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Tečić Vuger A, Separovic R, Tolaney SM, Trapani D. Globalization of clinical research in oncology: Status, challenges, and future directions. J Cancer Policy 2024; 42:100500. [PMID: 39134147 DOI: 10.1016/j.jcpo.2024.100500] [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: 05/26/2024] [Accepted: 08/05/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Cancer is the second-leading cause of death worldwide, and its burden is increasing around the world, particularly in low- and middle-income countries (LMICs). Yet, cancer research has historically been conducted primarily in high-income countries (HICs). METHODS In this review, we describe the results of our literature search into the current state of international cancer trials, including the benefits, challenges, limitations, and ethical concerns regarding the international conduct of HIC-led trials. We also propose some possible means of addressing these challenges and overcoming these barriers to extend the benefits of cancer research to people around the world. RESULTS Over the last several decades, there has been a shift toward inclusion of investigators and participants from LMICs in pivotal cancer clinical trials. CONCLUSIONS While inclusion of LMIC countries has benefits, including increased diversity of participant populations, investment in research infrastructure in LMICs, and potential expansion of cancer treatment options around the world, the continued leadership of most trials by HICs presents ethical concerns, including potential exploitation of researchers and participants from LMICs, lack of focus on cancer types prevalent in all participating regions, and disparities in access to approved therapies once the trial is complete.
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Affiliation(s)
- Ana Tečić Vuger
- University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Robert Separovic
- University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; University of Josip Juraj Strossmayer, Osijek, Croatia; University of Juraj Dobrila, Pula, Croatia
| | | | - Dario Trapani
- European Institute of Oncology, IRCCS, Milan, Italy; University of Milan, Department of Oncology and Hematology, Milan, Italy; Department of Pharmaceutical Sciences, Università del Piemonte Orientale (UNIUPO) "Amedeo Avogadro", Novara, Italy.
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Mack E, Horak P, Fröhling S, Neubauer A. [Precision oncology and molecular tumor boards]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:462-471. [PMID: 38652307 DOI: 10.1007/s00108-024-01689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/25/2024]
Abstract
Precision oncology is a field of personalized medicine in which tumor biology forms the basis for tailored treatments. The preferred approach currently applied in clinical practice is based on the concept of malignant tumors as genetic diseases that are caused by mutations in oncogenes and tumor suppressors. On the one hand, these can be targeted by molecular drugs, while on the other hand, next-generation sequencing allows for comprehensive analysis of all relevant aberrations, thus enabling the matching of appropriate treatments across entities based on molecular information. Rational molecular therapies are developed and annotated with supporting evidence by molecular tumor boards, which have been established at various academic centers in recent years. Advancing precision oncology to a new standard of care requires improved applicability of personalized molecular therapies and thorough scientific evaluation of precision oncology programs.
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Affiliation(s)
- Elisabeth Mack
- Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg und Philipps-Universität Marburg, Marburg, Deutschland.
- Klinik für Hämatologie, Medizinische Onkologie und Palliativmedizin, St. Marienkrankenhaus Siegen, Siegen, Deutschland.
| | - Peter Horak
- Abteilung für Translationale Medizinische Onkologie, Heidelberg, Deutschland
| | - Stefan Fröhling
- Abteilung für Translationale Medizinische Onkologie, Heidelberg, Deutschland
| | - Andreas Neubauer
- Klinik für Hämatologie, Onkologie und Immunologie, Universitätsklinikum Gießen und Marburg, Standort Marburg und Philipps-Universität Marburg, Marburg, Deutschland
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Shahzad M, Khalid MF, Amin MK, Basharat A, Ammad-Ud-Din M, Park R, Anwar I, Faisal MS, Jaglal M. Geographic and Racial Disparities in Chimeric Antigen Receptor-T Cells and Bispecific Antibodies Trials Access for Diffuse Large B-Cell Lymphoma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00034-X. [PMID: 38342727 DOI: 10.1016/j.clml.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND We investigate the geographical and racial disparities in accessing CAR-T and bispecific antibodies trials for DLBCL. MATERIALS AND METHODS ClinicalTrials.gov was searched, and 75 trials with at least 1 open site in the US were included. 2020 US Census Bureau data was used to obtain data on race and ethnicity. SPSS version 26 was used for analysis. RESULTS There were 62 CAR-T and 13 bispecific antibodies trials with 6221 enrolled or expected to enroll patients. Eighty-five percent of the clinical trials were only open in the US, and the majority 64% were pharmaceutical-funded. There were 126 unique study sites distributed over 31 states with 11 (0-51) mean number of trials per state and 4.5 (1-26) and 4.4 (1-24) mean number of CAR-T and bispecific antibodies trials per site, respectively. Southern states had the most number of trials 31%, followed by Midwestern 25%, Northeastern 24%, and Western 20%. The highest number of study locations were in California 13, New York 9, and Pennsylvania 9, while the highest number of open studies were in California 51, Texas 32, and New York 23. Twenty states had no open CAR-T or bispecific antibodies trials. Only 33% of African Americans (AA) lived in a county with a trial, and 7 out of 10 states with the highest proportion of AA residents (18.6%-41.4%) have no or less than 4 trial sites. Of the 62 counties analyzed, 92% were White predominant, while only 8% were AA predominant (P = .009). CONCLUSIONS Strategies should be framed to address the observed disparities and to improve access.
