Summary of current treatment options

lbinmsp said:

Informative
although a bit more 'scientific' than my pea-brain can handle. However, the comments suggesting that it is difficult to get enough RCC patients involved in these clinical trials was, in my opinion, hardly reasonable. Many of the trials have pretty stringent requirements which alone eliminate many prospective candidates (no previous treatment - or must have previous treatment - etc.). Also, most clinical trials are conducted in the 'big name' hospitals or universities - which are not convenient to many RCC patients. My personal opinion is, if these drug companies really want more RCC patients to participate, they need to think outside the box and extend these trials minimally to major university teaching hospitals. Yes, this would add expense to the trials - but why put the financial burden on the patient to travel hundreds of miles, perhaps away from job or family, hotel expense, etc. Even to go home between infusions or whatever the method of delivery is adds to the difficulty as I cannot imagine that your local oncologist would want to be responsible for the patient involved in a clinical trial on a drug they have no first-hand knowledge of.

Don't think for a second that I am against clinical trials - I just think the guys with the money (drug companies) need to step up to the plate a bit more if they truly want more RCC participation.

Trial participation
I agree with your view on this Liz, particularly considering that the costs involved pale to insignificance compared with the total overheads of the big drug companies.

Unfortunately there are additional factors that can't be resolved simply by laying out more money. The stringent requirements for many of the trials are necessary in order to allow the results to be statistically interpretable in a valid way. This is exacerbated by the complexity and heterogeneity of RCC.

With some rarer conditions, the number of patients is so small that it would be impossible to get the necessary statistically meaningful numbers even with 100% participation. My own case is an example. Even leaving aside questions of metastases, necrosis and so on, I have not been able to locate a single other person alive and kicking who has predominantly sarcomatoid chromophobe rcc. As a consequence of the lack of numbers, in a case like mine it's purely a matter of guesswork what might be a sensible course of action in respect of anything other than surgery.

There's been a well-motivated call in recent times for full disclosure of trial results by Big Pharma to avoid misinformation due to biased selective reporting and suppression of unfavourable results. I don't think this call is accompanied by sufficient qualification about the validity of the experimental designs. Many, if not most, trials might be better not reported because they are so badly thought up and implemented that what they appear to show is actually misleading. There's a lot of time and money wasted on duff "research'.