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Graff Z, Wachter F, Eapen M, Lehmann L, Cooper T. Navigating Treatment Options and Communication in Relapsed Pediatric AML. Am Soc Clin Oncol Educ Book 2024; 44:e438690. [PMID: 38862135 DOI: 10.1200/edbk_438690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Despite improved outcomes in newly diagnosed pediatric AML, relapsed disease remains a therapeutic challenge. Factors contributing to slow progress in improving outcomes include inherent challenges in pediatric clinical trial accrual and the scarcity of novel targeted/immunotherapy agents available for pediatric development. This paradigm is changing, however, as international collaboration grows in parallel with the development of promising targeted agents. In this review, we discuss the therapeutic landscape of relapsed pediatric AML, including conventional chemotherapy, targeted therapies, and the challenges of drug approvals in this patient population. We highlight current efforts to improve communication among academia, industry, and regulatory authorities and discuss the importance of international collaboration to improve access to new therapies. Among the therapeutic options, we highlight the approach to second hematopoietic stem cell transplant (HSCT) and discuss which patients are most likely to benefit from this potentially curative intervention. Importantly, we acknowledge the challenges in providing these high-risk interventions to our patients and their families and the importance of shared communication and decision making when considering early-phase clinical trials and second HSCT.
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Affiliation(s)
- Zachary Graff
- Department of Pediatrics, Division of Hematology, Oncology, and BMT, Medical College of Wisconsin, Milwaukee, WI
| | - Franziska Wachter
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Mary Eapen
- Department of Medicine, Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Leslie Lehmann
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Division of Hematology/Oncology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Todd Cooper
- Department of Pediatrics, Division of Hematology and Oncology, Seattle Children's Hospital, Seattle, WA
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2
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Nader JH, Bourgeois F, Bagatell R, Moreno L, Pearson ADJ, DuBois SG. Systematic review of clinical drug development activities for neuroblastoma from 2011 to 2020. Pediatr Blood Cancer 2023; 70:e30106. [PMID: 36458672 DOI: 10.1002/pbc.30106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/12/2022] [Accepted: 10/25/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Understanding the landscape of clinical trials for patients with neuroblastoma may inform efforts to improve drug development. PROCEDURE We evaluated therapeutic trials for patients with neuroblastoma from 2011 to 2020 in our search using clinical trial information from ClinicalTrials.gov, Clinicaltrialregister.eu, PubMed, and American Society of Clinical Oncology (ASCO) annual meeting collection. Trends in trials and treatments over time were evaluated qualitatively. RESULTS A total of 192 trials met inclusion criteria. A median of 20.5 trials were started per year, which was stable over time. There were 87 (45%) phase 1, 100 (51%) phase 2, and only five (2.6%) phase 3 trials. The median time to completion was 4.9 years for phase 1 and 2 trials (no phase 3 trials reported as completed during the study period). In all, 34% of trials were international, while 20% of trials were intercontinental. Eighty-nine percent of nonmyeloablative trials included at least one novel agent. 48% of these trials studied combination therapies, and 86% of these combinations included conventional chemotherapy. Among 157 trials that included a targeted agent, 78 targets were identified, with GD2 being the primary target under investigation in 16.7% of these trials. Only eight trials were included in regulatory decisions, which led to European Medicines Agency (EMA) or Food and Drug Administration (FDA) approval for neuroblastoma. CONCLUSIONS The large number of trials initiated per year, the range of targets, and the rate of intercontinental collaboration are encouraging. The paucity of late-stage trials, the prolonged trial duration, and relative lack of combination studies are major causes of concern. This work will inform future drug development for neuroblastoma.
