Cancer and neoplasms

Rethinking placebos: embracing synthetic control arms in clinical trials for rare tumors

Posted on by yun
12
Oct

External comparator arms should be used when investigating novel therapies for gastrointestinal stromal tumor and other rare tumors to facilitate drug testing and regulatory approvals.

Rare cancers, although individually uncommon, account for approximately one-quarter of all malignancies. Population-based studies have consistently shown that patients with rare cancers have worse outcomes than those diagnosed with more common cancers1. Although several factors contribute to poor survival rates, this pattern is likely linked to the inherent difficulties of clinical drug development for rare tumors2. Conventional clinical trial designs typically demand large numbers of participants to reach conclusive results, which poses a methodological challenge in the case of rare cancers.

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Fig. 1: Progression-free and overall survival in GIST.

References

  1. Gatta, G. et al. Lancet Oncol. 18, 1022–1039 (2017).

    Article 
    PubMed 

    Google Scholar 

  2. Casali, P. G. et al. Ann. Oncol. 26, 300–306 (2015).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  3. Goodwin, P. J. et al. J. Clin. Oncol. 31, 1123–1124 (2013).

    Article 
    PubMed 

    Google Scholar 

  4. Schaefer, I. M. et al. Am. Soc. Clin. Oncol. Educ. Book. 42, 1–15 (2022).

    PubMed 
    PubMed Central 

    Google Scholar 

  5. Demetri, G. D. et al. Lancet 368, 1329–1338 (2006).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  6. Demetri, G. D. et al. Lancet 381, 295–302 (2013).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  7. Blay, J. Y. et al. Lancet Oncol. 21, 923–934 (2020).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  8. Kang, Y. K. et al. Lancet Oncol. 14, 1175–1182 (2013).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  9. Kurokawa, Y. et al. Ann. Oncol. 33, 959–967 (2022).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  10. Subbiah, V. Nat. Med. 29, 49–58 (2023).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  11. Liu, N. et al. BMC Med. Res. Methodol. 21, 111 (2021).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  12. Chvetzoff, G. et al. J. Natl Canc. Inst. 95, 19–29 (2003).

    Article 
    CAS 

    Google Scholar 

  13. Mishra-Kalyani, P. S. et al. Ann. Oncol. 33, 376–383 (2022).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  14. Zer, A. et al. J. Clin. Oncol. 34, 1469–1475 (2016).

    Article 
    PubMed 

    Google Scholar 

  15. Modi, N. D. et al. JAMA Oncol. 8, 1310–1316 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

Download references

Acknowledgements

This work was funded in part by the FERO Foundation and the Asociación Española Contra el Cáncer (AECC CLSEN20004SERR), both through grants to C.S. The general work of M.C.H. has been supported by grants from the US Department of Veterans Affairs (1 I01 BX005358-01A1) and National Institutes of Health/National Cancer Institute (NIH/NCI; 1 R21 CA263400-01) and by philanthropic donations from the GIST Cancer Research Fund and the Jonathan David Foundation. The work of J.K.S. was supported by NIH/NCI R01 CA226803-01A1. We thank J. Carmona (scientific strategy office, VHIO) for critical review of this manuscript.

