Trials For Treatment Of Cancer Research Articles

The prognostic value of ECOG performance status on overall survival among patients with metastatic prostate cancer: A systematic review of the literature and meta-analysis.

124 Background: Eastern Cooperative Oncology Group Performance Status (ECOG PS) has been shown to be a strong predictor of mortality among patients with advanced cancer. However, in metastatic prostate cancer, there has been heterogeneity in the literature regarding the strength of association between different ECOG categories and overall survival (OS). Therefore, we conducted a systematic search and meta-analysis of studies reporting on the prognostic value of ECOG PS on OS within the metastatic prostate cancer population. Methods: We performed a systematic search of the literature within the Medline (PubMed) database from inception until March 21st 2022. Both trials and real-world data (RWD) studies were included. Using a random-effects model, a meta-analysis pooling ECOG categories on OS was performed separately for metastatic castrate resistant prostate cancer (mCRPC) and metastatic castrate sensitive prostate cancer (mCSPC) studies. We also stratified the analyses by prior use of chemotherapy and study type (RWD vs. Trial). Between-study heterogeneity was analyzed using the I2 statistic. Results: A total of 75 studies met the eligibility criteria, comprising of 32,298 patients. Nearly all studies (72 out of 75) were among patients with mCRPC, while the remaining three studies were among mCSPC patients. Overall, all ECOG PS categories were associated with OS, with the highest estimate observed among mCRPC patients with ECOG PS of ≥2 vs. <2 ([HR] = 2.10; 95% confidence interval [CI]: 1.87 to 2.37). In secondary analyses, among mCRPC patients with ECOG PS of ≥1 vs. <1, there was a significant difference according to study type (RWD: HR=1.98, 95% CI: 1.73 to 2.26 vs. trials HR=1.32, 95% CI: 1.13 to 1.54). There were no significant differences in the pooled HR of OS stratified by previous chemotherapy across all three ECOG PS categories. Conclusions: Overall, ECOG PS was a significant predictor of OS regardless of category, previous chemotherapy, and type of metastatic population, although differences were observed in RWD vs. trial populations. Additional studies are needed to quantify the association between ECOG PS and OS in the mCSPC population, as well as to better understand the role of ECOG PS on outcomes in RWD vs. trials of cancer treatments.

Challenges to Recruiting Men on Active Surveillance for Prostate Cancer in Clinical Chemoprevention Trials

Clinical trials play a critical role in evidence-based medicine, when rigorous scientific methodology is utilized to discover and test the effectiveness and safety of new drugs to prevent or cure diseases, including cancer. Participation in clinical trials thus becomes key to successful completion of these trials. Although it is estimated that >70% of Americans are inclined to participate in clinical trials, less than 5% of adult cancer patients participate in clinical trials. There is thus a large gap between those inclined to participate in clinical trials and actual participation in clinical trials. As with trials targeting men with prostate cancer (PCa) on active surveillance (AS), where the target population is mostly over 50 years of age, others have observed several challenges with recruitment and accrual in clinical trials. The participation rate is currently unavailable for men on primary and secondary chemoprevention trials. Additionally, with unanticipated environmental factors such as a pandemic or other natural emergencies that may severely impact the economy, personal property, travel and person-to person contact for study-related procedures, there is a need to continuously identify these challenges and determine solutions to recruitment barriers in chemoprevention trials to ensure timely completion of early phase trials. Recent studies regarding the impact of the pandemic on clinical trial recruitment have shown that cancer prevention trials were relatively more negatively impacted compared to cancer treatment trials. The goal of this manuscript is to review our experience in continuously evaluating the protocol and patient level challenges to recruiting subjects on AS for PCa in this cancer chemoprevention trial conducted at the Comprehensive Cancer Center (CCC) and report the contemporary strategies that we are utilizing to continue to recruit subjects in this trial. We provide data from our current trial as an example while discussing future strategies to improve overall clinical trial recruitment. These strategies can inform future design of contemporary cancer chemoprevention trials and, additionally, better select, focus and invest in strategies that are the most productive and efficient for recruiting target populations.

