The National Institute for Health and Care Research (NIHR) has launched a groundbreaking 'Just in Time' clinical trial initiative that could revolutionize how quickly new treatments reach pancreatic cancer patients. The scheme, being piloted for the first time in the PemOla trial, aims to reduce clinical trial setup time from several months to just days.
Revolutionary Trial Access Model
The 'Just in Time' scheme represents a fundamental shift in clinical trial operations, enabling hospitals to join trials when they identify eligible patients rather than going through lengthy pre-approval processes. This approach could dramatically expand patient access to experimental treatments by allowing more hospitals to participate and treating patients closer to home.
Dr Pippa Corrie, consultant medical oncologist at Addenbrooke's Hospital and researcher at the Department of Oncology, University of Cambridge, is leading the PemOla trial that serves as the pilot for this innovative approach.
Targeting Pancreatic Cancer's Genetic Complexity
The PemOla trial focuses on a precision medicine approach, exploring combination immunotherapy using pembrolizumab and olaparib specifically for pancreatic cancers characterized by a large number of genetic changes. This targeted strategy addresses one of the key challenges in precision medicine: identifying the small fraction of patients most likely to benefit from specific treatments.
Olaparib, originally discovered by Steve Jackson's laboratory at Cambridge University and commercialized through KuDOS before its acquisition by AstraZeneca, represents a significant Cambridge contribution to cancer treatment development.
Addressing Critical Unmet Medical Need
Pancreatic cancer remains one of the most formidable oncological challenges, with statistics highlighting the urgent need for new therapeutic approaches. Despite being among the ten most common forms of cancer, only one in five patients receive diagnosis in early stages. The long-term prognosis remains particularly dire, with only 5% of pancreatic cancer patients surviving more than 10 years beyond diagnosis.
The disease has seen remarkably little progress in patient outcomes over the past 50 years, despite extensive research efforts. While precision medicine has transformed treatment landscapes for many cancer types, pancreatic cancer patients have largely been left behind, with treatment options beyond standard surgery and chemotherapy remaining severely limited.
Immunotherapy Strategy
The trial's immunotherapy approach aims to activate the body's immune system to attack and destroy cancer cells. Immunotherapy drugs have demonstrated high effectiveness when administered to appropriate patients as precision medicines, making patient selection crucial for success.
Potential Impact on Clinical Research
If successful, the 'Just in Time' initiative could accelerate patient recruitment across clinical trials, reduce completion timelines, and decrease the administrative burden of establishing new trial sites. This could represent a significant advancement in developing precision medicines for rare patient populations who currently face limited treatment options.
The initiative aligns with NHS 10-year plan objectives to expand patient access to innovative medicines by accelerating clinical trials and integrating them more seamlessly into routine patient care. The urgent need for new pancreatic cancer treatments makes PemOla an ideal testing ground for this potentially transformative approach to clinical trial management.
