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Starting and stopping cancer drugs: The need for randomized trials
David J Benjamin1, Vinay Prasad2
1Hoag Family Cancer Institute, Newport Beach, CA, United States.
Abstract:
Precision oncology has gained widespread popularity over the past decade, and increasingly oncologists strive to provide the right treatment to the right patient. To date, precision efforts have focused on the specific mutational target(s), food/ drug interactions, functional oncology, or dose of drug given. Moreover, the tumor and blood samples of hundreds of thousands of patients with cancer have been sequenced in the United States alone with the goal of identifying and prescribing the most precise treatment. Despite this broad consideration of precision oncology, one neglected aspect of precision oncology is identifying the optimal start time and stopping point for cancer therapies. Is it possible to improve overall survival (OS) or quality of life for patients with more precise initiation and discontinuation of therapy? In this commentary, we review the historical basis to initiate, discontinue or switch therapies. We emphasize that largely these time points were selected arbitrarily, and subsequently constrained by historical accident. We highlight randomized efforts to better elucidate the time points in starting or stopping therapy. Finally, we provide suggestions for a research agenda on precision timing of anti-cancer drugs.
Insights
Precision oncology aims to optimize cancer treatment timing. Research is needed to determine the best start and stop points for therapies to improve patient survival and quality of life.
Area of Science:
- Oncology
- Pharmacology
- Clinical Trial Design
Background:
- Precision oncology currently focuses on molecular targets, drug interactions, and dosage.
- Extensive tumor and blood sequencing has been performed to personalize cancer treatments.
- Optimal timing for initiating and discontinuing cancer therapies remains largely unaddressed.
Discussion:
- Historical decisions regarding cancer therapy initiation and cessation were often arbitrary.
- Current clinical practices for treatment timing lack a strong evidence base.
- Randomized trials are crucial for establishing optimal therapeutic time points.
Key Insights:
- The precise start and stop times for cancer therapies are critical but neglected aspects of precision oncology.
- Arbitrary timing decisions may limit treatment efficacy and patient quality of life.
- A research agenda focusing on the temporal aspects of anti-cancer drug administration is warranted.
Outlook:
- Future research should prioritize randomized trials to define optimal initiation and discontinuation schedules for cancer therapies.
- Developing evidence-based guidelines for therapy timing can enhance overall survival (OS) and patient well-being.
- Integrating precision timing into precision oncology frameworks holds significant potential for improved patient outcomes.
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