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Early phase Cancer Trials during the COVID-19 pandemic - Dr Rakesh Popat

This past year has been demanding on all of us, but the plight of cancer patients during the pandemic is still being understood. The impact on clinical research has been profound with many trials being halted whilst a race to develop vaccines and effective treatments has pushed forward.  We are now seeing the success of this with vaccines being rolled out, but what became of other clinical trials? Drug development is many areas has fallen behind schedule which means that potentially effective cancer treatments have been delayed getting to clinic.

At UCLH, we decided to try and maintain our early phase cancer clinical trials program where possible.  We acknowledged that cancer continues despite COVID-19 and patients will still need access to novel agents when their standard treatments have stopped working.  It was a moral duty to try and keep our program going and help those cancer patients that needed these trials.  However, this was not easy. The hospital has and continues to be under great pressure due to the volume of sick COVID-19 patients, and the resources that we need to run clinical trials continues to be limited.  We worked closely together as clinicians to prioritise the trials that had the biggest potential benefit to patients without putting them at excessive risk and worked with our service support departments to ensure that these studies were  feasible to run in the current situation.  We also had to maintain the safety of our patients, recognising that many travel from far to reach us.  Fortunately, for commercial trials private transport costs are covered but for the studies that don’t have a travel budget, the UCLH transport team were very helpful in bringing our patients to the clinic.

For a couple of months at the beginning of the 1st wave, we stopped recruiting as we were concerned about the risks to patients.  However, from June we slowly restarted the early phase cancer trials program at the NIHR UCLH Clinical Research facility with enhanced safety measures.  Patients were required to have negative COVID swabs prior to attendance and were treated where possible in single rooms so reducing the risk of infection.  We also minimised additional visits by careful planning of appointments and implemented telephone clinics where possible.  This whole process has been made possible by many teams across the hospital pulling together despite the ongoing pressures of the pandemic.  In addition, behind the scenes our study co-ordinators have continued to work hard setting up new trials.  This is vitally important to ensure that we have a pipeline of trials opening when others close so that our patients have a variety of trials to be considered for.  We are also keen to continue to contribute to the global drug development process as well as the translational laboratory science that goes on alongside. 

One of the aspects that worries me, is if certain groups of patients may have been disadvantaged from access to cancer trials, particularly during the pandemic.  We’re going to look at the spectrum of patients that we’ve been enrolling to try and understand this better as well as improving our external communications to ensure we reach as many communities as possible.

I’m fortunate and grateful that I work in an organisation that embraces research and makes cancer a priority.  Despite the challenges we face, we will continue to strive to develop more effective cancer treatments for our patients.