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. 2018 Aug;65(8):e27074.
doi: 10.1002/pbc.27074. Epub 2018 Apr 18.

Role of clinical trials in survival progress of American adolescents and young adults with cancer-and lack thereof

Archie Bleyer  1   2 , Eric Tai  3 , Stuart Siegel  4
Affiliations

Role of clinical trials in survival progress of American adolescents and young adults with cancer-and lack thereof

Archie Bleyer et al. Pediatr Blood Cancer. 2018 Aug.

Abstract

In the United States, adolescent and young adult (AYA) patients with cancer have the lowest clinical trial participation rate of all age groups and slower progress in survival improvement than younger patients. Ominously, AYA clinical trial participation has been steadily decreasing since 2010, except in 15-19 year olds and AYAs with acute lymphoblastic leukemia. In order to reverse the accrual trend, multiple changes are necessary, including convincing community oncologists to pursue clinical trials on behalf of their AYA patients and to have the new National Community Oncology Research Program and National Clinical Trials Network lead a coordinated effort to increase accrual.

Keywords: adolescents and young adults; clinical trials; survival progress.

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Conflict of interest statement

CONFLICT OF INTEREST

None of the authors are aware of any conflict of interest, potential or current, with the information in this report or its purpose.

Figures

FIGURE 1
FIGURE 1
Annual NCI CTEP-sponsored treatment trials accruals of AYAs (age 15–39) during 2000–2015, by calendar year and 5-year age interval. A. All clinical trials except for AIDS-related malignancies (and infections during 2014–2015). B. ALL treatment trials. Accrual data kindly provided by Nita Seibel and Shanda Finnegan, CTEP, NCI
FIGURE 2
FIGURE 2
A. Accruals to treatment trials sponsored by National Cancer Institute (NCI)-sponsored cooperative groups and NCI-designated cancer centers (black curve) and proportion of all cancer accounted for by 14 cancers with peak age proportion during AYA years during (purple curve), 2000–2014, by single year of age. B. Ratio of accruals to proportion of the 14 cancers of all cancer (red curve). Accrual data source is the same as in Figure 1. Data on the proportion of all cancer were obtained from incidence data for SEER 18 regions and from the U.S. Census Bureau for population data
FIGURE 3
FIGURE 3
Joinpoint analysis of 5-year leukemia-specific survival of patients with ALL, 2000–2014, SEER18, and estimated treatment trial accrual proportion for 2000–2004, by single year of age. Joinpoint analysis was performed with the National Cancer Institute Joinpoint Regression Program. Survival regressions are for 2–17,17–20, and 20–81 years. Accrual proportion regressions are for 2–16,16–23, and 23–80 years. P-values refer to the linear regression of the corresponding age segment. The inset shows all of the annual data of survival rates and accrual proportions as a function of survival with accrual proportion, demonstrating a linear regression for accrual proportion values >10%. Accrual data source is the same as in Figure 1
FIGURE 4
FIGURE 4
Annual ALL 5-year leukemia-specific survival, age < 30, 1975–2009, SEER, by 10 year age intervals. Joinpoint analysis was performed with the National Cancer Institute Joinpoint Regression Program. Survival data were obtained from the SEER program. APC, average annual percent change. Annual values are assessed from two consecutive years (year of and year before)
See this image and copyright information in PMC

References

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