Finding Hope with Clinical Trials: Q&A with Nick Slack

Nick Slack
Chairman and CEO
START Center for Cancer Research

Clinical trials can offer patients who have run out of options with another chance at treatment. Unfortunately, actually getting enrolled in clinical trials is a much more complicated process than many people realize. Nick Slack, chairman and CEO of The START Center for Cancer Research, spoke with Pharmaceutical Executive about how his company works to make this easier on patients.

Pharmaceutical Executive: How did you get involved in this work?
Nick Slack: My background is nearly 20 years in the clinical research space, largely working for companies that have supported the process of clinical research, trying to make it function better for all parties, patients, researchers, biopharma companies, heroes, etc. And I recently took over as chairman and CEO of START.

I'll start off by explaining what some of the obstacles hospitals are facing when it comes to supporting breakthrough clinical trials in oncology.

With clinical research trials, over 50% of them are in cancer. So half of all clinical trials start in cancer. About 80% of cancer patients are treated in community health care systems, community, community settings, or community oncology practice groups. The majority of cancer clinical trials are conducted inside of academic medical centers. Typically, academic medical centers only see about 20% of cancer patients.

As a result, there's a huge access issue for cancer patients when they need a clinical trial.

So, typically if you fail on third line standard of care approved therapy, finding a clinical trial is literally the next option. You can almost think about it de facto as standard of care. What's frightening is that the majority of cancer patients will not have access to a clinical trial when they need one, because so many of those trials are happening inside of the academic medical centers. So, you got a huge healthcare access issue. That's really facing all of us.

The other part of that is the biopharma companies are conducting the majority of their trials in those same academic medical centers who are literally out of capacity to take any more of those trials on. As a result of that it takes months, if not a year, just to open a trial at an academic medical center. They rarely enroll on time, if they enroll at all. Meanwhile, those trials could be placed in community settings, benefiting the researchers, physicians, and the patients.

What we do at START, we focus on early phase oncology trials. Since 50% of clinical trials happen in cancer, the fastest growing segment of those trials are in early phase oncology. What we do at START is actually set up early phase oncology trial clinics inside of community oncology practice groups and hospitals. We do that globally. We have 25 early phase oncology investigators, which makes our team not just one of the largest in the world, but also one of the most experienced in the world. We're able to bring those trials into the referring physicians who need those trials for their patients.

PE: you could maybe go into a little more detail how important these trials are for the patients trying to get into.
Slack: If you're a patient, or your family member is a cancer patient, and you fail on third line, your only option literally is a clinical trial. It's that important. It could be the difference between life and death, it could be the choice between hope or not having any hope at all. Any way you look at it, it is absolutely critical to deliver comprehensive cancer care, and you cannot deliver cancer care without having clinical trials. Unfortunately, the majority of patients will not have that option.

PE: One of the big things preventing patients are geographic barriers. What? are some of the solutions you found for that.
Slack: There are geographic barriers, but then there's just convenience and trust barriers. Let's talk about those first because patients will travel for clinical trials. What they really want is to have options, such as where they are and where they're being treated. If they've established trust with their medical oncologist, they want to stay put. They don't want to have to go and navigate a large academic medical center. The most important thing is to be where those patients want to be treated, and have options to give them where they are. That's one aspect of what we do at START. We literally meet the patients where they are and provide pathways for them and the referring physicians to take part in a clinical trial if their care calls for it.

There's also there's also just the phenomenon of how difficult it is to navigate the system to find trials. How do you navigate a major academic medical center? How do you find the right researchers? How do you find the right trials? If you're not seamlessly interconnected in your care journey with your referring physician and a researcher who's right there with you, then it's very, very challenging. Everything that we do is to focus on optimizing those pathways. We're constantly talking to the referring physicians in our clinics about the trials that we have for patients who might be in need of those trials. And we make it as easy as possible for the patients to participate if they need to.

PE: Could you go into more detail about some of the successes you've seen at START?
Slack: There are a lot of ways to measure success, but I would say one of the wonderful things in our history is that we enrolled the first patient ever to take Keytruda pembrolizumab. Keytruda, obviously, has been the most successful cancer drug of all time. However, you look at it, mainly from a survivability standpoint, and to have dosed the first patient in the world on that game changing drug, speaks to a very rich history.

Of course, our history is more expansive than that. To date, we have supported 43 FDA new therapies that have been approved, a number of which have been breakthrough status. And, you know, in the process, I would just say, there's no clear way to measure hope. But we give patients hope every single day who need a clinical trial who would not otherwise have access to those trials were it not for START.