Differences in Quality of Life and Toxicity for Male and Female Patients following Chemo(radiotherapy) for Bladder Cancer

AimsBC2001, a randomised trial of treatment for muscle-invasive bladder cancer, demonstrated no difference in health-related quality of life (HRQoL) or late toxicity between patients receiving radical radiotherapy with and without chemotherapy. This secondary analysis explored sex-based differences in HRQoL and toxicity. Materials and methodsParticipants completed the Functional Assessment of Cancer Therapy Bladder (FACT-BL) HRQoL questionnaires at baseline, end of treatment, 6 months and annually until 5 years. Clinicians assessed toxicity with the Radiation Therapy Oncology Group (RTOG) and Late Effects in Normal Tissues Subjective, Objective and Management (LENT/SOM) scoring systems at the same timepoints. The impact of sex on patient-reported HRQoL was evaluated using multivariate analyses of change in FACT-BL subscores from baseline to the timepoints of interest. For clinician-reported toxicity, differences were compared by calculating the proportion of patients with grade 3–4 toxicities occurring over the follow-up period. ResultsFor both males and females, all FACT-BL subscores had a reduction in HRQoL at the end of treatment. For males, the mean bladder cancer subscale (BLCS) score remained stable through to year 5. For females, there was a decline in BLCS from baseline at years 2 and 3 with a return to baseline at year 5. At year 3, females had a statistically significant and clinically meaningful worsening of mean BLCS score (–5.18; 95% confidence interval –8.37 to –1.99), which was not seen in males (0.24; –0.76 to 1.23). RTOG toxicity was more frequent in females than males (27% versus 16%, P = 0.027). ConclusionResults suggest that female patients treated with radiotherapy ± chemotherapy for localised bladder cancer report worse treatment-related toxicity in post-treatment years 2 and 3 than males.

Increasing Racial and Ethnic Equity, Diversity, and Inclusion in Cancer Treatment Trials: Evaluation of an ASCO-Association of Community Cancer Centers Site Self-Assessment.

Clinical trial participants do not reflect the racial and ethnic diversity of people with cancer. ASCO and the Association of Community Cancer Centers collaborated on a quality improvement study to enhance racial and ethnic equity, diversity, and inclusion (EDI) in cancer clinical trials. The groups conducted a pilot study to examine the feasibility, utility, and face validity of a two-part clinical trial site self-assessment to enable diverse types of research sites in the United States to (1) review internal data to assess racial and ethnic disparities in screening and enrollment and (2) review their policies, programs, procedures to identify opportunities and strategies to improve EDI. Overall, 81% of 62 participating sites were satisfied with the assessment; 82% identified opportunities for improvement; and 63% identified specific strategies and 74% thought the assessment had potential to help their site increase EDI. The assessment increased awareness about performance (82%) and helped identify specific strategies (63%) to increase EDI in trials. Although most sites (65%) were able to provide some data on the number of patients that consented, only two sites were able to provide all requested trial screening, offering, and enrollment data by race and ethnicity. Documenting and evaluating such data are critical steps toward improving EDI and are key to identifying and addressing disparities more broadly. ASCO and Association of Community Cancer Centers will partner with sites to better understand their processes and the feasibility of collecting screening, offering, and enrollment data in systematic and automated ways.

Moderna and Merck’s cancer vaccine shows promise in trials

A personalized messenger RNA (mRNA) cancer vaccine jointly developed by Moderna and Merck & Co. has shown positive results in a randomized Phase 2 clinical trial, the companies announced Dec. 13. The shot, when combined with Merck’s checkpoint inhibitor Keytruda, reduced the risk of cancer recurrence or death by 44% compared with Keytruda alone over a period of 1 year. It was tested in people with stage 3/4 melanoma who had their tumors removed but had elevated chance of the cancer returning because of features of their melanoma, Michelle Brown, Moderna’s program director for oncology, said in a Dec. 14 roundtable with reporters. Moderna and Merck say they are the first companies to show efficacy in a randomized clinical trial for an investigational mRNA-based cancer treatment. Some vaccines to treat cancer are already approved, but they haven’t shown a substantial survival benefit, and not all have a clear mechanism of

Cancer Exosome Loaded with Paclitaxel for Targeted Lung Cancer Therapy

Lung cancer is a serious issue to threat the health of human and the treatment using currently available chemotherapy drug, such as paclitaxel (PTX) is significantly impaired by the poor solubility and targetability. In this study, we used the cancer exosome (CE) derived from lung cancer cell line A549 to load PTX (CE/PTX) and construct a drug delivery system (DDS) for the treatment of A549 tumor in a mice mode. The DDS realized better inhibition on both A549 cells and tumors as compared to commercial PTX formulation (Taxol). Therefore, we believe this strategy can be applied to clinical trials for better cancer treatment.

