What use are clinical trials to young people? Lessons from UK trial accrual 2005-2009


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Jeremy Whelan
University College Hospitals, London, United Kingdom

Abstract

Improvements in survival for teenagers and young adults (TYA) with cancer have lagged behind those observed in children and older adults. In attempting to understand this gap, attention has focused on participation of TYA in clinical trials.

 

Since 2005, the NCRI TYA CSG has investigated participation of TYA in selected cancer clinical trials. During 2005-2009 approximately 70% of children under four entered trials, compared to 45.3% of patients aged 10-14. For patients aged 15-19 years 28.2% entered trials, compared to just 11.1% of patients aged 20-24 years. During 2005-09, the numbers of patients aged 0-19 entering trials increased while the number of patients age 20-24 years entering trials decreased.

 

The reasons why fewer teenagers and young adults are entered into trials are likely to be multiple and complex, although trial availability, place of care and restrictive age eligibility criteria are known to be causative factors. In addition, the potential of longer or more intensive therapy, along with longer follow up and/or more hospital visits may make trial entry less compatible with life stage commitments for some TYA.

 

In England, five year survival rates for TYA are approximately 69% for males, and 73% for females. However, due to the spectrum of tumours arising in TYA, this ranges from 89% for male germ cell tumours, to 42% for males with leukaemia and, 46% for bone sarcoma. New agents, and hence trials, are required to improve survival for these frequently presenting tumours in TYA. It is also apparent that other factors contribute to improved outcomes but clinical trial accrual rates remain an important but not the sole indicator of improvements in care for TYA.