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Affiliation(s)
| | - Florence Bourgeois
- Harvard Medical School, Boston, Massachusetts, USA
- Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program (CHIP), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rochelle Bagatell
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lucas Moreno
- Paediatric Oncology and Haematology Division, Vall d'Hebron Hospital, Barcelona, Spain
| | - Andrew D J Pearson
- Division of Clinical Studies, Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - Steven G DuBois
- Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
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3
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Rahimzadeh V, Wolfert S, Buenger V, Campbell C, French R, Ludwinski D, Weinstein A, Barrett C. A systematic literature review to identify ethical, legal, and social responsibilities of nonprofit organizations when funding clinical trials in pediatric cancer. Pediatr Blood Cancer 2022; 69:e29854. [PMID: 35713116 DOI: 10.1002/pbc.29854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022]
Abstract
Nonprofit organizations (NPOs) play critical roles as funding sources, research partners, and disseminators of drug developments in pediatric cancer. Yet the literature provides limited guidance about ethical best practices when NPOs make trial funding decisions in this space. We conducted a systematic review of the literature indexed in PubMed and Web of Science to identify the ethical, legal, and social responsibilities of NPOs to four key stakeholder groups in funding pediatric cancer trials: (i) patients/families, (ii) researchers, (iii) industry sponsors, and (iv) donors. We applied the lifecycle framework for patient engagement in drug research and development proposed by Geissler and colleagues to analyze themes related to NPOs' responsibilities across 54 articles that met our inclusion criteria. Emergent themes included transparency surrounding conflicts of interest, the rigor of scientific review, and communication with patients/communities about trial progress. Our research identified critical gaps in best practices for negotiating research partnerships, managing competing research priorities, and pursuing alternative financing models including venture philanthropy. Results from our review informed a set of best practices to guide NPOs in making trial funding decisions that align with stakeholder values and interests.
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Affiliation(s)
- Vasiliki Rahimzadeh
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, California, United States.,Coalition Against Childhood Cancer (CAC2) Ethics Think Tank, Philadelphia, PA, USA
| | - Susan Wolfert
- Coalition Against Childhood Cancer (CAC2) Ethics Think Tank, Philadelphia, PA, USA.,Taylor Matthews Foundation, New York, NY, USA
| | - Vickie Buenger
- Coalition Against Childhood Cancer (CAC2) Ethics Think Tank, Philadelphia, PA, USA.,Texas A&M University, Mays Business School, College Station, Texas, USA
| | - Cindy Campbell
- Coalition Against Childhood Cancer (CAC2) Ethics Think Tank, Philadelphia, PA, USA.,Ty Louis Campbell Foundation, Pawling, NY, USA
| | - Robin French
- Coalition Against Childhood Cancer (CAC2) Ethics Think Tank, Philadelphia, PA, USA.,Morgan Adams Foundation, Denver, CO, USA
| | - Donna Ludwinski
- Coalition Against Childhood Cancer (CAC2) Ethics Think Tank, Philadelphia, PA, USA.,Solving Kids' Cancer, New York, NY, USA
| | - Amy Weinstein
- Coalition Against Childhood Cancer (CAC2) Ethics Think Tank, Philadelphia, PA, USA.,Pediatric Brain Tumor Foundation, Atlanta, GA, USA
| | - Caitlyn Barrett
- Coalition Against Childhood Cancer (CAC2) Ethics Think Tank, Philadelphia, PA, USA.,CureSearch for Children's Cancer, Baltimore, MD, USA
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4
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Design, organisation and impact of treatment optimisation studies in breast, lung and colorectal cancer: The experience of the European Organisation for Research and Treatment of Cancer. Eur J Cancer 2021; 151:221-232. [PMID: 34023561 DOI: 10.1016/j.ejca.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/29/2021] [Accepted: 04/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment optimisation studies (TOSs) are clinical trials which aim to tackle research questions that are often left unaddressed within the current drug development paradigm due to a lack of financial and regulatory incentives to undertake them. Examples include comparative effectiveness, therapeutic sequencing and dose de-escalation studies. Trials of this nature have historically been primarily carried out by academic institutions and not-for-profit organisations such as the European Organisation for Research and Treatment of Cancer (EORTC). OBJECTIVES Our objective was to conduct an in-depth analysis of the breast, lung and colorectal cancer TOSs that have been performed by the EORTC in the past four decades. METHODS We searched the EORTC clinical trials database for relevant studies and subsequently analysed them based on a number of predefined criteria relating to their design, organisation and scientific impact. RESULTS The 113 EORTC TOSs examined in this analysis were mainly standard-sized, international, multicentre phase III trials using a relatively simple, randomised, open-label design and comparing pharmacological combination regimens against standard-of-care treatments in terms of their potential to improve overall survival of patients with cancer. Although they were typically financially and/or materially supported by the industry, their legal sponsor was nearly always an independent party that did not benefit monetarily from their outcomes. If meaningful findings were obtained, their results, regardless of whether positive or negative, were published in high-impact journals, and the corresponding articles usually received a considerable number of citations. CONCLUSIONS Our analysis provides an empirical framework for setting up future TOSs based on the EORTC experience in oncology.
