Clinical trials represent leading-edge medical science. However, very few adults diagnosed with cancer each year are enrolled in them. While there are a number of various treatment approaches being offered, the majority of patients are not aware that this is a viable option for them.
If treatment options above and beyond standard treatment are being offered, why are patients not using this valuable resource?
Results from surveys and focus groups concluded that the vast majority of patients are simply unaware of clinical trials. Further, doctors are not enrolling patients due to a lack of time, staffing, funding, and resources. Indeed, enrolling a patient in a trial requires a significant amount of time and resources for physicians. There are also some serious misconceptions about clinical trials held by some physicians and patients. (And please note that molecular targeted clinical trials need to be viewed separately from other trials.)
Since targeted trials are based on well-established molecular mechanisms, they do not require large-scale studies to produce relevant statistical data. This is an important distinction. The techniques used to identify the more general chemotherapy drugs currently being used were based on applying the same drug to many patients with a particular form of cancer. They did not consider the genetic variation amongst the patients, their cancers, or diet. In the case of these generalized and less stratified trials, large numbers of patients were needed to produce relevant statistical data.
A common myth is that a patient may receive a placebo (control group) instead of the treatment being tested (single or double blind studies). However, clinical trials for cancer do not typically use this approach. There are two considerations regarding this point:
The use of molecular signatures in identifying optimal therapies has problems and benefits:
While the numerous variations of therapeutic approaches, combined with the complexity of navigating the copious clinical trials databases has proved a daunting task, this effort can be greatly mitigated by having a statistically determined molecular outline that allows the user to focus on finding trials based on predefined molecular variables (markers).
Not only does this approach reduce the time and effort required but it also: allows for personalized treatments (better results with less side effects); reduces the patient burden for the doctor and medical system; and provides scientific data. Furthermore, even if the patient is not accepted in the trial, they are provided with important molecular data that can greatly improve further treatment efforts.
And finally, using multiple targeted clinical trials allows the patient to greatly reduce the overall genetic variation of their cancer, one trial at a time.
This article was first published on June 16, 2011, written by Alex Rolland.
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