
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada
| | - Benjamin Haibe-Kains
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada; Department of Computer Science, University of Toronto, Toronto, Canada; Ontario Institute for Cancer Research, Toronto, Canada; Vector Institute for Artificial Intelligence, Toronto, Canada; Biostatistics Division, Dalla Lana School of Public Health, Toronto, Canada
| | - Lillian L Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
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Gao JJ, Krol D, Narayan P, Cardoso F, Regan MM, Goetz MP, Hurvitz SA, Mauro L, Hodgdon C, Miller CP, Booth B, Bloomquist E, Ison G, Osgood C, Bhatnagar V, Fashoyin-Aje L, Pazdur R, Amiri-Kordestani L, Beaver JA. Bringing safe and effective therapies to premenopausal women with breast cancer: efforts to broaden eligibility criteria. Ann Oncol 2021; 32:950-3. [PMID: 33991601 DOI: 10.1016/j.annonc.2021.05.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
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Giantonio BJ. Eligibility in Cancer Clinical Research: The Intersection of Discovery, Generalizability, Beneficence, and Justice. Clin Cancer Res 2021; 27:2369-2371. [PMID: 33602680 DOI: 10.1158/1078-0432.ccr-21-0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
Eligibility criteria in clinical trials limit the study population for safety and scientific purposes. The American Society of Clinical Oncology and The Friends of Cancer Research collaboration reconsidered common eligibility criteria in cancer trials and found many to be unnecessarily restrictive. The current recommendations further their efforts to facilitate accrual and improve the generalizability of research results to practice.See related articles, p. 2394, 2400, 2408, 2416, 2424, and 2430.
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Affiliation(s)
- Bruce J Giantonio
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts.
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It's time to invite more people to join clinical trials. Nature 2021; 592:659-60. [PMID: 33911278 DOI: 10.1038/d41586-021-01099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Noronha V, Dhumal S, Patil V, Joshi A, Menon N, Nawale K, Tambe R, Prabhash K. Post hoc analysis of the screening log of phase III investigator-initiated randomized clinical trial comparing palliative oral metronomic versus intravenous chemotherapy in head-and-neck cancer. Cancer Res Stat Treat 2021. [DOI: 10.4103/crst.crst_157_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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