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Ferrari A, Stark D, Peccatori FA, Fern L, Laurence V, Gaspar N, Bozovic-Spasojevic I, Smith O, De Munter J, Derwich K, Hjorth L, van der Graaf WTA, Soanes L, Jezdic S, Blondeel A, Bielack S, Douillard JY, Mountzios G, Saloustros E. Adolescents and young adults (AYA) with cancer: a position paper from the AYA Working Group of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). ESMO Open 2021; 6:100096. [PMID: 33926710 PMCID: PMC8103533 DOI: 10.1016/j.esmoop.2021.100096] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
It is well recognised that adolescents and young adults (AYA) with cancer have inequitable access to oncology services that provide expert cancer care and consider their unique needs. Subsequently, survival gains in this patient population have improved only modestly compared with older adults and children with cancer. In 2015, the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE) established the joint Cancer in AYA Working Group in order to increase awareness among adult and paediatric oncology communities, enhance knowledge on specific issues in AYA and ultimately improve the standard of care for AYA with cancer across Europe. This manuscript reflects the position of this working group regarding current AYA cancer care, the challenges to be addressed and possible solutions. Key challenges include the lack of specific biological understanding of AYA cancers, the lack of access to specialised centres with age-appropriate multidisciplinary care and the lack of available clinical trials with novel therapeutics. Key recommendations include diversifying interprofessional cooperation in AYA care and specific measures to improve trial accrual, including centralising care where that is the best means to achieve trial accrual. This defines a common vision that can lead to improved outcomes for AYA with cancer in Europe.
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Affiliation(s)
- A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - D Stark
- Leeds Institute of Medical Research, School of Medicine University of Leeds, Leeds, UK.
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - L Fern
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Laurence
- Medical Oncology Department and SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
| | - N Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - I Bozovic-Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - O Smith
- National Children's Cancer Service, Children's Health Ireland at Crumlin and Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - J De Munter
- University Hospital Ghent Cancer Center, UZ Gent, Ghent, Belgium
| | - K Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - L Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - W T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Soanes
- Teenage Cancer Trust, London, UK
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - S Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, KlinikumStuttgart - Olgahospital, Stuttgart, Germany
| | - J-Y Douillard
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Mountzios
- 2nd Department of Medical Oncology and Clinical Trial Unit, Henry Dunant Hospital, Athens, Greece
| | - E Saloustros
- Department of Oncology, University Hospital of Larissa, Larissa, Greece
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Laetsch TW, DuBois SG, Bender JG, Macy ME, Moreno L. Opportunities and Challenges in Drug Development for Pediatric Cancers. Cancer Discov 2021; 11:545-559. [PMID: 33277309 PMCID: PMC7933059 DOI: 10.1158/2159-8290.cd-20-0779] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/08/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
The use of targeted small-molecule therapeutics and immunotherapeutics has been limited to date in pediatric oncology. Recently, the number of pediatric approvals has risen, and regulatory initiatives in the United States and Europe have aimed to increase the study of novel anticancer therapies in children. Challenges of drug development in children include the rarity of individual cancer diagnoses and the high prevalence of difficult-to-drug targets, including transcription factors and epigenetic regulators. Ongoing pediatric adaptation of biomarker-driven trial designs and further exploration of agents targeting non-kinase drivers constitute high-priority objectives for future pediatric oncology drug development. SIGNIFICANCE: Increasing attention to drug development for children with cancer by regulators and pharmaceutical companies holds the promise of accelerating the availability of new therapies for children with cancer, potentially improving survival and decreasing the acute and chronic toxicities of therapy. However, unique approaches are necessary to study novel therapies in children that take into account low patient numbers, the pediatric cancer genomic landscape and tumor microenvironment, and the need for pediatric formulations. It is also critical to evaluate the potential for unique toxicities in growing hosts without affecting the pace of discovery for children with these life-threatening diseases.
