The outcomes of patients with lung cancer have improved significantly in recent years, largely due to the treatment targeting the cancer's specific genetic profile and the impact of immunotherapy, often in different groups of patients. In this interview, Ross Camidge, MD, PhD, Director of Thoracic Oncology at the University of Colorado Cancer Center, discusses the importance of considering multiple factors when deciding on clinical trials for patients.
Oncology Data Advisor: When would you recommend that a patient with lung cancer join a clinical trial?
Ross Camidge, MD, PhD: A trial is an envelope that a treatment is wrapped in. For an individual patient, therefore, it can be a good or a bad thing, depending on what the treatment is relative to what the patient needs. In theory, for society, all trials generate knowledge; so on one level, these are always a good thing, but that's too simplistic. Some trials aren't going to usefully advance human knowledge, and some trials might offer patients treatments that are possibly inappropriate or outdated. In short, always consider a trial, but the ultimate decision regarding whether it's "good" or "bad" depends on the trial and the patient and the field at the time.
Oncology Data Advisor: In your literature review of phase 1 oncology trials, you reported that the distribution of the trial population did not reflect the US population at large; instead, it was "heavily skewed toward White/Caucasian." Do you have any thoughts on how clinicians might recruit other race/ethnicity groups for clinical trials?
Dr. Camidge: This may be multifactorial. The location of good trials in the country, as well as the ease of access to the trial sites are some of the issues. Also, successful trial recruitment involves presentation of the opportunity from staff that the patients feel comfortable with and respected by, ensuring that barriers regarding language and access and support are minimized as much as possible.
Oncology Data Advisor: Why is it important to consider health-related quality of life as an end point in clinical trials?
Dr. Camidge: Increasingly in oncology, patients are on therapy for a long time. Our grading system for trial-related adverse events is one clue to this, but it is hampered due to the same grade for different kinds of toxicities not necessarily reflecting equal impact on a person's life. It's similar for dose reductions. A higher dose reduction rate implies that a drug may be less well tolerated, but these dose reductions happen when they are influenced by the trials' rules. Finally, quality of life can help differentiate the overall impact of a drug on a person, but these readouts also have to pull apart what is a side effect of a drug versus what is an improving or worsening symptom caused by the effect of the drug on the cancer.
Oncology Data Advisor: Which of the current lung cancer trials most interest you?
Dr. Camidge: At the University of Colorado, we get offered clinical trials to consider taking on for our patients multiple times a week. We turn down most of them in a bid to "pick the winners" for our patients. We've done pretty well at this over the years. In terms of this or that trial that interests any MD, here it's based on seeing what preclinical and early clinical data suggest—whether it will or will not be a winner. It changes as the data change, so I can't say this is or is not a winner today as it may be different tomorrow.
Oncology Data Advisor: Can you comment on how global registries that collect data on lung cancer, such as the eNRGy1 global multicenter registry, can further the research and development of novel therapeutic strategies?
Dr. Camidge: For rare subtypes of any disease we often don't know their natural history when they are first described—the kind of registry described allows a glimpse of what might be expected with standard approaches and allows us to interpret efficacy of a new therapy relative to "standard care" better in rare subtypes of a disease early in drug development.
For more expert perspectives from Dr. Camidge, check out his free CME/NCPD-approved activity on non-small cell lung cancer.
For More Information
Camidge DR, Park H, Smoyer KE, et al (2021). Race and ethnicity representation in clinical trials: findings from a literature review of Phase I oncology trials. Future Oncol, 17(24):3271-3280. DOI:10.2217/fon-2020-1262
Drilon A, Duruisseaux M, Han JY, et al (2021). Clinicopathologic features and response to therapy of NRG1fusion-driven lung cancers: the eNRGy1 global multicenter registry. J Clin Oncol, 39(25):2791-2802. DOI:10.1200/JCO.20.03307
Garcia Campelo MR, Lin HM et al (2021). Health-related quality of life in the randomized phase III trial of brigatinib vs crizotinib in advanced ALK inhibitor-naive ALK + non-small cell lung cancer (ALTA-1L). Lung Cancer, 155:68-77. DOI:10.1016/j.lungcan.2021.03.005
About Dr. Camidge
Ross Camidge, MD, PhD, is the Director of Thoracic Oncology at the University of Colorado. He is a Professor of Medicine–Medical Oncology and the Joyce Zeff Chair in Lung Cancer Research at the University of Colorado School of Medicine. He is the recipient of numerous awards for his role as a mentor, lecturer, clinical researcher, and clinician for providing outstanding patient care. Dr. Camidge specializes in the treatment of lung cancer and other thoracic malignancies. The discoveries that he and his team have contributed have improved the standard of lung cancer care multiple times. He has authored over 300 peer-reviewed publications and is the principal investigator on numerous national and international therapeutic trials.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.