Why medical trials matter
Covid-19 has brought trials to the public’s attention, but more needs to be done to encourage funding for life-saving new treatments in Ireland...
WE are now a nation who is very much aware of how medical trials work, given the publicity surrounding the trial soft he Covid- 19 vaccine.
But trials take place not just for pandemics - in Ireland cancer trials are taking place all the time and can offer life-saving new treatments to many.
Cancer Trials Ireland is at the forefront of these - but the body says we need more funding to encourage more trials to come here.
‘We want people to be aware of trials so that if they are offered a trial they will seriously consider it as a way of accessing new treatment,’ says Professor Ray McDermott, clinical lead with Cancer Trials Ireland.
‘But also we would like the Government to fund more trials so that we have more options for our patients. Fundamentally going on a trial is the way new treatments come through for cancer. We often read about people fundraising for treatment and travelling overseas to go for treatment. If we can get access to those trials here, it will allow people to get their treatment in Ireland and access the latest treatments.’
At any one time in Ireland there are around 50 to 100 clinical trials for cancer taking place.
‘Everyone is aware of the trials of the vaccine for Covid19 and has a better understanding of what they do, and that is how you find out whether a new medicine works or not,’ says Professor McDermott.
‘We did one recently with prostate cancer which looked at bringing a new hormone treatment in earlier in the disease process. That changed how prostate cancer is managed everywhere in the world.
‘We are doing a lot of trials with immunotherapy which everyone is aware of at the minute and it works better in some diseases than it does in others.
ALOT of the trials we would have open now are trials that combine immunotherapy with other drugs attacking cancer, looking to i ncrease response rates and remissions.’
In a recent survey undertaken by Cancer Trials Ireland it was found that 73 per cent of us believe the Covid- 19 pandemic has highlighted the importance of clinical trials. Among those who had a diagnosis of cancer, 87 per cent felt trials were a good idea. One in two of us would be open to participating in a trial bow, in order to contribute to the advancement of treatments and therapies.
The research also revealed that 63% of people being aware of Cancer Trials Ireland, attributed to the work of the late Pat Smullen, who raised €2.6m for pancreatic research in 2019.
And taking part in a trial could be as easy as just asking your doctor.
‘When you’re with your physician you may ask if there are any trial options for you,’ Professor McDermott says. ‘It depends on where you are in your illness as trials might not be the option for you, depending on what your specific circumstances are.
‘But it is always worth discussion with the doctor who is looking after you and seeing if there is an option when you are presented with your options and what you are doing next.’
With new treatments and better patient outcomes at the forefront of the current and future trials being undertaken, next month, a new clinical trial aimed at highrisk prostate cancer patients ( DASL- HiCaP) will open in Ireland.
Typically, high-risk prostate cancer is treated through a combination of treatments - hormone deprivation, radiotherapy and the option of surgery, chemotherapy, or both. This trial is designed to see if adding a new well-tolerated hormonal therapy can help standard therapy and prevent high risk localised disease from spreading to other parts of the body. The trial will open in up to eight hospital sites around Ireland, with a target of recruiting at least 80 patients. The hope is that DASL-HiCaP might show new ways of improving outcomes for men with prostate cancer.
However, Cancer Trials Ireland believes patients would get faster access to trials if the approval process was streamlined. Currently there are a number of separate ethics committees around the country and Cancer Trials Ireland is calling for a centralised research ethics committee to deal with all trials.
IT has launched a petition calling for the Minister for Health and Department of Health to expedite amending and enacting all relevant legislation for Centralised National Research Ethics and increase ethical review capacity for all health research in Ireland. The petition has had more than 600 signatures to date.
‘Basically at the moment there are a lot of ethics committees around the country,’ says Professor McDermott.
‘Any trial that opens has to have first of all two sets of approvals. Number one is approval from the Health Products Regulatory Agency who want to make sure the trial is designed correctly and that drugs are safe.
‘Then there is ethics approval which is more focused on the patient part - so making sure the patient information leaflet and all the information the patient is getting about the study is written in the right type of language, easily understood and that no-one will be discommoded by being on the study.
‘Ethics Approval is separate to the HPRA; there are a number of ethics committees around the country.
‘But for Ireland to be attractive and a destination for international trials we have to be consistent in our approach to ethics and also we have to be able to respond in a timely fashion. The idea behind the single ethics committee is that first of all we can have a definite timeline for review and secondly that the responses that we get are consistent, because when you have 20 different ethics committees you often get different answers depending on who you go to.
‘They would have the expertise and set time lines and have to meet fairly frequently but that would be ideal.’
And after such success in informing the public about Covid-19 trials, CTI believes more could be done to bring other trials to Ireland.
‘The critical importance of clinical trials has never been clearer,’ says Professor McDermott.
‘Our funders – including the Health Research Board, the Irish Cancer Society – have been crucial to this work. For people living with cancer in Ireland, access to trials can offer the opportunity to access treatments when the standard treatments are not working.’
For more i nformation s ee cancertrials.ie