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Affiliation(s)
- Moazzam Shahzad
- H. Lee Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL.
| | | | | | | | | | - Robin Park
- H. Lee Moffitt Cancer Center, Tampa, FL; University of South Florida, Tampa, FL
| | - Iqra Anwar
- Kansas University Medical Center, Kansas City, KS
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Repetto M, Crimini E, Boscolo Bielo L, Guerini-Rocco E, Ascione L, Bonfanti A, Zanzottera C, Mazzarella L, Ranghiero A, Belli C, Criscitiello C, Esposito A, Barberis MCP, Curigliano G. Molecular tumour board at European Institute of Oncology: Report of the first three year activity of an Italian precision oncology experience. Eur J Cancer 2023; 183:79-89. [PMID: 36801623 DOI: 10.1016/j.ejca.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Precision oncology aims to improve clinical outcomes by personalising treatment options for patients with cancer. Exploiting vulnerabilities identified in a patient's cancer genome requires reliable interpretation of a huge mole of alterations and heterogeneous biomarkers. ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT) allows evidence-based evaluation of genomic findings. Molecular tumour boards (MTBs) convey the required multi-disciplinary expertise to enable ESCAT evaluation and strategical treatment choice. MATERIALS AND METHOD We retrospectively reviewed the records of 251 consecutive patients discussed by European Institute of Oncology MTB between June 2019 and June 2022. RESULTS One-hundred eighty-eight (74.6%) patients had at least one actionable alteration. After MTB discussion, 76 patients received molecularly matched therapies (MMTs) while 76 patients received standard of care. Patients receiving MMT displayed higher overall response rate (37.3% versus 12.9%), median progression-free survival (mPFS 5.8 months, 95% confidence interval [CI] 4.1-7.5 versus 3.6 months, 95% CI 2.5-4.8, p = 0.041; hazard ratio 0.679, 95% CI 0.467-0.987) and median overall survival (mOS 35.1 months, 95% CI not evaluable versus 8.5 months, 95% CI 3.8-13.2; hazard ratio 0.431, 95% CI 0.250-0.744, p = 0.002). Superiority in OS and PFS persisted in multivariable models. Among 61 pretreated patients receiving MMT, 37.5% of patients had PFS2/PFS1 ratio ≥1.3. Patients with higher actionable targets (ESCAT tier I) had better OS (p = 0.001) and PFS (p = 0.049), while no difference was observed in lower evidence levels. CONCLUSIONS Our experience shows that MTBs can yield valuable clinical benefit. Higher actionability ESCAT level appears to be associated with better outcomes for patients receiving MMT.
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Affiliation(s)
- Matteo Repetto
- Division of Early Drug Development, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, 20122, Italy
| | - Edoardo Crimini
- Division of Early Drug Development, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, 20122, Italy
| | - Luca Boscolo Bielo
- Division of Early Drug Development, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, 20122, Italy
| | - Elena Guerini-Rocco
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, 20122, Italy; Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Liliana Ascione
- Division of Early Drug Development, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, 20122, Italy
| | - Andrea Bonfanti
- Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, 20122, Italy
| | - Cristina Zanzottera
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
| | - Luca Mazzarella
- Division of Early Drug Development, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Alberto Ranghiero
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Carmen Belli
- Division of Early Drug Development, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Carmen Criscitiello
- Division of Early Drug Development, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, 20122, Italy
| | - Angela Esposito
- Division of Early Drug Development, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Massimo C P Barberis
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, 20122, Italy.
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El-Galaly TC, Gaidzik VI, Gaman MA, Antic D, Okosun J, Copland M, Sexl V, Fielding AK, Doeswijk R, Parker H, Dreyling M, Döhner K, Almeida AM, Macintyre E, Gribben JG, Grønbæk K. A Lack of Diversity, Equity, and Inclusion in Clinical Research Has Direct Impact on Patient Care. Hemasphere 2023; 7:e842. [PMID: 36844176 PMCID: PMC9946429 DOI: 10.1097/hs9.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
| | - Verena I. Gaidzik
- Department of Internal Medicine III, University Hospital of Ulm, Germany
| | - Mihnea-Alexandru Gaman
- Faculty of Medicine “Carol Davila” University of Medicine and Pharmacy Bucharest Romania & Department of Hematology Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Darko Antic
- Clinic for Hematology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Serbia
| | - Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, United Kingdom
| | - Mhairi Copland
- Paul O’Gorman Leukaemia Research Centre, School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom
| | - Veronika Sexl
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine, Vienna, Austria
| | | | - Robin Doeswijk
- European Hematology Association, EHA Executive Office, The Hague, The Netherlands
| | - Helen Parker
- European Hematology Association, EHA Executive Office, The Hague, The Netherlands
| | | | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Germany
| | - António Medina Almeida
- Department of Clinical Hematology, Hospital da Luz, Lisbon, Portugal
- Faculdade de Medicina, Universidade Catolica Portuguesa, Lisbon, Portugal
| | - Elizabeth Macintyre
- Université Paris Cité, CNRS, Inserm, INEM, F- 75015 Paris, France
- Hematology, AP-HP, Hôpital Necker-Enfants Malades, F- 75015 Paris, France
| | - John G. Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, United Kingdom
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine and Biotech Research and Innovation Centre (BRIC), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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