2023-09-30 18:00:06
Etienne Brain, oncologist, at the Institut Curie, in Saint-Cloud (Hauts-de-Seine), June 1, 2022. LP/OLIVIER ARANDEL/PHOTOPQR/LE PARISIEN/MAXPPP
Noting that elderly or fragile populations are too often excluded from therapeutic trials, Etienne Brain, oncologist at the Institut Curie, on the Saint-Cloud site (Hauts-de-Seine), has directed his work towards the study of these populations in order to offer them more appropriate treatments. In June 2022, he received the Byrl James Kennedy Prize for Scientific Excellence in Geriatric Oncology, awarded by the American Association of Clinical Oncology (ASCO).
When did you realize the importance of adapting cancer treatments for fragile patients?
Between 1990 and 2000, chemotherapy delivered after surgery for breast cancer – with the aim of preventing relapses – became more aggressive. There has been a considerable escalation of his indications. At the beginning of the 2000s, I was able to observe serious accidents, some fatal, particularly among elderly or fragile patients. I was then struck by the inconsistent representation of these elderly subjects in clinical research: while half of cancers occur after the age of 65 – they will undoubtedly be 60% within ten years – 90% of people participating in trials cancer clinics are under 65 years old! And, among the 10% of participants over 65, the vast majority are under 70 and are selected for their satisfactory general health. This discordance between the clinical trial population and the population of the « real life” therefore leads to building recommendations on evaluations carried out on a relatively younger population, which is not the most affected, to apply them without discernment to older people.
Where does this discrepancy between the clinical trial population and the “real life” population come from?
Oncology is an extremely dynamic discipline where biotechnology has played an important role, relying on academic but also industrial research. However, when firms develop a new treatment, they want to reach a market as quickly as possible to justify their investments. They must therefore quickly demonstrate the benefit of the treatment, without being hampered by complications – the risk of which increases in the presence of complex health conditions, themselves more frequent with age. Result: these trials recruit very few elderly people. The model for developing new treatments is therefore intrinsically at odds with the vast majority of cancer patients, with those who are elderly representing a potentially large share of prescriptions. Behind this model, there exists an insidious law of the market that society has great difficulty admitting.
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