Curing cancer — child's play

To the Editor: Last week, a close friend began chemotherapy for breast cancer, and this week, my husband is having a radical prostatectomy for prostate cancer. Hardly surprising, given our age and that these are the commonest cancers of women and men. However, it is surprising that despite them both being treated by the best oncology specialists, neither is enrolled in a clinical trial.

It seems that clinical trials in these diseases are more common for recurrent or metastatic disease and are usually drug company trials aimed at marketing new and expensive drugs for patients with incurable cancer. Indeed, the availability of targeted therapies has transformed many incurable cancers into chronic diseases, but the costs threaten to break the health budget.

A simple way to reduce these costs is to cure patients when they present with de novo disease. Improving the cure rate is achieved by enrolling patients in clinical trials. Until cancer has 100% cure without toxicity, there is always a question to be asked by means of a randomised controlled trial. These trials may or may not include new drugs and interactions with industry (at arm's length to avoid any real or perceived conflicts of interest).

I am describing embedded clinical research in all cancer treatment centres aimed at continual improvement in outcomes. Research in such centres is performed by committed oncologists (including surgeons, radiation oncologists and the entire multidisciplinary team) setting aside the time to take part in cooperative group trials. The cooperative groups require minimal funding, as most of the costs of cancer treatment are being incurred whether or not the patient is in a trial. However, they do need government commitment and hospital administrative support for data management and statistical analysis.

To see an example of how this system works in practice, look no further than the paediatric oncologists who have worked collaboratively for half a century, enrolling patients in embedded clinical trials, and are now curing over 80% of children with cancer.1,2