Targeting targeted agents: open issues for clinical trial design.
Molecularly targeted agents for the treatment of solid tumors had entered the market in thelast 5 years, with a great impact upon both the scientific community and the society. Many randomized phase III trials conducted in recent years with new targeted agents, despite previous data coming from preclinical research and from phase II trials were often promising, have produced disappointingly negative results.
Some other trials have actually met their primary endpoint, demonstrating a statistically significant result favouring the experimental treatment. Unfortunately, with a few relevant exceptions, this advantage is often small, if not negligible, in absolute terms.
The difference between statistical significance and clinical relevance should always be considered when translating clinical trial results in the practice. The reason why this revolution did not significantly impact on cancer treatment to displace chemotherapy from the patient'bedside is in part due to complicated, and in many cases, unknown, mechanisms of action of such drugs; indeed, the traditional way the clinical investigators were used to test the efficacy of 'older'chemotherapeutics, has become out of date from the methodological perspective.
As these drugs should be theoretically tailored upon featured bio-markers expressed by the patients, the clinical trial design should follow new rules based upon stronger hypotheses than those developed so far. Indeed, the early phases of basic and clinical drug development are crucial in the correct process which is able to correctly identify the target (when present).
Targeted trial designs can result in easier studies, with less, better selected, and supported by stronger proofs of response evidences, patients, in order to not waste time and resources.
Author: Emilio BriaMassimo Di MaioPaolo CarliniFederica CupponeDiana GiannarelliFrancesco CognettiMichele Milella
Credits/Source: Journal of Experimental &Clinical Cancer Research 2009, 28:66
Published on: 2009-05-22
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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