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UK childhood cancer survival rate soars

Success attributed to participation in clinical trials since 1977

Caroline White

Wednesday, 18 July 2012

More children are surviving cancer in Britain than ever before finds research published in the Annals of Oncology today. Increasing participation in clinical trials since 1977 when the UK Children’s Cancer Study Group (UKCCSG) was set up, has helped drive this success, say the authors.

The UKCCSG’s principal aim was to set up a comprehensive portfolio of national and international trials for most children’s cancers. As result, between 1978 and 2005 two-thirds of children diagnosed with cancer in Britain had a cancer type for which there was an open national or international clinical trial.

During this period, survival increased significantly in all these categories, with the greatest improvements being seen in germ cell tumours and hepatoblastoma.

Between 1966-70, only 28% of children diagnosed with cancer survived for five years. By 2005 this had increased to 79%.

Lead author Charles Stiller, Registry Director at the Childhood Cancer Research Group, at the University of Oxford (UK) said that improvements in childhood cancer survival match those reported by the relevant clinical trials running between 1978 and 2005.

“During this time there has been an increasing level of participation in trials, with around 90% of all children with many types of cancer enrolled, and this has been facilitated by the organisation of care into specialist children’s cancer units,” he said.

“Although trends in childhood cancer survival have been reported in relation to improvements in treatment in the UK and elsewhere, this is the first time that population-based survival has been examined in relation to the clinical trials open to entry at the time.”

The researchers analysed data on 25,853 children (66% of all registered childhood cancers) diagnosed before the age of 15 in Britain during 1978-2005. In total there were 39,067 children with cancer, but this study focused on the two-thirds for whom there was a multi-centre trial of first-line treatment open to entry during a total of at least 10 years within the period of the study.

For each diagnostic category, the risk of death fell each year, ranging from 2.7% for rhabdomyosarcoma, to 12% for germ cell tumours of the testes and ovaries. The percentage of children enrolled in trials varied widely between different cancers and at different times during the study period, but there was a tendency for entry rates to be higher in more recent times for most cancers.

“Examples of cancers where a really big difference was seen over the study period are acute lymphoblastic leukaemia (ALL) and hepatoblastoma,” said Mr Stiller.

“ALL is the most frequent cancer in children. In 1978 only 49% of children survived for five years, but survival increased steadily throughout the study period and from each trial era to the next. By the end of this study, 90% of children were surviving five years from diagnosis and most of them could be considered cured.

Co-author Kathy Pritchard-Jones, Professor of Paediatric Oncology at the Institute of Child Health, University College London and Great Ormond Street Hospital for Children NHS Trust, said: “The key message from this study is that clinical trials are good for you if you are a cancer patient. Taking part in clinical trials is considered best practice for most newly diagnosed childhood cancers now.”

She added: “It also emphasises the importance of doctors working together to take the leadership role to make sure clinical trials and access to new treatments are available for children with cancer. Despite initiatives at a European level to incentivise the pharmaceutical industry, they still have a very poor track record in initiating or supporting clinical trials that could benefit children with cancer.” 

Since the implementation of the EU Clinical Trials Directive in 2004, comprehensive trial portfolios are no longer available and intervals between trials have increased, say the authors.

“If no trial is available it may not have an immediate effect on survival. However, if that situation were to persist for many years, one would predict that the rate of improvement of survival would cease and children in the UK would no longer be receiving ‘cutting edge’ treatment at the international forefront of innovative thinking,” warned Professor Pritchard-Jones.

Population survival from childhood cancer in Britain during 1978-2005 by eras of entry to clinical trials. doi:10.1093/annonc/mds183

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