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Corbaux P, Bayle A, Besle S, Vinceneux A, Vanacker H, Ouali K, Hanvic B, Baldini C, Cassier PA, Terret C, Verlingue L. Patients' selection and trial matching in early-phase oncology clinical trials. Crit Rev Oncol Hematol 2024; 196:104307. [PMID: 38401694 DOI: 10.1016/j.critrevonc.2024.104307] [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: 11/15/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Early-phase clinical trials (EPCT) represent an important part of innovations in medical oncology and a valuable therapeutic option for patients with metastatic cancers, particularly in the era of precision medicine. Nevertheless, adult patients' participation in oncology clinical trials is low, ranging from 2% to 8% worldwide, with unequal access, and up to 40% risk of early discontinuation in EPCT, mostly due to cancer-related complications. DESIGN We review the tools and initiatives to increase patients' orientation and access to early phase cancer clinical trials, and to limit early discontinuation. RESULTS New approaches to optimize the early-phase clinical trial referring process in oncology include automatic trial matching, tools to facilitate the estimation of patients' prognostic and/or to better predict patients' eligibility to clinical trials. Classical and innovative approaches should be associated to double patient recruitment, improve clinical trial enrollment experience and reduce early discontinuation rates. CONCLUSIONS Whereas EPCT are essential for patients to access the latest medical innovations in oncology, offering the appropriate trial when it is relevant for patients should increase by organizational and technological innovations. The oncologic community will need to closely monitor their performance, portability and simplicity for implementation in daily clinical practice.
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Affiliation(s)
- P Corbaux
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Medical Oncology, Institut de Cancérologie et d'Hématologie Universitaire de Saint-Étienne (ICHUSE), Centre Hospitalier Universitaire de Saint-Etienne, France
| | - A Bayle
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - S Besle
- Centre de Recherche en Cancérologie de Lyon (CRCL), France
| | - A Vinceneux
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - H Vanacker
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Centre de Recherche en Cancérologie de Lyon (CRCL), France
| | - K Ouali
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - B Hanvic
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - C Baldini
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - P A Cassier
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Centre de Recherche en Cancérologie de Lyon (CRCL), France
| | - C Terret
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - L Verlingue
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Centre de Recherche en Cancérologie de Lyon (CRCL), France.
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Charton E, Baldini C, Fayet Y, Schultz E, Auroy L, Vallier E, Italiano A, Robert M, Coquan E, Isambert N, Moreau P, Touzeau C, Le Tourneau C, Ghrieb Z, Kiladjian JJ, Delord JP, Gomez Roca C, Vey N, Barlesi F, Lesimple T, Penel N, Soria JC, Massard C, Besle S. Inequality factors in access to early-phase clinical trials in oncology in France: results of the EGALICAN-2 study. ESMO Open 2023; 8:101610. [PMID: 37536254 PMCID: PMC10415590 DOI: 10.1016/j.esmoop.2023.101610] [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: 12/09/2022] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Investigation of the disparities in the access to experimental treatment in early-phase clinical trials is lacking. The objective of the EGALICAN-2 study was to identify the factors underpinning such inequalities. METHODS A national prospective survey was conducted in 11 early-phase clinical trial centers (CLIP2) certified by the French National Cancer Institute. Sociodemographic, socioeconomic and medical data were collected. Univariate logistic regression models were carried out to estimate odds ratios and 90% confidence intervals associated with the effect of each study variable. A multivariate logistic regression model was built to explore the independent factors associated with the administration of the experimental treatment (C1D1). A post hoc analysis was carried out excluding female cancer patients. RESULTS Between 2015 and 2016, 1355 patients referred from 11 CLIP2 centers in France were included in the study. Eight hundred and forty-eight patients received C1D1 (73%) and 320 patients (27%) were screening failure. Median age was 58 years (range 17-97 years) and 667 patients (54%) were female. Most patients had a metastatic disease (n = 751, 87%). In the multivariate logistic regression analysis, the significant independent factors associated with C1D1 were male sex, initial care received in a hospital with an early-phase unit and living in wealthy metropolitan areas (P values <0.05). In the post hoc analysis, the sex factor was no longer significant [odds ratio = 1.21 (95% confidence interval 0.86-1.70), P value = 0.271]. CONCLUSIONS This study investigated the factors producing social inequalities in the context of early-phase clinical trials in oncology. Our research highlights factors of sex, care pathway and geographic location. Gynecological cancer was found to impact C1D1 significantly, unlike breast cancer. The results of this study should contribute to improve patient access to early-phase clinical trials.
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Affiliation(s)
- E Charton
- Human and Social Sciences Department, Centre Léon Bérard, Lyon.
| | - C Baldini
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - Y Fayet
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon
| | - E Schultz
- CEPED (UMR 196), University of Paris, IRD, Paris; SESSTIM, CANBIOS Team, Aix-Marseille University, INSERM, IRD, Marseille
| | - L Auroy
- University of Grenoble Alpes, CNRS, Sciences Po Grenoble, Grenoble
| | - E Vallier
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | | | - M Robert
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Saint-Herblain
| | - E Coquan
- Medical Oncology Department, Centre François Baclesse, Caen
| | - N Isambert
- Medical Oncology Department, University Hospital of Poitiers, Poitiers
| | - P Moreau
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon
| | - C Touzeau
- Department of Hematology, University Hospital of Nantes, Nantes
| | - C Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris
| | - Z Ghrieb
- Service de Pharmacologie et Investigations Cliniques, Hôpital Saint-Louis, AP-HP, Paris
| | - J-J Kiladjian
- Service de Pharmacologie et Investigations Cliniques, Hôpital Saint-Louis, AP-HP, Paris
| | - J-P Delord
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - C Gomez Roca
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse
| | - N Vey
- Department of Hematology, Institut Paoli-Calmettes, Marseille
| | - F Barlesi
- CRCM, INSERM, CNRS, APHM, Aix-Marseille University, Marseille; Gustave Roussy, Villejuif
| | - T Lesimple
- Department of Oncology, Eugene Marquis Center, Rennes
| | - N Penel
- Centre Oscar Lambret, Lille University, Lille
| | - J-C Soria
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - C Massard
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif
| | - S Besle
- Human and Social Sciences Department, Centre Léon Bérard, Lyon; Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif; Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de recherche en cancérologie de Lyon, Institut Convergence PLAsCAN, Lyon, France
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Baldini C, Charton E, Schultz E, Auroy L, Italiano A, Robert M, Coquan E, Isambert N, Moreau P, Le Gouill S, Le Tourneau C, Ghrieb Z, Kiladjian J, Delord J, Roca CG, Vey N, Barlesi F, Lesimple T, Penel N, Soria J, Massard C, Besle S. Access to early-phase clinical trials in older patients with cancer in France: the EGALICAN-2 study. ESMO Open 2022; 7:100468. [PMID: 35533427 PMCID: PMC9271476 DOI: 10.1016/j.esmoop.2022.100468] [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: 11/01/2021] [Revised: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Patients and methods Results Conclusions Older patients are underrepresented in early-phase clinical trials (17.7%) compared with the number of new cases (50%). The rate of signed informed consent was similar across age groups (92.7% in younger patients versus 90.6% in older patients). The rate of screening failure was consistent across all age groups (28.5% in younger patients versus 24.3% in older patients). In older patients the initial care received in the center having a phase I unit was associated with study drug administration.
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