Patients' selection and trial matching in early-phase oncology clinical trials.

BACKGROUND: Early-phase clinical trials (EPCT) represent an important part of innovations in medical oncology and a valuable therapeutic option for patients with metastatic cancers, particularly in the era of precision medicine. Nevertheless, adult patients' participation in oncology clinical trials is low, ranging from 2% to 8% worldwide, with unequal access, and up to 40% risk of early discontinuation in EPCT, mostly due to cancer-related complications. DESIGN: We review the tools and initiatives to increase patients' orientation and access to early phase cancer clinical trials, and to limit early discontinuation. RESULTS: New approaches to optimize the early-phase clinical trial referring process in oncology include automatic trial matching, tools to facilitate the estimation of patients' prognostic and/or to better predict patients' eligibility to clinical trials. Classical and innovative approaches should be associated to double patient recruitment, improve clinical trial enrollment experience and reduce early discontinuation rates. CONCLUSIONS: Whereas EPCT are essential for patients to access the latest medical innovations in oncology, offering the appropriate trial when it is relevant for patients should increase by organizational and technological innovations. The oncologic community will need to closely monitor their performance, portability and simplicity for implementation in daily clinical practice.

[10-year outcome of aortocoronary bypass. Apropos of a consecutive series of 114 patients]. / Devenir à 10 ans des pontages aorto-coronaires. A propose d'une série consécutive de 114 patients.

The cases of 114 consecutive patients undergoing saphenous vein coronary bypass surgery over 10 years ago were reviewed. The perioperative mortality was 2.6% and the incidence of non-fatal myocardial infarction in the same period was 6.1%. The 10 year survival rate was 80%; the most important prognostic factor for survival was left ventricular function (89% vs 51%; p less than 0.001). Other significant prognostic factors were the degree of revascularization (p less than 0.05) and the severity of the coronary artery disease (p less than 0.05). The incidence of recurrent ischaemia during follow-up depended mainly on the quality of myocardial revascularisation (p = 0.003). Taking into account the high proportion of patients with single vessel disease in this series (38.6%), our results were comparable with other reported studies of the same subject and the same period (1970-1976).