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Authors and Affiliations

  1. Department of Medical Oncology, Vall d’Hebron University Hospital, Barcelona, Spain

    César Serrano

  2. Sarcoma Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain

    César Serrano

  3. The Life Raft Group, Wayne, NJ, USA

    Sara Rothschild & Denisse Evans

  4. Oncology Data Science, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain

    Guillermo Villacampa & Víctor Navarro

  5. The Institute of Cancer Research, London, UK

    Guillermo Villacampa

  6. Portland VA Health Care System and Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA

    Michael C. Heinrich

  7. Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Suzanne George

  8. Department of Medical Oncology, Centre Léon Bérard, Lyon, France

    Jean-Yves Blay

  9. Université Claude Bernard, Lyon, France

    Jean-Yves Blay

  10. Department of Surgery, Division of Surgical Oncology, University of California San Diego, La Jolla, CA, USA

    Jason K. Sicklick

  11. Department of Pharmacology, University of California San Diego, San Diego, CA, USA

    Jason K. Sicklick

  12. Case Comprehensive Cancer Center in Cleveland, Cleveland, OH, USA

    Gary K. Schwartz

  13. Department of Medical Oncology, All India Institute of Medical Science (AIIMS), New Delhi, India

    Sameer Rastogi

  14. Division of Clinical Studies, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, UK

    Robin L. Jones

  15. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

    Piotr Rutkowski

  16. Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Neeta Somaiah

  17. Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA

    Jonathan C. Trent

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Corresponding author

Correspondence to
César Serrano.

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Competing interests

C.S. has received research funding (institution) from IDRX, Blueprint, Karyopharm, Pfizer, Deciphera and Bayer; consulting fees (advisory role) from Newbay, Cogent, Immunicum AB, Deciphera and Blueprint; payment for lectures from Roche, PharmaMar, Deciphera, Bayer and Blueprint; and travel grants from Gilead, PharmaMar, Pfizer and Bayer AG. M.C.H. reports consulting roles for Blueprint, Deciphera, C Stone Pharmaceuticals, Zai Labs, Cogent and Theseus Pharmaceuticals, and patents, royalties and other intellectual property regarding a patent on treatment of GIST-licensed to Novartis. G.V. has received speaker’s fees from MSD, GSK, Pfizer and Pierre Fabre, and has held an advisory role with AstraZeneca. S.G. has received funding (institution) from IDRX, Theseus, Blueprint, Deciphera, BioAtla, Springworks, Merck, Eisai and Daiichi Sankyo; consulting fees from Immunicum, Deciphera, Blueprint and Kayothera; equity in Abbott Labs; and other fees from WCG (Ayala-DSMB). J.-Y.B. receives research support (institution) from Deciphera, Eisai, Roche, Pharmamar, Bayer, GSK and MSD. J.K.S. receives consultant fees from Deciphera, Aadi and Grand Rounds; serves as a consultant for CureMatch; has received speaker’s fees from Deciphera, Hoffman-La Roche, Foundation Medicine, Merck, QED and Daiichi Sankyo; and owns stock in Personalis. R.L.J. reports consulting or advisory roles for Lilly, Immune Design, Merck Serono, Adaptimmune, Daiichi Sankyo, Eisai, Morphotek, TRACON Pharma, Immodulon Therapeutics, Deciphera, PharmaMar, Blueprint Medicines Corporation, Clinigen Group, Epizyme, Boehringer Ingelheim, Bayer, Karma Oncology and UpToDate; research funding from GlaxoSmithKline; and reimbursement of travel and accommodation expenses from PharmaMar. P.R. has received honoraria for lectures and Advisory Board meetings from MSD, BMS, Novartis, Pierre Fabre, Sanofi, Merck, Philogen and Astra Zeneca outside of the scope of this study. N.S. has received consulting fees (advisory role) from Deciphera, Bayer, Boehringer-Ingelheim, Epizyme and Aadi Biosciences. J.C.T. consulted for Blueprint, Deciphera, Cogent, Daiichi-Sankyo, Foghorn, Bayer and Adcendo. Life Raft Group, where S.R. and D.E. are employed, has received program-related grants from Blueprint, Cogent Biosciences, Daichii Sankyo, Deciphera, Genentech, IDRx, Novartis, Pfizer and Theseus. The remaining authors declare no conflicts of interest.

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Serrano, C., Rothschild, S., Villacampa, G. et al. Rethinking placebos: embracing synthetic control arms in clinical trials for rare tumors.
Nat Med (2023). https://doi.org/10.1038/s41591-023-02578-z

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  • Published: 12 October 2023

  • DOI: https://doi.org/10.1038/s41591-023-02578-z

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