NCRI Cancer Conference 2009: Improving clinical trials for cancer treatments

Clinical trials play a crucial role in bringing new treatments to patients. But is there room for improvement in the way trials are run?

Emphatically yes, argued Professor Ian Tannock in a thought-provoking session at the NCRI conference this morning.

He outlines the main points of his talk in this short video:
[youtube=http://www.youtube.com/watch?v=4f1y2fIw1jo]

Clinical trials compare new treatments with current techniques to see which are best for patients. Professor Tannock, of the Princess Margaret Hospital in Toronto, Canada, said that despite some improvements – such as recruiting more participants onto trials – there are still many problems with the way trials are designed and run.

For example, trial results showing a clear difference between the treatments being compared are published sooner than those that don’t show significant benefits. This is called ‘publication bias’, meaning that less impressive results are not as well publicised.

Publication bias is a problem because these so-called ‘negative’ results still need to be communicated to doctors and patients. Knowing that two drugs give the same benefit is useful as it can mean patients have more choice over their treatment.

Professor Tannock also emphasised that new treatments should help patients ‘live longer or live better’, and that this is what all trials should measure. ‘Living better’ – having a better quality of life with fewer side effects from treatment – is important to every patient, especially if their cancer can’t be cured.

But Professor Tannock pointed out that most clinical trials don’t measure the effect treatments have on patients’ quality of life, even when their cancer is incurable – he argued that this needs to change.

He also covered the controversial topic of cost-effectiveness. In Professor Tannock’s home country of Canada, the cost of eight weeks’ supply of cancer drugs ranges from around $60 for some older drugs to over $30,000 for some of the latest treatments – an enormous difference.

This raises the question of whether researchers should be running more clinical trials looking at cheaper, but possibly equally effective older drugs. For example new research has helped us to understand much more about the faulty genes involved in cancer – in some cases revealing that old drugs could work on new molecular tricks.

Professor Tannock argued that ‘newly approved does not mean new and improved’ – implying that new drugs aren’t necessarily better. He suggested that by focusing clinical research on trials of newer and very expensive drugs, researchers might miss some valuable results that could benefit not only patients but also the health service providers that pay for treatments.

Pharmaceutical companies are more likely to sponsor trials of the newer drugs. Independent organisations such as the Medical Research Council and Cancer Research UK also support cutting-edge drug trials. But they are also more likely to fund trials of existing drugs, as well as trials that seek to improve radiotherapy and surgery (for example, the recent PARSPORT trial),

Clinical trials are the final step in the process of improving treatments for people with cancer. But Professor Tannock argued that there will always be ways to improve the trials themselves, so that they can continue to give relevant and useful results for people with cancer.

Nell