Pharma Strategy Blog

Earlier this week I was reading Fierce Biotech's excellent article about the human face of the drug industry and was surprised to learn about one of the requests from the women with breast cancer who were featured in the post:

"All three women were frustrated by the lack of available clinical trials for Stage IV patients."

Given that most cancer drugs are tested in the advanced stage first, I would have expected more there than earlier stage disease.

It's interesting first to look at how many trials there are for common conditions.  In the NIH database, I searched for some common diseases and came up with the following:

Cancer is by far the most active category in the clinical trials I searched for; in fact, all the others added up to 32,260, a bit more together than cancer alone.

So I decided to check the databases out further, but along the way I came across some frustrations. Firstly, if you go to the NIH site, you can't actually search by stage of cancer type easily.  You can search by Phase (ie phase of clinical trial) but that's not the same thing as disease stage:

Ugh.  Ok, off to the more cancer specific forum at the NCI, which accesses the same trial database but has a different front end for search, surely that would be more useful?

Again, you can search for all sorts of things (hidden for space reason) except stage of disease!

To find the actual list of trials you want out of 25,885 available for all CANCER as a condition, you have to click on the search box for CONDITION and type in words like 'metastatic', 'advanced', 'stage IV' for example.  But how many people would know or actually think of that?

Using breast cancer as an example, we can find all trials involved with the disease and how many studies are for advanced stage disease:

Breast Cancer 

– All: 3,618

– Metastatic OR Advanced OR Stage IV: 1,267

Thus 45% of breast cancer studies, or nearly half, are in later stage disease.

There is a nifty little feature that maps out the location of those studies as well for great context under the Map button:

Inevitably, most of those studies are run in the USA, but it's good to see improved access for women with breast cancer in other parts around the world too.

Of course, many of those trials may have completed, been suspended or finished enrolling. Fortunately, you can hide non-active trials, so this brings the 1,267 number down further to 576 studies globally open for advanced breast cancer, and from the map tab, 380 are open in the US, 167 in the EU and only a paltry 29 in the ROW:

That's a far cry from the massive 25,000 global cancer studies we started off with!