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Structural and clinical barriers keep 3 of 4 cancer patients from participating in trials

‘Patients are willing to participate in trials if they’re offered one’

Feb. 19, 2019 | By Diane Mapes / Fred Hutch News Service

Dr. Joseph Unger

Fred Hutch biostatistician Dr. Joseph Unger led a new meta-analysis that determined barriers like lack of trials at treatment centers and clinical exclusions keep 3 out of 4 patients from participating in a cancer clinical trial.

Fred Hutch file photo

A new meta-analysis led by Dr. Joseph Unger of Fred Hutchinson Cancer Research Center has revealed that structural and clinical barriers prevent more than 3 out of 4 cancer patients from participating in clinical trials.

The study is part of an ongoing effort to understand why patient participation is so low in cancer clinical trials. Unger, a health services researcher and biostatistician who focuses on disparities in cancer research, published his findings today in JNCI, the Journal of the National Cancer Institute.

“From the beginning of a patient’s cancer evaluation, from the moment they walk into the clinic, there are multiple barriers to participating in a clinical trial,” he explained. “It turns out structural barriers alone — the fact that there’s just not a trial available — represent the reason why more than half of patients don’t go on trials.”

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Dr. Harmit Malik elected fellow of American Academy of Microbiology

His pioneering approaches to studying genetic conflict are transforming traditional evolutionary genetics

Feb. 15, 2019 | By Sabrina Richards / Fred Hutch News Service

Dr. Harmit Malik

Dr. Harmit Malik

Photo by Robert Hood / Fred Hutch News Service

Fred Hutchinson Cancer Research Center investigator Dr. Harmit Malik has been elected a fellow of the American Academy of Microbiology, an honorific leadership group within the American Society for Microbiology. Malik, a member of the Hutch's Basic Sciences Division and a Howard Hughes Medical Institute investigator, was one of 109 fellows elected this year. Annual fellow selection is a highly selective, peer-reviewed process that is based on nominees’ records of scientific achievement and original, microbiology-advancing contributions.

Malik studies genetic conflict, the competition between genes with opposing functions that shapes their evolution. Interactions between pathogens and host immune proteins influence evolution on both sides, as microbes and hosts evolve to evade or counteract the other's defenses. 

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Q&A: A new focus on small cell lung cancer

Dr. David MacPherson discusses the state of small cell lung cancer research, how his lab is tackling this deadly disease, and what makes him excited for the future

Feb. 7, 2019 | By Sabrina Richards / Fred Hutch News Service

Dr. David MacPherson

Dr. David MacPherson focuses his entire research program on improving our understanding of small cell lung cancer, an aggressive and deadly disease.

Photo by Robert Hood / Fred Hutch News Service

About 15 percent of lung tumors are small cell lung cancer. Treatment for this aggressive and deadly malignancy has remained nearly unchanged for decades. Recently, however, immunotherapy drugs have modestly extended patient survival. But researchers are trying to do more.

Fred Hutchinson Cancer Research Center small cell lung cancer expert Dr. David MacPherson is working to understand the biology of the disease in order to develop more effective, targeted therapies. He chatted about his most recent work, published in the journal Science Signaling, as well as the state of small cell lung cancer research and what gives him hope for the future. The interview has been edited and condensed.

Can you give us a primer on small cell lung cancer, and why more research is needed?

This is one of the most aggressive of all cancer types. It’s also about the sixth most frequent cause of cancer deaths in the U.S. But despite the high number of patients dying from small cell every year, there have been relatively few labs that have historically been studying this disease. We have a very poor understanding of the biology of small cell compared to a lot of other prevalent tumor types.

Until very recently the treatment was the same chemotherapy as it was about 30 years ago. In about two-thirds of cases, patients respond very well, but the problem is that the patient then comes back to the clinic months later with chemotherapy-resistant, recalcitrant tumors. There’s very little that can be done for those patients. The recent addition of immune checkpoint inhibitors to the chemotherapy regimen has provided some improvements in response and standard of care, but extensions in survival were modest. It’s really a tumor type where we need to do a better job in the clinic.

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