We are rapidly moving into a brave new world of cancer care. Vice President Biden, through the recent Moonshot summits that were held in hundreds of locations around the country, urged us to break down the barriers and move forward with all deliberate speed to bring new discoveries to the care of our patients, cutting the typical time of research initiatives in half.
An important component of that effort must be a more robust and effective way to get patients with cancer into clinical trials. Unfortunately, for 95 percent or so of cancer patients, that just doesn’t happen. The reasons are many: Trials are in centers too far from home, patients may not meet the criteria for participation, they may be suspicious of the motivations for the trial, health professionals don’t discuss the options.
Whatever the reasons, we have to find a better way. The reality is that, as we become more knowledgeable about cancer as a disease, we find many more targets that could be the basis for new drugs. But each time we “slice and dice” the numbers of patients with a particular cancer who have a specific abnormality in their cancer cells, we have fewer patients who may be eligible for a specific new cancer treatment.
That means we will have to bring the trials to the patients, if we are to make the progress all of us desire. That’s no easy task, since it will require many parts of the “system” that don’t work together very well today to work together much better in the future.
There are no easy answers about how to do this.
Patients and families have to be more active in pursuing clinical trials. Health professionals have to be more willing to discuss clinical trials with their patients, and to help them get enrolled in those trials when they are available. Regulators and researchers have to figure out how to collect the information they need to get patients into trials more quickly with fewer barriers. That will involve finding patients more readily with the help of electronic health records and software meant to advance the application of precision medicine; effecting wider distribution of information about trials that are enrolling; and analyzing how drugs work once they clear clinical trials and are put to use in real-world populations.
All of that is a tall order, but it is, indeed, a moonshot worthy of undertaking. Mr. Biden has issued the challenge, and it’s up to all of us to make it happen. If we do, then we may well be able to cross the chasm of getting new treatments to cancer patients more quickly. And if we don’t, we will have only ourselves to blame.
-- Len Lichtenfeld, MD