Targeting cullin neddylation for cancer and fibrotic diseases.

Protein neddylation is a post-translational modification, and its best recognized substrates are cullin family proteins, which are the core component of Cullin-RING ligases (CRLs). Given that most neddylation pathway proteins are overactivated in different cancers and fibrotic diseases, targeting neddylation becomes an emerging approach for the treatment of these diseases. To date, numerous neddylation inhibitors have been developed, of which MLN4924 has entered phase I/II/III clinical trials for cancer treatment, such as acute myeloid leukemia, melanoma, lymphoma and solid tumors. Here, we systematically describe the structures and biological functions of the critical enzymes in neddylation, highlight the medicinal chemistry advances in the development of neddylation inhibitors and propose the perspectives concerning targeting neddylation for cancer and fibrotic diseases.

NF-κB: a mediator that promotes or inhibits angiogenesis in human diseases?

The nuclear factor of κ-light chain of enhancer-activated B cells (NF-κB) signaling pathway, which is conserved in invertebrates, plays a significant role in human diseases such as inflammation-related diseases and carcinogenesis. Angiogenesis refers to the growth of new capillary vessels derived from already existing capillaries and postcapillary venules. Maintaining normal angiogenesis and effective vascular function is a prerequisite for the stability of organ tissue function, and abnormal angiogenesis often leads to a variety of diseases. It has been suggested that NK-κB signalling molecules under pathological conditions play an important role in vascular differentiation, proliferation, apoptosis and tumourigenesis by regulating the transcription of multiple target genes. Many NF-κB inhibitors are being tested in clinical trials for cancer treatment and their effect on angiogenesis is summarised. In this review, we will summarise the role of NF-κB signalling in various neovascular diseases, especially in tumours, and explore whether NF-κB can be used as an attack target or activation medium to inhibit tumour angiogenesis.

Assessment of Two Commercial Comprehensive Gene Panels for Personalized Cancer Treatment.

(1) Background: Analysis of tumor DNA by next-generation sequencing (NGS) plays various roles in the classification and management of cancer. This study aimed to assess the performance of two similar and large, comprehensive gene panels with a focus on clinically relevant variant detection and tumor mutation burden (TMB) assessment; (2) Methods: DNA from 19 diagnostic small cell lung cancer biopsies and an AcroMetrix™ assessment sample with >500 mutations were sequenced using Oncomine™ Comprehensive Assay Plus (OCAP) on the Ion Torrent platform and TruSight Oncology 500 Assay (TSO500) on the Illumina platform; (3) Results: OCAP and TSO500 achieved comparable NGS quality, such as mean read coverage and mean coverage uniformity. A total of 100% of the variants in the diagnostic samples and 80% of the variants in the AcroMetrix™ assessment sample were detected by both panels, and the panels reported highly similar variant allele frequency. A proportion of 14/19 (74%) samples were classified in the same TMB category; (4) Conclusions: Comparable results were obtained using OCAP and TSO500, suggesting that both panels could be applied to screen patients for enrolment in personalized cancer treatment trials.

Temporal phosphoproteomics reveals WEE1-dependent control of 53BP1 pathway

Wee1-like protein kinase (WEE1) restrains activities of cyclin-dependent kinases (CDKs) in S and G2 phase. Inhibition of WEE1 evokes drastic increase in CDK activity, which perturbs replication dynamics and compromises cell cycle checkpoints. Notably, WEE1 inhibitors such as adavosertib are tested in cancer treatment trials; however, WEE1-regulated phosphoproteomes and their dynamics have not been systematically investigated. In this study, we identified acute time-resolved alterations in the cellular phosphoproteome following WEE1 inhibition with adavosertib. These treatments acutely elevated CDK activities with distinct phosphorylation dynamics revealing more than 600 potential uncharacterized CDK sites. Moreover, we identified a major role for WEE1 in controlling CDK-dependent phosphorylation of multiple clustered sites in the key DNA repair factors MDC1, 53BP1, and RIF1. Functional analysis revealed that WEE1 fine-tunes CDK activities to permit recruitment of 53BP1 to chromatin. Thus, our findings uncover WEE1-controlled targets and pathways with translational potential for the clinical application of WEE1 inhibitors.

