How to get more out of existing cancer drugs: smarter use for better outcomes
It’s always a celebration in the oncology community when a new medicine shows it makes patients live longer. I’ve experienced first-hand this feeling through standing ovations at major cancer conferences after clinical trial results were presented. The standing ovation comes to celebrate many years of work, dedication and efforts by thousands of individuals _employees in companies, healthcare professionals, patients, investors, regulators_ that ultimately culminates into the formal approval of the medicine.
But that approval also triggers an acceleration of human thinking and creativity about how to intelligently use the new tool that the medicine represents. As the drug starts being used more broadly, new insights trigger scientists, doctors and other creative thinkers to explore if the medicine could also be used in other or better ways. For instance, a medicine may become more effective if it is given before cancer surgery rather than after.
Why post-approval research matters
While there is no shortage of ideas and hypotheses, resources and efforts to generate new evidence in support of the optimised use of the medicine are not limitless. Companies make strategic choices, leaving some opportunities on the table. Academic groups, with government or charitable funding, could step in to answer those questions.
Together with some experts – colleagues at the MRC Clinical Trials Unit at the University College London, a British patient representative and a representative of a Dutch healthcare insurance (i.e. payers, those who pay for the medicine) – I’ve written a scientific article about these drug optimisation questions. Our intention was to provide guidance to ourselves and to the academic community about which questions to prioritise.
What are these questions? For example: does the drug needs to be given continuously over many months, or would regular treatment breaks be safe? Or, for how long should it be given? One year or two?
Optimising approved treatments to improve patient care
Optimisation trials can help improve cancer treatment by reducing side effects, increasing convenience, and saving money for patients and health systems—without compromising outcomes. For example, studies have shown that some drugs work just as well at lower doses or shorter durations. Others reveal that giving treatment before surgery (neoadjuvant) instead of after (adjuvant) can make a real difference.
However, even when trials show a clear benefit, it’s not always easy to change clinical practice. Regulatory challenges, funding gaps, and hesitation from patients and doctors often slow things down.
What the Anticancer Fund is doing
The Anticancer Fund has come forward to support optimisation trials. For instance, the ANZadapt trial aims to evaluate if patients with advanced prostate cancer can benefit from individualised treatment breaks rather than staying continuously on treatment, which is currently recommended but may accelerate the development of resistance to the treatment. Preliminary data suggests this approach is effective, with the added advantage that patients require treatment only about half the time.
Making the right choices when every euro counts
There is no magical recipe to identify which questions will greatly benefit patients. So this is what our team at the Anticancer Fund tries to figure out when selecting trials we fund – keeping in mind that such a clinical trial will cost between 500.000 and 1 million euros. Science, patient preferences, rigour and ‘momentum’ are four major elements. Leave one out and chances that everyone’s (trial participants, clinicians and us) time and resources will eventually be wasted dramatically increase.
Determining the optimal use of approved drugs is one way to innovate with existing treatments—it’s part of our research motto at the Anticancer Fund. We need more support for this kind of research—and more urgency to turn good evidence into better care.
