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The Alliance for Clinical Trials in oncology today announced that an independent Data and Safety Monitoring Board (DSMB) determined that the phase III CABINET (A021602) pivotal trial met its primary endpoint at an interim analysis in both of the trial’s cohorts, demonstrating statistically significant and clinically meaningful improvements in progression-free survival (PFS).

CABINET is evaluating cabozantinib compared with placebo in patients with either advanced pancreatic neuroendocrine tumors (pNET) or advanced extra-pancreatic neuroendocrine tumors (also referred to as carcinoid tumors) who experienced progression after prior systemic therapy. The DSMB recommended the study stop early due to efficacy and findings will be discussed with the U.S. Food and Drug Administration. Detailed results from the trial will be presented at an upcoming scientific meeting.

“Patients with progressive neuroendocrine tumors have limited treatment options. At present, after progression on previous therapies, the treatment path is unclear, underscoring the need for additional options for this disease that is rising in incidence,” said Jennifer Chan, MD, MPH, study chair for the CABINET trial and Clinical Director of the Gastrointestinal cancer Center and Director of the Program in Carcinoid and Neuroendocrine Tumors at Dana-Farber cancer Institute.

“These promising findings from the CABINET trial, in which cabozantinib showed an efficacy benefit for patients with pancreatic and extra-pancreatic neuroendocrine tumors, are welcome news and show the potential for cabozantinib to address important unmet needs for this community.”

The safety profile of cabozantinib observed in the trial was consistent with its known safety profile, and no new safety signals were identified.

“The Alliance and NCTN have a long and established history of successful practice changing cancer clinical trials. The results of CABINET add to this important work to further improve the outcomes of patients with the rare tumors of pancreatic and extra-pancreatic NET,” said Suzanne George, MD, Interim Group Chair of the Alliance, Associate Professor of Medicine at Harvard Medical School and Clinical Director at the Center for Sarcoma and Bone oncology at Dana-Farber cancer Institute.

CABINET (Randomized, double-blinded phase III study of cabozantinib versus placebo in patients with advanced neuroendocrine tumors after progression on prior therapy) is a multicenter, randomized, double-blinded, placebo-controlled phase III pivotal trial that enrolled 290 patients in two separate cohorts (pNET, n=93; extra-pancreatic NET, n=197) in the United States.

Patients were randomized 2:1 into the cabozantinib or placebo arms of the study in each of the two cohorts. Patients must have had measurable disease per RECIST 1.1 criteria and must have experienced disease progression after at least one FDA-approved line of prior therapy other than somatostatin analogs. The primary endpoint was PFS in each cohort. Upon confirmation of disease progression, patients were unblinded, and those receiving placebo were permitted to cross over to open-label therapy with cabozantinib. Secondary endpoints included overall survival, radiographic response rate and safety.

“The CABINET trial is a great example of the importance of the National Clinical Trials Network, sponsored by the National cancer Institute, in conducting rigorous, practice changing trials at both academic and community oncology practices throughout the United States, working with industry partners, patient advocacy, and academia,” noted Eileen O’Reilly, MD, from Memorial Sloan Kettering cancer Center and Jeffrey Meyerhardt, MD, MPH, from Dana-Farber cancer Institute, who co-chair the Gastrointestinal Committee for the Alliance.

Each year, about 12,000 people will be diagnosed with neuroendocrine tumors. These tumors are cancers that develop from cells in the diffuse neuroendocrine system. The cells can be found throughout the body, but the most common places for tumors to develop are in the gastrointestinal tract, lungs, and pancreas. Most NETs grow slowly, but some are more aggressive, growing rapidly and spreading to other parts of the body. There are several types of treatment for neuroendocrine cancer, including surgery, liver-directed therapy, somatostatin analogs, Chemotherapy, targeted therapy, and peptide receptor radionuclide therapy.

“This is great news for patients with advanced neuroendocrine tumors! You will now have another weapon in your arsenal against these cancers,” said Julie Krause, a GI patient advocate with the Alliance. “If you are progressing on standard care for treatment of pancreatic and extra-pancreatic neuroendocrine tumors, cabozantinib showed amazing results in the CABINET trial. I am very excited about this advance for these patients.”