Combination therapy for cancer with IL-27 and anti-PD-1: A simplified mathematical model

Many experiential and clinical trials in cancer treatment show that a combination of immune checkpoint inhibitor with another agent can improve the tumor reduction. Anti Programmed death 1 (Anti-PD-1) is one of these immune checkpoint inhibitors that re-activate immune cells to inhibit tumor growth. In this work, we consider a combination treatment of anti-PD-1 and Interleukin-27 (IL-27). IL-27 has anti-cancer functions to promote the development of Th1 and CD8$^+$ T cells, but it also upregulates the expression of PD-1 and Programmed death ligand 1 (PD-L1) to inactivate these T cells. Thus, the functions of IL-27 in tumor growth is controversial. Hence, we create a simplified mathematical model to investigate whether IL-27 is pro-cancer or anti-cancer in the combination with anti-PD-1 and to what degree anti-PD-1 improves the efficacy of IL-27. Our synergy analysis for the combination treatment of IL-27 and anti-PD-1 shows that (i) ant-PD-1 can efficiently improve the treatment efficacy of IL-27; and (ii) there exists a monotone increasing function $F_c(G)$ depending on the treatment efficacy of anti-PD-1 $G$ such that IL-27 is an efficient anti-cancer agent when its dose is smaller than $F_c(G)$, whereas IL-27 is a pro-cancer agent when its dose is higher than $F_c(G)$. Our analysis also provides the existence and the local stability of the trivial, non-negative, and positive equilibria of the model. Combining with simulation, we discuss the effect of the IL-27 dosage on the equilibria and find that the T cells and IFN-$\gamma$ could vanish and tumor cells preserve, when the production rate of T cells by IL-27 is low or the dosage of IL-27 is low.

Clinical biostatistics in the 2020s

Clinical biostatistics in the 2020s

Preservation of Neurocognition after Proton Beam Radiation Therapy for Intracranial Tumors: First Results from REGI-MA-002015

Proton beam radiation therapy reduces dose to healthy brain tissue and thereby decreases the risk of treatment-related decline in neurocognition. Considering the paucity of prospective data, this study aimed to evaluate neurocognitive performance in an adult patient population with intracranial tumors. Between 2017 and 2021, patients enrolled in the MedAustron registry study and irradiated for intracranial tumors were eligible for neurocognitive assessment. Patients with available 1-year follow-up data were included in the analysis. The test battery consisted of a variety of standardized tests commonly used in European Organization for Research and Treatment of Cancer trials. Scores were transformed into z scores to account for demographic effects, and clinically relevant change was defined as a change of ≥1.5 standard deviations. Binary logistic regression analysis and the χ2 test were conducted for clinical parameters and dosimetric hippocampal parameters to evaluate the relationship with overall cognitive decline and changes in memory. One hundred twenty-three patients with mostly nonprogressive, extra-axial tumors and neurocognitive assessment at baseline and treatment end as well as 3, 6, and 12 months after completion of proton beam radiation therapy were analyzed. Overall, 7 test scores revealed stability in neurocognitive function with minimal positive changes 1 year after treatment completion (statistically significant in 6 of 7 tests), whereas the majority had no or minimal baseline deficits. At 1-year follow-up, 89.4% of all patients remained stable in their overall cognitive functioning without clinically relevant deterioration in 2 or more tests. None of them showed disease progression. Of the patients, 8.1% presented with radiation-induced brain lesions and exhibited a higher percentage of overall cognitive deterioration without reaching statistical significance. Multivariate binary logistic regression analysis revealed higher age at baseline as the only independent parameter to be associated with an overall clinically relevant cognitive decline. There was no significant correlation of hippocampal doses and memory functioning. One year after proton therapy, we observed preservation of cognitive functioning in the vast majority of our patients with intracranial tumors.

Experiences of participants in a clinical trial of a novel radioactive treatment for advanced prostate cancer: A nested, qualitative longitudinal study.

