Jan 4, 2019
Jennifer C. King, PhD, is director of science and research
for Lung Cancer Alliance. She is a member of the Telemedicine Working Group.
In the current oncology clinical trials landscape, many barriers
remain to clinical trial enrollment that affect both the oncologist
and the patient.1 Among these are trial locations, strict eligibility
requirements, insufficient resources to support appropriate clinical
trial education and screening, as well as patient and provider
attitudes about trials.
In lung cancer, we now have four approved immunotherapy drugs
(all anti-PD-1/PD-L1 checkpoint inhibitors) and the number of clinical
trials for combinations of these and other new immunotherapies is
exploding. A quick search of clinicaltrials.gov for the generic term
“immunotherapy” and a condition of cancer resulted in 820 actively
recruiting studies. In addition, immunotherapy is being considered
earlier in the treatment paradigm. Results of a study by Forde and
colleagues provided early evidence that this type of drug could work
even in a pre-surgical setting.2 The implication is that it is critical for
clinicians and patients to have conversations about IO clinical trials
at every point in the treatment process—not just when patients with
late-stage lung cancer have few options left. How do physicians and
patients keep up with and make sense of this changing environment?
Fortunately, there are new tools and services that can help facilitate
conversations and education about clinical trials. Companies such
as Antidote (www.antidote.me) and Smart Patients (smartpatients.
com/trials/search) are structuring and annotating clinical trial data
from clinicaltrials.gov and the National Cancer Institute. These
new search tools allow for simplified, patient-friendly language in
searches and results as well as the ability to search for things like a
specific molecular target or immunotherapy drug.
At Lung Cancer Alliance (lungcanceralliance.org), we use a
combination of online tools and telephone-based navigation to
educate and empower patients to have informed conversations
about clinical trials with their healthcare team. Our trained treatment
and trial specialists consider patients’ treatment histories, walk them
through online tools, provide access to a molecular testing program if
needed, research the most appropriate treatment, and send options
for discussion with their physician along with general education
about trials. In our follow-up, we’ve found that three quarters of
patients go on to have a conversation about trials with their physician,
including many who have not had those conversations before. In
addition, half of those conversations lead to the patient connecting
with a trial investigator. We find that this personalized discussion
and education, which can be provided virtually through the phone
and online, can demystify clinical trials and provide new options for
the oncologist and patient to consider together.
As oncologists struggle with having enough hours in the
day, telehealth-based services like this—provided by advocacy
organizations or elsewhere—can help address barriers such as
patient education, proper trial selection, and screening so that we
can improve patient enrollment in clinical trials.
1. American Cancer Society Cancer Action Network. Barriers to patient enrollment
in therapeutic clinical trials for cancer—a landscape report. Available
online at: www.acscan.org/sites/default/files… Last accessed September, 10,
2. Forde PM, Chaft JE, Smith KN, et al. Neoadjuvant PD-1 blockade in resectable
lung cancer. N Engl J Med. 2018;378(21):1976-1986.