This is a very interesting analysis of cancer vaccine trials using data mining from Open Access journal, Immunome Research.
The authors have taken advantage of there being quite a lot of publicly available information on clinical trials these days (yes, it is there, if you know where to look¹) to amass a whole host of information on cancer vaccine clinical trials for a type of analysis known as data mining.
There own summary of the results reads:
This application enables rapid extraction of information about institutions, diseases, clinical approaches, clinical trials dates, predominant cancer types in the trials, clinical opportunities and pharmaceutical market coverage. Presentation of results is facilitated by visualization tools that summarize the landscape of ongoing and completed cancer vaccine trials. Our summaries show the number of clinical vaccine trials per cancer type, over time, by phase, by lead sponsors, as well as trial activity relative to cancer type and survival data. We also have identified cancers that are neglected in the cancer vaccine field: bladder, liver, pancreatic, stomach, esophageal, and all of the low-incidence cancers.
Two cool things I learned from the paper were: Vaccines for cancers have been in development since the 1970s, and melanoma has been the cancer studied most for a vaccine, even though the first ones out to market have been for cervical cancer (expect melanoma vaccines in the next 1-5 years?).
But as we are looking to shift this discussion towards the pharmaceutical industry, let’s look at who runs clinical trials (Pop up: Figure 2a).
While most trials are indeed conducted by independent cancer research centres, when it comes to important Phase III trials, all but two trials were run by pharmaceutical companies.
Some cynics will say this possibly is not a good sign. These companies have spent quite a bit of money on the rights to these vaccines, won’t they have a conflict of interest in the outcome of these trials (i.e. they’ll want them to succeed no matter what)?
But let’s see if I can convince you of the opposite, or at least that opposite is plausible.
One of the repeated mantras from the side of Pharma during the Insight forum regarding Pharma-sponsored education was, who else will pay for it if they don’t? The same principle applies to clinical trials. Who else? The tax payer? Non profits? Would you want to buy medicine from a company that is not prepared to put up the money needed to test them?
The main premise for making Pharma bear the cost of Phase III clinical trials is so that they will only progress with those medicines that actually work and benefit the community. They are not about to invest in medicines that don’t work.²
Now, you might say that’s fine. Pharma can foot the bill, and someone else can do the research. Even if I ignore forcing Pharma to use some sort of ‘independent’ clinical research organisation (CRO) still has the same level of incentive to ensure trial ‘success’,³ I’d argue it is unfair to take the research responsibility away from Pharma.
These trials, like the educational activities, whether we want them to be or not, will be used as marketing tools by the company. They will have the company name attached, and the company will be held responsible for any harm that results from there action. If Pharma is responsible for the ultimate outcome of the trial, it’s really not fair to not allow them to call the shots on how to run it.
Putting their name and their money on the line should keep the bastards honest more than anything else can. Does it make a case, or have I totally sold out to the capitalist propaganda?
Cao, X., Maloney, K., & Brusic, V. (2008). Data mining of cancer vaccine trials: a bird’s-eye view Immunome Research, 4 (1) DOI: 10.1186/1745-7580-4-7
¹ Albeit, all that information could be ordered more nicely, collected together, and in one spot, issues which the authors discuss a little in the article
² I’ll admit other factors are considered industry beyond just whether the medicine is ‘good’, namely profitability, which isn’t always the same as “best outcome for the whole community”, but on the whole ineffective medicines with dangerous side effects in overcrowded therapy areas are considered not profitable investments and are not be taken to Phase III by any company that wish to stay solvent.
³ CROs who don’t acheive results risk the Big Pharma Conspiracy taking there business elsewhere. If you have one monopoly CRO without competition you are in even worse situation – there is no incentive to perform quality research, and arguable an incentive to fail so that they’ll have to perform more trials.