Qualitative studies nested within clinical trials can provide insight into the treatment experience, how this evolves over time and where improved supportive care is required. The purpose of this qualitative study is to describe the lived experiences of men with advanced prostate cancer participating in the TheraP trial; a randomised trial of 177Lu-PSMA-617 compared with cabazitaxel chemotherapy. Fifteen men with advanced prostate cancer were recruited from the TheraP clinical trial with interviews conducted at three timepoints during the trial. An interpretative phenomenological approach was used, and interviews analysed using thematic analysis. This research paper reports the results from the mid-point, conclusion and follow up interviews, focusing specifically on participants' experiences of trial participation. Three themes were identified representing the lived experiences of men with advanced prostate cancer participating in the TheraP trial: (1) facing limited options; (2) anticipating outcomes and (3) coping with health changes. Men who enrol in clinical trial of anti-neoplastic treatments for prostate cancer need targeted psychological and supportive care that includes attention to unique aspects of the experience of having prostate cancer and being in a clinical trial. As part of their trial experience, men with advanced prostate cancer need to be regularly assessed for survivorship needs, fully informed, supported and referred to services for regular care and support across the trajectory of their disease. NCT03392428. Registered on 8 January 2018 (ANZUP1603).

A Comprehensive Analysis of Institutional and Nationwide Datasets Identifies Key Parameters that Influence Racial Minority Enrollment onto Clinical Trials

<h3>Purpose/Objective(s)</h3> Minority accrual to clinical cancer treatment trials remains consistently low across the United States. We hypothesize that specific aspects of clinical cancer trials associate favorably with minority accrual, and may guide future clinical trial design. <h3>Materials/Methods</h3> We identified cancer treatment trials with a minimum of 10 patients at a multi-institutional NCI designated cancer center from 2010-2022. We also analyzed the National Cancer Database (NCDB) from 2004 to 2018 to assess co-variables that influence minority accrual across the United States. Racial minorities were defined as any non-white individual for both our institutional and NCDB cohorts. Our study endpoint was the probability of enrolling a minority patient on a clinical cancer treatment trial. Separate univariable and multivariable logistic regression were used to determine whether co-variables from either our institutional dataset or the NCDB associated with the study endpoint. P-values of less than 0.05 were considered statistically significant. All analysis was performed in R (R Foundation for Statistical Computing, version 4.0.2). <h3>Results</h3> We identified a total of 352 cancer treatment trials from our multi-institutional cohort. These trials enrolled a total of 7,981 patients, and a total of 969 minorities (12%). Clinical trials treating breast and genitourinary malignancies had a favorable association with accruing a minority patient when compared to other solid tumors (OR 1.32 95% CI 1.04-1.66 and OR 1.33, 95% CI 1.02-1.71). Phase II clinical trials had a less favorable association with accruing a minority patient (OR 0.75, 95% CI 0.62 – 0.91) when compared to early phase trials (pilot + phase I + phase I/II). Analysis of the NCDB identified 19,139 minorities enrolled on institutional or double-blinded clinical trials. Minorities enrolled on clinical trials were more likely to be female versus male (OR 1.22, 95% CI 1.09-1.37), un-insured versus private insurance or Medicare (OR 2.22, 95% CI 1.67 – 2.94 and OR 1.96, 95% CI 1.43 – 2.63), live within 30 miles of their hospital (OR 2.33, 95% CI 2.08 – 2.63), receive treatment at academic versus community facilities (OR 1.75, 95% CI 1.52-2.04), and be treated with surgery (OR 1.59, 95% CI 1.41 – 1.79). Minority patients enrolled on clinical trials were more likely to have breast and genitourinary cancers (OR 1.54, 95% CI 1.31 – 1.81 and OR 1.35, 95% CI 1.14 – 1.61). <h3>Conclusion</h3> Twelve percent of patients that enrolled on clinical trials in our institutional cohort were minorities, which is comparable to current minority representation in NCI trials. Our analysis found that minority patients enrolled on early phase clinical trials, breast and genitourinary treatment trials, tended to be female, un-insured, live within 30 miles of a facility, and receive surgical treatment. This analysis demonstrates that minority patients favorably associate with specific aspects of cancer treatment trials that should be addressed in future clinical trial design.

