IGCS 2010, 23-26 October, Prague
The development of ovarian cancer treatments
Dr Edward Trimble – National Cancer Institute, Maryland, USA
My name is Edward Trimble; I work at the US National Cancer institute. By training I’m a gynaecologic oncologist and our office organises clinical trials for patients with cancer, cancer treatment trials. We’ve been in the business of running cancer treatment trials since 1955 and each year we put about 25,000 patients on clinical trials. We work with networks, primarily in the US and Canada, but we have sites and partnerships elsewhere in the world. We try to figure out better ways to treat patients with cancer; we’re also interested in reducing the toxicity associated with cancer treatment and exploring ways, more recently, to evaluate cancer in some populations that have been under-represented in our trials, particularly older patients with cancer, older patients with comorbidity. We also realise that we’ve missed out on the population of adolescents and young adults with cancer, that they fall between or they just don’t access our trials. So we do a good job of accessing children with cancer and healthy older patients, let’s say ages 45-70, with cancer but that intermediate population have not seen our trials so we’re trying to do a better job of opening trials for them.
So this is important for now, for example, for the HPV vaccine?
Well the HPV vaccine is a prophylactic vaccine to prevent cancer. It’s a very exciting development and we would like to see it widely adopted throughout the world. One of the challenges with this particular vaccine is the current cost, we hope the cost will come down but when it was first brought to the market it was too expensive for widespread uptake. I understand the cost is beginning to come down so we’re hopeful that more countries will be able to adopt it into national vaccination programmes.
Other trials in gynae cancer that are important that may be presented at this meeting?
A number of important trials are going to be presented. There were two parallel trials evaluating the addition of bevacizumab, or Avastin, to the standard primary treatment, primary chemotherapy for ovarian cancer. One trial was conducted primarily in the UK, one was primarily conducted in the US, Japan and Korea. They looked at different doses of bevacizumab but both showed a significant improvement in progression free survival associated with the addition of bevacizumab which is an angiogenesis inhibitor, antiangiogenesis agent, when added to standard carboplatinum and paclitaxel.
So in the States, in the UK, people can get into clinical trials; in developing countries if somebody is diagnosed with a cancer and needs a drug that maybe is not available, how can we help these people?
It’s a challenge because even in the States a relatively small proportion of people have access to trials because they are treated at sites which have trials open. It’s a little bit easier in the UK because they’ve done really a wonderful job of integrating clinical trials into the national health system so that as people are diagnosed with cancer they are encouraged to seek treatment at sites with expertise in cancer and at those sites they have clinical trials available. The US it’s a little more difficult, we have made an effort to broaden accessibility for trials but in the States less than 3% of adults go on NCI sponsored clinical trials, in the UK they’re up to about a 15% rate of access to clinical trials. In the developing world it’s far lower in terms of access to cancer treatment itself and, beyond that, access to sites that are active in clinical trials.
So how do you think we can better this?
I think while clinical trials are important, to me what is more important is having access to the best possible treatment based on what we know from clinical trials. So even in the UK, if it’s 15% of people who go on trials, that means that 85% of people do not go on trials and so we want to make sure that that 85% get the best possible treatment. So in the big picture, getting access to effective cancer treatment is probably more important than access to clinical trials which we know is always going to be limited, either because of the cost of running clinical trials or because of the eligibility requirements for those trials.
But if there’s an important drug, can you get access to it if it is still under clinical trial?
No, you have to go on a trial and then, even if the drug is approved, then it’s a question of is it available in your country? The drug company has to apply for registration in that country and then it’s a question of the cost of the drug and whether the national health service in that country decides that they want to pay for that particular drug.