Phase I trials as valid therapeutic options for patients with cancer

Abstract

For many years, oncology phase I trials have been referred to as 'toxicity trials' and have been believed to have low clinical utility other than that of establishing the adverse event profile of novel therapeutic agents. The traditional distinction of clinical trials into three phases has been challenged in the past few years by the introduction of targeted therapies and immunotherapies into the routine management of patients with cancer. This transformation has especially affected early phase trials, leading to the current situation in which response rates are increasingly reported from phase I trials. In this Perspectives, we highlight key elements of phase I trials and discuss how each one of them contributes to a new paradigm whereby preliminary measurements of the clinical benefit from a novel treatment can be obtained in current phase I trials, which can therefore be considered to have a therapeutic intent.

Fig. 1 |. Phase I trials as valid therapeutic options.

The design adaptations made in phase I trials in the past few years (in aspects including dosing, biomarkers^,,,,,, safety, survival and responses) have helped them to become valid therapeutic options. We propose that researchers can anticipate therapeutic responses in contemporary phase I trials and therefore these trials can be considered to have therapeutic intent.