CHEMOPREVENTIVE AGENTS ON A MOUSE SKIN CARCINOGENESIS MODEL: AN INTEGRATIVE REVIEW

Squamous cell carcinoma (SCC) is a non-melanoma skin cancer, with chronic sun exposure as the main risk factor. Excisional surgery is the most indicated treatment; however, patients can suffer functional, aesthetic, and psychological damage depending on the lesion site. Topical administration of 7,12-dimethylbenz[a]anthracene (DMBA) and 12-O-Tetradecanoylphorbol-13-acetate (TPA) induce to the appearance of benign skin tumors in mice, some of which develop into SCC. This protocol has been used to analyze the effects of many chemopreventive agents that may block or inhibit the mechanisms of action of chemical carcinogenesis. We compared the effects of chemopreventive agents in an induced skin carcinogenesis animal model. In the Scopus, PubMed, and EMBASE databases, we searched for manuscripts published between June 16, 2011, and June 16, 2021. We excluded studies conducted in vitro or on transgenic mice; in addition, studies without drug dosage, route of administration, or tumor incidence were excluded. We selected 26 studies and analyzed their main characteristics and the outcomes of tumorigenesis analysis. Most chemopreventive agents have shown excellent potential to inhibit the development of skin tumors. This review also discusses the standardization of studies in animal models to ensure better responses and future randomized clinical trials for cancer treatment and prevention.

Evaluation of acute toxicity of cancer-targeting albumin-based artificial metalloenzymes

Recently, the development of abiotic metal-mediated drug delivery has been significant growth in the fields of anticancer approach and biomedical application. However, the intrinsic toxicity of abiotic metal catalysts makes in vivo use difficult. Our group developed a system of cancer-targeting albumin-based artificial metalloenyzmes (ArMs) capable of performing localized drug synthesis and selective tagging therapy in vivo for cancer therapy. The toxicity of the system at higher concentrations was investigated in vitro and in vivo in the study to demonstrate its safety for potential application in clinical trials. In cell-based experiments, the study revealed that the cytotoxicity of metal catalysts anchored within the binding cavity of the cancer-targeting ArMs could be significantly reduced compared to free-in-solution metal catalysts. Moreover, the in vivo data demonstrated that the cancer-targeting ArMs did not cause considerable damage in organs or change in the hematological parameters in a single-dose (160 mg/Kg) toxicity study in rats. Therefore, the system is safe, highlighting that it could be used in clinical trials for cancer treatment.

PKC signal amplification suppresses non-small cell lung cancer growth by promoting p21 expression and phosphorylation

Protein kinase C (PKC) activation was previously associated with oncogenic features. However, small molecule inhibitors targeting PKC have so far proved ineffective in a number of clinical trials for cancer treatment. Recent progresses have revealed that most PKC mutations detected in diverse cancers actually lead to loss-of-function, thus suggesting the tumor-suppressive roles of PKC proteins. Unfortunately, the development of chemicals to enhance PKC activity is lagging behind relative to its small molecular inhibitors. Here, we report that a bisindolylmaleimide derivative (3,4-bis(1-(prop-2-ynyl)-1H-indol-3-yl)-1 H-pyrrole-2,5-dione, BD-15) significantly inhibited cell growth in non-small cell lung cancer (NSCLC). Mechanistically, BD-15 treatment resulted in markedly enhanced phosphorylation of PKC substrates and led to cell cycle arrest in G2/M. Further, BD-15 treatment upregulated p21 protein levels and enhanced p21 phosphorylation. BD-15 also promoted caspase3 cleavage and triggered cellular apoptosis. In xenograft mouse models, BD-15 exerted anti-tumor effects to suppress in vivo tumor formation. Collectively, our findings revealed the tumor-suppressive roles of BD-15 through enhancing PKC signaling and thus leading to upregulation of p21 expression and phosphorylation.

Implementing Modernized Eligibility Criteria in US National Cancer Institute Clinical Trials.

In 2018, the Cancer Therapy Evaluation Program (CTEP) at the US National Cancer Institute published new protocol template language that focused on organ function and prior and concurrent cancers in an effort to modernize eligibility criteria for cancer treatment trials. We conducted an analysis of CTEP-supported trials to evaluate the uptake and incorporation of the new language. The analysis included evaluation of 122 protocols approved in the years 2018-2020 for inclusion of the modernized eligibility criteria and consistency with new protocol template language related to 7 major eligibility criteria. These were cardiac function, liver function, kidney function, HIV status, prior and/or concurrent malignancies, treated and/or stable brain metastasis, and new and/or progressive brain metastases. Overall, CTEP trials evaluated in this period demonstrated that eligibility criteria were implemented to a relatively high degree ranging from a low of 54.1% for prior and/or concurrent malignancies to a high of 93.4% for eligibility criteria related to HIV infection. The findings demonstrate that modernized eligibility criteria can be successfully implemented but that consistent implementation requires sustained focused effort. As a result of these findings, CTEP began a new initiative in January 2022 that incorporates a specific review of eligibility criteria for new protocols to promote and improve consistency with the modernization effort.

