Oncologist seeks to bring cancer trials to patients so ‘no dreams are left unfulfilled’
Editor’s note: This is the second in a series of five stories from ASCO Voices, a session during ASCO Annual Meeting focused on the human side of oncology.
To Shaalan Beg, MD, MBA, it seemed like serendipity saved his patient.
Allison was a young woman starting a career in the hospitality industry and embarking on a life with her fiancé, a pilot. Her diagnosis of metastatic pancreatic cancer brought her life as she knew it to a screeching halt.
Beg met with the couple and discussed Allison’s diagnosis, treatment options and prognosis. As he had done hundreds of times before, Beg ordered a molecular profile, referred Allison for a Mediport and scheduled her for chemotherapy.
A few weeks later, he got a phone call from the company that conducted the molecular profiling test. They found a biomarker and wanted to be sure Beg knew about it.
“I remember thinking, ‘That’s weird. I’ve ordered this test a lot, and they’ve never called me before,’” said Beg, a medical oncologist affiliated with Science 37, a clinical research organization focused on decentralized clinical trials. “Then I remembered an investigator across the state who had tweeted about a clinical trial he had just opened. He was looking for people with that same biomarker. I messaged him and he replied, and eventually they connected.”
Four years later, Beg would hear Allison’s case cited at one of the world’s largest oncology conferences as evidence of the power of precision medicine in treating one of the most devastating cancers.
“She has become the poster child for precision therapy in pancreatic cancer,” Beg said, “and that’s when it struck me: What if I hadn’t ordered that molecular test?”
‘So many factors had to line up’
Having been part of this remarkable success story, Beg contemplated the series of events that enabled it to happen. He found himself going over other “what ifs.” What if the company hadn’t called about the biomarker? What if his colleague from across the state had not chosen to tweet about a clinical trial he was excited about? What if Allison’s insurance wasn’t accepted at the new organization?
“So many factors had to line up before anyone could even offer Allison an opportunity to enroll in the clinical trial,” Beg said. “Those are the reasons why less than 5% of people with cancer are ever treated on a clinical trial.”
A collaboration between American Cancer Society, the Meyer Foundation and UT Southwestern Medical Center seeks to change this statistic, according to Beg.
“This group is using [molecular and cellular oncology programs] to develop a tool that would use currently existing data in a structured format to screen people for clinical trials, both within the organizations where they are seen, as well as outside of those organizations,” he said. “Serendipity can no longer be our enrollment strategy.”
Beg discussed the obstacles to clinical trials for patients with cancer, including difficulty traveling long distances to be assessed for enrollment and financial inability to relocate to be closer to a trial. However, clinical trial investigators now have the ability to improve access to clinical trials by partnering with patients, he said.
“Given the advancements in telemedicine and technology, people now have access to clinical trials regardless of where they live,” he said. “The FDA has issued guidance on decentralized clinical trials. This provides much-needed clarity on how someone’s primary doctor and their clinic can support clinical research activities without being burdened by regulatory processes.”
Eliminating ‘what ifs’
Beg cited research by Science 37 showing that industry leaders have begun to adopt decentralized and modern clinical trial components in oncology studies. These components have been found to decrease disparities in clinical trial access while expediting study timelines and decreasing participant burden.
“So, the good news is we don’t need to ask ourselves ‘what if?’ any longer,” he said. “I see a future where someone’s ability to enroll in a clinical trial doesn’t depend on what ZIP code they live in. In order to accomplish that, we need to challenge the existing clinical trial infrastructure by adopting modern components into our clinical trials.”
Beg said he is hopeful that these efforts will expedite the development of new cancer treatments and make them accessible to those who need them most. He said he also would like to see patients have the ability to participate in clinical research while maintaining their relationship to their own doctors and staying close to their families and communities.
“At a time when most cancer clinical trials are behind on enrollment, we can’t afford to also deny access to these trials to most people,” he said.
Beg ended his presentation with a quote from a book that has special meaning for him, “Like a Needle in a Haystack: My Survival From Stage-4 Pancreatic Cancer,” by Allison Lippman Kuban — the patient he matched with a clinical trial after ordering molecular profiling.
“Mrs. Kuban writes, ‘What would you do if you could make one dream come true? Did you answer that you would find a cure for cancer? I am living that dream on a trial drug,’” Beg said. “So, let’s get together and modernize the clinical trial process. Let’s bring it into the 21st century, so no person is left behind and no dreams are left unfulfilled.”
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“Partnering with patients for modern clinical trials.” ASCO Voices Session. Presented at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
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