West of Scotland Managed Clinical Network in Lung Cancer Research and Development

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West of Scotland Managed Clinical Network in Lung
Cancer (Research and) Development

• David J Dunlop
• Consultant and Clinical Senior Lecturer in
  Medical Oncology
• North Glasgow Hospitals University NHS Trust

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Smoking Lung Cancer The Terminator
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Start with a quote

• I think that all patients with cancer should be
  in a clinical trial. If theyre not in a clinical
  trial it implies that we know how to treat the
  disease, which we dont

David Jablons, UCLA
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Funding for Cancer Research

• 450-500m pa funding for research
• Government/Charity 300-350m
• CR-UK 130m
• SEHD 9m
• Industry 135
• DoH 70-75m

Aetiology 16 Prevention 2 Early detection,
Diagnosis and Prognosis 8 Treatment
22 Cancer control, survival And outcomes 6
Biology 41 Scientific model systems 2
Direct support For research Funding-
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Best Selling Medicines, 2001

• b/year
• Lipitor Cholest/Trigly reducer Pfizer 7,026
• Losec Antiulcer AZ 6,054
• Zocor Cholest/Trigly reducer Merck 5,286
• Norvasc Calcium antagonist Pfizer 3,695
• Ogastro Antiulcer Abbott 1,791
• Zyprexa Antipsychotic Lilly 3,186
• Celebrex Nonsteroidal Pharmacia 3,132
• Erypo Erythropoietin JJ 2,912
• Seroxat Antidepressant GSK 2,828
• Vioxx Nonsteroidal Merck 2,603
• .
• 62.Taxol Antimitotic BMS 847

To most pharmaceutical companies, cancer isnt
big business!
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Research Funding Site Specific
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Why should we do Clinical Trials in Cancer?

• Patients treated in trials and trials environment
  will benefit
• Increased patient satisfaction, quality of life
• Clinical research quality care
• Braunholtz et al, 2001 reviewed 21 RCTs
  likely that clinical trials have a positive
  rather than a negative effect on the outcome of
  patients
• Enhanced clinical programmes reputation
• Its the right thing to do
• Collaborative, sharing patients, partnership,
  everybody wins, learning environment

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Cancer Clinical Trials

• 100 newly diagnosed patients with cancer
• 70 considered trial candidates
• Suitable study for 40
• 20 are eligible
• 10 refuse
• 10 left

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BOC Catchment Area
2.8m pop.
BOC
Outreach clinics
40 miles
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Restructuring Cancer Service Delivery in West of
Scotland A geographical service becomes a
site-specific service

• Forth Valley
• General
• Breast
• Lung
• GI cancer

• Lanarkshire
• General
• Breast
• Lung
• GI cancer

BOC Complex/rare Academic Research Radiotherapy Tr
aining

• GGHB
• General x2
• Breast x2
• Lung x2
• GI cancer x2

• Ayrshire and Arran
• General
• Breast
• Lung
• GI cancer

• Argyll and Clyde
• General
• Breast
• Lung
• GI cancer

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How can a Network positively influence clinical
trial participation?

• Resources and Infrastructure
• Communication/Empowerment
• IT-closing the audit loop!
• Patient advocacy/lobby/influence

Audit
Excellence
Progress
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Delivery of the Oppurtunity to participate in
clinical trials.

• Facilitated by Regional Cancer Research Network
• Delivered through multi-professional teams
• Resourced by network grants, charities and
  pharmaceutical industry
• Challenged by European Directive on Clinical
  Trials

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Importance of teams in lung cancer care

• An Impact Evaluation of multi-professional team
  working on outcomes in patients with non-small
  cell lung cancer
• David J Dunlop, Lynn Forrest, Donald McMillan
• Depts of Medical Oncology and Surgical Oncology,
  Glasgow Royal Infirmary, G4 0SF
• Cancer in Scotland Action for Change, Dunblane,
  7th Oct 2003.

• The bottom line from this study of over 400
  patients is that a
• Multidisciplinary team approach
• improves access to oncological interventions
• improves survival of stage IV patients
• increases patient recruitment into clinical
  trials from less
• than 5 to 67 in 4 years

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Case Presentation

• AC ? 60
• Nov 2000
• Abnormal CXR
• Ix stage IIIB NSCLC
• PS 0

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Treatment

• Phase III clinical trial
• Cisplatin Gemcitabine OR
• Cisplatin, Gemcitabine and IRESSA
• Dec 00 Feb 01

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Another Bottom Line
Thank you for your attention!