It is estimated that around 80% of non-COVID trials have been stopped or interrupted due to concerns about patient safety. Vulnerable populations who participate in trials are most affected by the virus, so it makes sense that many of these trials have not gotten back to normal – even as restrictions ease.
At the same time, the devastating effect that this closure has had on medical research cannot be ignored. In the UK more than 1,500 clinical trials of new drugs and treatments for cancers, heart disease and other serious illnesses have been permanently closed. As well as this, 9,000 have been suspended and most will need large cash injections to be reactivated.
That this is a problem cannot be stated enough – especially when it comes to oncology trials. According to the World Health Organization, cancer deaths are the second leading cause of death globally and the disease was responsible for an estimated 9.6 million deaths in 2018. As well as this, oncology trials typically have a low success rate and longer recruitment times due to stringent patient inclusion criteria and cannot afford to be further delayed.
While there is some good news - globally more than a third of oncology trials have now started up again. As a society, we must not get off-track after we have come so far in the fight against cancer. It is understandable that talk of “back to normal” may seem premature to some - but the last few months have seen a tremendous uptake of new technologies by sponsors and site staff to keep clinical trials functioning where possible.
For the clinical trials industry, this is not “normal.” It is revolutionary and all of us in the industry should do our best to ensure that this change in trial management process paves the way for as many trials as possible to get (safely and quickly) up and running again.
Trials that were stopped, in many cases were stopped from enrolling new patients. But where they could, sponsors moved at hyper speed in their adoption of solutions such as decentralized trials, wearables and real-time communication technologies.
The usually conservative pharmaceutical industry has demonstrated that it can move fast when necessary. The genie is out of the bottle about the amazing opportunity the industry has to completely rethink the future management of trials.
Picture a world where trials were run at maximum efficiency and drugs got to market much faster. Where the diversity problem could finally be addressed, as neglected and underrepresented groups could have more flexibility, addressing the gender and ethnic minority gap. And we would know that during times of global crisis and chaos (such as another pandemic) clinical trials could keep going. The new habits that the industry would have to adopt is a small price to pay for this peace of mind.
Patient enrollment is one key area where technology could have a huge impact on speed and efficiency. As mentioned above, inclusion criteria are especially strict for oncology trials. Many studies have exclusions based on whether patients have had chemotherapy, have an advanced stage of the disease or have not recently been diagnosed. In fact, according to figures from the National Center for Biotechnology Information, 16% of protocol amendments are due to changes in inclusion/exclusion criteria.
Oncology trials also have lower completion rates across all phases. Analysis of clinical trial data from 2000 to 2015 by Oxford Academic, showed that just 73.9% of the trials reached completion, with the median duration for oncology rates 13.1 years in comparison to 5.9 to 7.2 years for non-oncology trials.
Typically, oncology trials have a lower approval rate as well, which, according to Oxford Academic, could be as low as 3.4%. And FDA approval in the United States currently has a 97% failure rate, generally due to issues with drug efficacy or toxicity.
Treatments can be also very targeted, based on specific genetic markers, making it much harder to find suitable patients in comparison to non-oncology trials. This is where biomarkers can help. Biomarkers predict responses to oncology drugs, so if patients can be screened for the biomarker before enrolment, then there is a much higher chance that the patient will respond to the treatment.
Additionally, by expanding the pool of research sites and investigators, this too can help with patient enrollment. As we’ve written in many of our blogs, by working with more novel research sites, the standard of care with clinical trials can be available to those who otherwise may be left behind because of socioeconomic factors, geography, or general lack of access to clinical trials. Technology to make the conduct of clinical trials simpler will go a long way in expanding the number and the diversity of investigators and research sites.
The complexity of oncology clinical trials means that technology can be especially useful when it comes to speeding up patient enrollment. Rather than having to constantly seek out the protocol to confirm eligibility, typically tucked away in a paper format or on a portal on a desktop computer somewhere, real-time access like what we can provide with Teckro allows physicians and research staff get immediate answers from their digital device right then and there. This is saving precious time and also improving the decision-making process of which participants to enroll into a given study.
As oncology trials take longer and have a low success rate, any further delays in clinical trials will be devastating for millions of people worldwide over the next few years. There is already a huge cancer care backlog with millions of patients around the world facing delays in diagnosis and treatment. It is imperative that we learn valuable lessons from the pandemic so we can keep trials – especially oncology trials – running during future emergencies. We cannot forsake clinical trials every time there is a global pandemic - there is too much at stake.