If you have a severe or chronic illness, participating in a clinical trial to evaluate a new treatment may offer you a chance to improve and/or extend your life or provide access to a new treatment that may or may not be better than those that are already available. Results from previous clinical trials have led to important discoveries that make our lives better – such as new drugs to treat cancer and diabetes, vaccines, ways to stop smoking, and improved medical procedures.
What is a Clinical Trial?
Clinical trials are often referred to as “drug trials” or “device trials”. They are research studies where a drug or device company or investigator is trying out a new medication or treatment for a specific disease or condition. The drug used in a clinical trial is referred to as an “investigational” drug, meaning it has not yet been approved for patient use. Clinical trials are conducted to determine the investigational drug’s safety and effectiveness, the most effective medication dose, how a drug might affect a person’s body and may look at biomarkers or DNA in order to explore a genetic cause of a certain condition or disease.
The sponsor will select a Lahey physician to be the site principal investigator (PI) of their trial. The site PI will be the person “in charge” of running the trial at Lahey Hospital & Medical Center and is typically selected based on his/her experience with the disease being studied. Sub-investigators and research staff will also assist the PI with the conduct of the trial.
Before a clinical trial can be conducted at Lahey Hospital & Medical Center, it is reviewed by the Lahey Institutional Review Board (IRB). The IRB is composed of medical professionals, physicians, non Lahey employees and laymen. The primary responsibility of the IRB is to protect the rights and welfare of research subjects and follows rules that are defined in the United States Code of Federal Regulations. The IRB reviews the trial protocol which describe the sponsor and principal investigators credentials, purpose and duration of the trial, the background research that has been performed to date, the schedule and types of tests and procedures a trial is requiring, the eligibility criteria (who is eligible to participate), the study medication and dose and any materials which may be provided to the subjects
Becoming a Patient in a Clinical Trial
To become a trial subject, you must first volunteer to participate in the trial and you have to meet certain eligibility criteria such as age, family history, disease duration and medication use. The sponsor of a clinical trial is usually a drug company.
Types of Clinical Research
There are several types of clinical research studies.
- Treatment trials test new treatments, new combinations of drugs, or new approaches to surgery or radiation therapy.
- Diagnostic trials determine better tests or procedures for diagnosing a particular disease or condition.
- Prevention trials look for better ways to prevent a disease in people who have never had the disease or to prevent the disease from recurring.
- Quality of life trials explore and measure ways to improve the comfort and quality of life of people with a chronic illness.
- Screening trials test the best way to detect certain diseases or health conditions.
- Cost-effectiveness studies compare interventions in terms of their costs and health effects and assess how much value the interventions provide.
- Outcomes research seeks to understand the end results of particular health care practices and interventions in order to monitor and improve the quality of care. These types of studies are performed by investigators in our Comparative Effectiveness Research Institute (CERI).
Clinical trial phases
There are various phases of clinical trials including Pre-Clinical, Phase I, Phase II, Phase III and Phase IV.
Preclinical trials are referred to as “non human” trials and include in vitro (test tube or culture) and in vivo (animal) experiments. This type of research is generally conducted in a laboratory using animals such as rodents, rabbits and monkeys. Preclinical trials are performed in order to obtain preliminary information on a drug or treatment’s effectiveness. If a drug is believed to be potentially effective, a Phase I trial may be initiated.
- Phase I trials are the first studies done with human subjects. These trials are generally conducted on a small group of patients (up to 100) and are conducted to look at safety and risks of a study drug or treatment or dose ranges. Subjects are generally considered “healthy volunteers” and are monitored closely.
- Phase II trials are conducted to determine effects on the treatment of disease. These trials are generally conducted on a larger group of patients (up to 300) and looks at how the drug works. Phase II studies can be divided by Phase IIA and Phase II B. Phase IIA studies typically look at dosing or how much of a drug to give. Phase IIB looks at how the drug works.
- Phase III trials compare the new treatment with the available standard treatment to see which one is more effective, or compares the new treatment to a placebo, or inactive substances. These trials are much larger in scale and are conducted at multiple centers with hundreds to thousands of patients. They are typically conducted as “randomized, double-blind and controlled” trials used as the gold standard for the industry.In these trials placebos or inactive substances are typically used along with the study medication. Subjects are “randomized” or assigned by chance the study drug or placebo, and they are “double blinded” meaning the subject nor will the study staff know which the subject has been assigned until the end of the trial. These studies further explore the safety and efficacy and are reviewed by the FDA (Federal Drug Administration) when considering drug approval. Most of the trials conducted at Lahey Hospital & Medical Center are Phase III trials. Phase IIB studies are also routinely conducted and explore an approved drug or treatment for use in other diseases, are performed to seek additional safety data or are used for marketing purposes.
- Phase IV trials are known as “post market” studies or studies of drugs that have received FDA approval. These trials are generally conducted to explore the long term effects of a drug or treatment with a larger group of patients. Typically these studies are required by the FDA for these purposes.
For more information on clinical trial phases or the FDA approval process, please visit the FDA website.
Cooperative Group Cancer Trials
Lahey Hospital & Medical Center is a member of the Cancer Trials Support Unit (CTSU). CTSU is sponsored by the National Cancer Institute (NCI) and is a national network of physicians who participate in NCI-sponsored cancer treatment trials, cancer prevention trials, control trials and other cancer related studies.
The NCI sponsors several physician and medical professional cooperative groups. A cooperative group is a large network of researchers, physicians, and health care professionals at public and private institutions across the country who are members of the group.The Cancer Cooperative groups work toward a common goal of promoting and participating in research trials committed to the prevention, detection and treatment of cancer, improving quality of life initiatives and survival odds, and improving the practice of oncology medicine.
Lahey participates in a variety of these cooperative trials sponsored by the Adult Cooperative Clinical Trials Groups listed below
- ACOSOG: formally American College of Surgeons Oncology Group
- CALGB: Cancer and Leukemia Group B
- ECOG: Eastern Cooperative Oncology Group
- GOG: Gynecologic Oncology Group
- NSABP: National Surgical Adjuvant Breast and Bowel Project
- RTOG: Radiation Therapy Oncology Group
- SWOG: formally SouthWest Oncology Group
You may search an alphabetical listing of condition or disease to find a cancer trial that may be right for you.