New Advances in Supportive Care: Chemoprotective Agents as Novel Opportunities in Geriatric Oncology.

To explore the effectiveness of trilaciclib and ALRN-6924 in the prevention of cancer chemotherapy-induced toxicity in older patients. New chemoprotective agents are necessary because age is the main risk factor for chemotherapy complications that account largely for the poorer outcome of cancer in the elderly. Trilaciclib and ALRN-6924 cause a reversible block of the proliferation of normal cells through cell cycle arrest (CCA). With this mechanism, they may prevent the toxicity of cycle-active cancer treatment including neutropenia, anemia, thrombocytopenia, lymphopenia, mucositis, and alopecia. Myelopoietic growth factors may prevent neutropenia in the aged, but they may cause severe bone pain, may aggravate thrombocytopenia and anemia, and may cause myelodysplasia and acute leukemia as a late complication. The prevention of thrombocytopenia, anemia, mucositis, and alopecia is unsatisfactory at present. These complications may jeopardize the treatment outcome as they require a reduction of treatment dose/intensity and because many patients find the resulting symptoms intolerable. In three studies of patients with extensive disease small cell lung cancer (ES-SCLC), trilaciclib reduced the severity and duration of neutropenia and thrombocytopenia as well as the need for blood transfusions. In addition, it produced a significant expansion of T-cell clones. Trilaciclib received FDA approval for the prevention of chemotherapy-induced myelosuppression in patients with ES-SCLC. ALRN-6924 is currently studied in phase II study of ES-SCLC. In a phase IB of 38 patients, ALRN-6924 prevented myelosuppression to an extent comparable with trilaciclib. Both drugs proved as effective in patients 65 and older as they were in the younger ones. In an "ex vivo" study, ALRN-6924 protected the epithelial stem cells of hair follicles from taxanes and promised to prevent alopecia. The possibility that CCA of tumor cells may reduce the effectiveness of cycle-active chemotherapy is a major concern. For this reason, the use of trilaciclib, an inhibitor of CDK 4/6, should be limited to tumors with inactivated RB1, and the use of ALRN-6924, an inhibitor of P53, should be limited to tumors with inactivated P53. Chemotherapy-related toxicities limit dose intensity and contribute to significant morbidity and mortality in elderly cancer patients. Trilaciclib and ALRN-6924 are of particular interest to geriatric oncologists because of their novel mechanism of action. Ameliorating chemotherapy-induced toxicities holds the promise of transforming the practice of geriatric oncology by enabling chemotherapeutic regimens that are currently not feasible for this patient population. Specifically, these agents may prevent chemotherapy-induced neutropenia and thrombocytopenia, perhaps the most life-threatening complications of cytotoxic chemotherapy, thereby obviating the need for the use of rescue strategies such as hematopoietic growth factors. In addition, these agents offer the potential for broad tissue protection from other chemotherapy-related toxicities, including mucositis, diarrhea, and alopecia, which historically have been poorly managed. Importantly, by preventing a spectrum of chemotherapy-related toxicities, these agents may permit the administration of chemotherapy at full-dose intensity, prevent functional decline, and grant maintenance of resilience to older cancer patients. As a result, the successful prevention of chemotherapy-induced side effects may not only mitigate the costs of care but also improve patient outcomes and quality of life. Finally, chemoprotective strategies offer the opportunity to apply geriatric principles to clinical trials of cancer treatment. In particular, they may allow the testing of prolongation of "active life expectancy" as a major goal of clinical trials in elderly patients. They may also enable novel and more practical forms of clinical trials. By assessing the risk of chemotherapy-related toxicity with the Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) or the Cancer and Aging Research Group (CARG) instruments, these agents may permit researchers to utilize patients as their own controls and endorse the approval of supportive care drugs based upon the risk profile of individual patients.