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Affiliation(s)
- Theodore W Laetsch
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, and Abramson Cancer Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | | | - Margaret E Macy
- Children's Hospital Colorado and University of Colorado, Denver, Colorado
| | - Lucas Moreno
- Division of Pediatric Hematology and Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Nader JH, Neel DV, Shulman DS, Ma C, Bourgeois F, DuBois SG. Landscape of phase 1 clinical trials for minors with cancer in the United States. Pediatr Blood Cancer 2020; 67:e28694. [PMID: 32886429 PMCID: PMC7896417 DOI: 10.1002/pbc.28694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/11/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Understanding trends in characteristics of early phase trials that allow minors with cancer to participate may inform additional efforts to improve cancer drug development for young people. METHODS We accessed data for oncology phase 1 or phase 1/2 trials in the United States from ClinicalTrials.gov with lower age bound for eligibility <18 years. Descriptive statistics were calculated and trends over time evaluated using logistic and multinomial logistic regression. RESULTS Six hundred twelve trials met inclusion criteria. Sixty-five percent of trials were for older adults that also allowed minors, while 9% were exclusively for patients ≤18 years of age. Eighty-three percent of trials included at least one novel agent, while 17% studied only conventional therapies. Fifty-eight percent of trials studied treatments not yet Food and Drug Administration (FDA) approved (48% if exclusively for patients ≤18 years). Fifteen percent of trials for which dose-escalation method could be determined, utilized a model-based design. Eighteen percent of all trials were industry sponsored (48% if exclusively for patients ≤18 years). Forty-nine percent of all trials were multicenter (69% if exclusively for patients ≤18 years). There was an increase in trials exclusively focused on patients with central nervous system (CNS) tumors over the study period (P ≤ .02). No other temporal trends were seen. The median times from first-in-adult to first-in-pediatric for monotherapy and combination trials were 5.7 and 3.3 years, respectively. CONCLUSION The paucity of clear temporal trends highlights the need for innovation in early drug development for young people. Our analysis serves as a benchmark against which to evaluate initiatives to improve pediatric cancer drug development.
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Affiliation(s)
- Jaclynne H. Nader
- University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - David S. Shulman
- Harvard Medical School, Boston, Massachusetts, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Clement Ma
- Harvard Medical School, Boston, Massachusetts, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Florence Bourgeois
- Harvard Medical School, Boston, Massachusetts, Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Steven G. DuBois
- Harvard Medical School, Boston, Massachusetts, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
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Buergy D, Riedel J, Sarria GR, Ehmann M, Scafa D, Grilli M, Wenz F, Hofheinz RD. Unfinished business: Terminated cancer trials and the relevance of treatment intent, sponsors and intervention types. Int J Cancer 2020; 148:1676-1684. [PMID: 33045097 DOI: 10.1002/ijc.33342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/08/2022]
Abstract
The aim of the study was to report on the association of trial sponsors with intervention type, treatment intent, recruitment success and reasons to terminate cancer trials. The ClinicalTrials database was searched for interventional Phase 3 cancer trials (01/2006-05/2017). Noncancer studies and ongoing studies were excluded, permanently suspended studies were counted as terminated. Trials were stratified according to sponsors (industry/nonindustry), intervention type, setting (curative/palliative) and intent of intervention (curative/symptom-control/life-extending). We identified 345 terminated trials and 1137 completed studies as a control group. The frequency of premature termination did not differ significantly between sponsors. Time to termination was shorter but recruitment per month prior to termination was higher in industry-sponsored studies (7.0 vs 2.2 patients/month; P < .001). Drug interventions were more common in industry-sponsored, all other interventions in nonindustry-sponsored settings (P < .001). Life-extending palliative interventions occurred more frequently, symptom-control interventions in a curative setting less frequently in industry-sponsored trials (both P < .001). Intervention, setting and intent were not associated with termination in industry-sponsored trials. In nonindustry-sponsored trials, the frequency of drug interventions and life-extending (noncurative) interventions were increased in terminated trials (both P < .05); symptom-control interventions in curative settings occurred more frequently in completed studies. Industry-sponsored trials were more often terminated due to toxicity/inefficacy while lack of accrual occurred more frequently in nonindustry-sponsored trials (P < .01). Interventions, treatment setting/intent and reasons for termination differed between sponsor types. In nonindustry-sponsored trials, drug interventions and life-extending (noncurative) interventions were associated with premature termination and symptom-control interventions (curative setting) were associated with trial completion.
