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Clinical Trials for Cancer
Bob Riter
bob@ibca.net
People diagnosed with cancer often wonder if they should participate in a clinical
trial. They sometimes ask for my opinion.
I begin by saying that clinical trials are essential for the advancement of
medicine. That said, a clinical trial may or may not make the most sense for
a specific individual at a specific point in time.
Most clinical trials compare the standard treatment for a particular cancer
with a new treatment that might be better. These are known as Phase
III trials. Patients are randomly assigned to the standard treatment or to the
new treatment and then followed over time to see which group does better.
One trial found that women with breast cancer that had breast conserving surgery
(also known as a lumpectomy), followed by radiation, did just as well as women
who had a mastectomy. This finding made breast conserving surgery the new standard
of care for many women with breast cancer.
Other trials have compared different combinations of chemotherapy drugs and
the timing of when those drugs are given. For example, trials have led to some
people now receiving (and benefiting) from chemotherapy given before surgery.
But it is important to remember that the “new” treatment does not
always prove to be better than the standard treatment.
In the 1990s, there was considerable interest in treating aggressive breast
cancers with much higher doses of chemotherapy than was standard. Much of this
treatment was done outside of clinical trials. When trials were undertaken,
it was found that the high dose chemotherapy was no more effective, but far
more toxic, than the standard chemotherapy.
Women who received the high dose chemotherapy did a real service to the broader
community by furthering our knowledge. But I suspect that not everyone who participated
in the trial was motivated by altruism. They understandably wanted to improve
their own chances of surviving cancer.
My advice for people considering a clinical trial is to talk with their oncologists
as to which trials are available and the potential pros and cons of participating.
You can also research trials online at http://www.cancer.gov/clinicaltrials
or by calling 800-4-CANCER.
Key issues to consider are the effectiveness and ease of the standard treatment.
Personally, I’d be more interested in pursuing a clinical trial if the
standard treatment didn’t have very good results and/or was onerous to
undertake. But, again, it’s an individual choice.
Another factor is the convenience of participating in the trial. It’s
one thing if the trial is available locally (and some trials are), and something
else if you have to travel across the country to take part.
Second opinions are valuable, both from specialized cancer centers that offer
multiple trials and from your primary care physician who can help you sift through
the information and provide context for your decision making.
In sum, clinical trials are important, necessary, and worthwhile. But participating
is an individual choice based on your specific situation and values.
From the Ithaca Journal, May 31, 2007
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