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Affiliation(s)
- Daniel Buergy
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Julian Riedel
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Michael Ehmann
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Maurizio Grilli
- Library for the Medical Faculty of Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- Board of Directors, Freiburg Medical Center, Freiburg, Germany
| | - Ralf D Hofheinz
- Day Treatment Center (TTZ), Interdisciplinary Tumor Center Mannheim (ITM) and 3rd Medical Clinic, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Kouzy R, Abi Jaoude J, Mainwaring W, Lin TA, Miller AB, Jethanandani A, Espinoza AF, Verma V, Fuller CD, Minsky BD, Rödel C, Taniguchi CM, Ludmir EB. Professional Medical Writer Assistance in Oncology Clinical Trials. Oncologist 2020; 25:e1812-e1815. [PMID: 32885898 PMCID: PMC7648360 DOI: 10.1634/theoncologist.2020-0406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background The use of professional medical writers (PMWs) has been historically low, but contemporary data regarding PMW usage are scarce. In this study, we sought to quantify PMW use in oncologic phase III randomized controlled trials (RCTs). Methods We performed a database query through ClinicalTrials.gov to identify cancer‐specific phase III RCTs; we then identified whether a PMW was involved in writing the associated trial manuscript reporting primary endpoint results. Results Two‐hundred sixty trials of 600 (43.3%) used a PMW. Industry‐funded trials used PMWs more often than nonindustry trials (54.9% vs. 3.0%, p < .001). Increased PMW usage was further noted among trials meeting their primary endpoint (53.4% vs. 32.9%, p < .001) and trials that led to subsequent Food and Drug Administration approval (63.1% vs. 36.3%, p < .001). By treatment interventions, PMW use was highest among systemic therapy trials (50.2%). Lastly, the use of PMWs increased significantly over time (odds ratio: 1.11/year, p = .001). Conclusion PMW use rates are high among industry‐funded trials. We urge continued and increased transparency in reporting the funding and use of PMWs. Considering the increase in industry‐sponsored cancer clinical trials, the use of professional medical writers for publication of trial results has become an increasingly important topic. This brief communication reports the current rate of involvement of medical writers in publications of cancer clinical trials.
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Affiliation(s)
- Ramez Kouzy
- The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | | | - Timothy A. Lin
- The Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Austin B. Miller
- The University of Texas Health Science Center McGovern Medical SchoolHoustonTexasUSA
| | - Amit Jethanandani
- The University of Tennessee Health Science Center College of MedicineMemphisTennesseeUSA
| | | | - Vivek Verma
- The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Bruce D. Minsky
- The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Claus Rödel
- University of FrankfurtFrankfurtGermany
- German Cancer Research CenterHeidelbergGermany
- German Cancer ConsortiumFrankfurtGermany
- Frankfurt Cancer InstituteFrankfurtGermany
| | | | - Ethan B. Ludmir
- The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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10
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Neel DV, Shulman DS, Ma C, Bourgeois F, DuBois SG. Sponsorship of oncology clinical trials in the United States according to age of eligibility. Cancer Med 2020; 9:4495-4500. [PMID: 32351000 PMCID: PMC7333829 DOI: 10.1002/cam4.3083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
Background The sponsorship mix of trials relevant to young people with cancer has not been reported. Understanding this sponsorship mix may have implications for policies and regulations related to pediatric cancer drug development. Methods We analyzed sponsorship of interventional trials first opened in the United States from 2007 to 2018 using the ClinicalTrials.gov registry. A total of 51 781 trials across non‐oncology disciplines and 18 431 oncology trials were classified according to lower age of eligibility (≥18 years vs < 18 years). Studies were stratified according to sponsorship (industry vs non‐industry). Trial characteristics were compared by sponsorship category. Trends in sponsorship were tracked over time. Results Within oncology trials for patients ≥ 18 years, sponsorship was 33% industry and 67% non‐industry. Among oncology trials that included patients < 18 years, sponsorship was 16.6% industry and 83.4% non‐industry (P < .001). 15.5% of industry‐sponsored trials in non‐oncology disciplines included patients < 18 years, whereas only 5.2% of industry‐sponsored oncology trials were open to patients < 18 years (P < .001). Relative to trials with non‐industry sponsors, there was a statistically significant increase in industry sponsorship of oncology trials that included patients < 18 years over time (P < .001). Trial characteristics differed significantly according to sponsor type regardless of age of eligibility. Conclusions Interventional oncology trials that include patients < 18 years are less likely to be industry‐sponsored compared to oncology trials exclusively in patients ≥ 18 years. Compared to other medical disciplines, a smaller proportion of industry‐sponsored oncology trials included patients < 18 years. Trial sponsorship is associated with differential trial characteristics, such as trial duration and number of patients enrolled, regardless of age.
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Affiliation(s)
| | - David S Shulman
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Clement Ma
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Florence Bourgeois
- Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
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