Provided by
Alliance for Clinical Trials in oncology

When I first entered the world of cancer, in 2007, I really believed that everyone in the sector was doing the right things. Lovely charities, who might help me. Pharmaceuticals and research all doing their best to find a cure. Plus politicians who must be working against one of the worlds biggest killers, surely? My goodness, was I green and naive. Nothing could’ve been further from the truth, of course. As a businessman I could never understand, how the amount of financial and human resources put into cancer, didn’t produce the relative progress it should.

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But now, 16 years on, it really makes sense. No, I don’t believe the old chestnut about big pharma having the cure for cancer. But I DO believe that the entire sector is corrupt. Everyone earning more, as the world becomes sicker, and more reliant on drug companies. We have a less than transparent charity, cancer Research, running most of our research in the UK. Does that really make sense? Government ‘slipping in to bed,’ with private healthcare wherever they can. The NHS can only offer us the basic treatment in most cases, due to initial cost. Plus the incredible waiting lists, where many of us will die, before we even have the opportunity of treatment. Worst of all we are going backwards now. So here is my analysis about healthcare corruption, and why I believe we are experiencing it in the UK.

Examining Corruption in Healthcare Systems Around the World

Healthcare is a basic human right, but unfortunately corruption remains an insidious issue, plaguing health systems globally. From bribery to fraudulent billing practices, this article analyzes the complex factors that foster corruption in healthcare, and potential solutions.

Defining Corruption in Healthcare

Corruption encompasses an array of unethical practices. This includes bribes for preferential treatment, under-the-table payments for access to medicines or care, procurement fraud, informal payments, absenteeism, and the misappropriation of resources. Corrupt practices siphon off resources meant for patient care and infrastructure.

According to Transparency International, corruption is one of the top obstacles to achieving universal health coverage worldwide. But corruption looks different across contexts, demanding localized solutions.

Hotspots for Healthcare Corruption

Corruption in healthcare rears its head everywhere, but it thrives in particular environments:

Resource Limitations – Where healthcare resources like staff, equipment, and medicines are scarce, corruption often persists as workers exploit shortages for personal gain.

Weak Governance – Lack of accountability and oversight enables graft. Reform is difficult in bureaucratic systems or with political interference.

Low Wages – Underpaid healthcare staff are more tempted towards informal payments and misappropriation to supplement incomes.

High Out-Of-Pocket Costs – When patients pay most costs out-of-pocket, they may resort to bribery to skip long queues or access treatment.

Poverty – Poor populations are most burdened by corruption as they cannot afford bribes or private care.

Drivers and Enablers of Corruption

Complex factors enable corruption to metastasize in healthcare systems. These include:

• Asymmetric Information – When patients lack medical expertise, providers can exaggerate diagnoses for financial gain.
• Supplier Monopolies – Sole suppliers of medicines or equipment can charge inflated prices through procurement corruption.
• Perverse Incentives – Pressures like sales targets for doctors can encourage over-prescription.
• Deficient Laws – Loopholes regarding bribes, gifts from industry, and procurement processes enable corrupt behaviors.
• Cultural Acceptance – In some contexts, bribery is normalized as the only way to obtain care. This perpetuates the cycle.
• Poor Accountability – Absent or ineffective oversight, auditing, and prosecution allows corruption to flourish.

Impact on Patients and Populations

The impacts of corruption in healthcare are wide-ranging:

• Poor Quality of Care – Patients suffer from incorrect diagnoses, inadequate treatment, long queues, and subpar facilities. Preventable deaths may result.
• Inequitable Access – The poor struggle to obtain basic care while the wealthy pay bribes to jump queues. This worsens inequality.
• Inefficiency and Waste – Misused resources, fraud, and bloated bureaucracies inflate costs and deplete budgets.
• Loss of Public Trust – Corruption erodes faith in healthcare systems. Citizens disengage or resort to self-medication.
• Public Health Risks – Shortages caused by graft enable outbreaks and epidemics to spread.

Strategies to Curb Corruption

There are no quick fixes, but policies and actions to discourage fraud include:

• Transparency Initiatives – Open contracting, freedom of information laws, disclosures of gifts and assets, whistleblower protection.
• Participatory Governance – Patient empowerment through information campaigns, report cards, patient charters, community monitoring.
• Overhaul Procurement – E-procurement systems, rotation of suppliers, external audits on pricing.
• Performance Management – Develop key indicators on absenteeism, diagnosis accuracy, infection rates and monitor rigorously.
• Increase Accountability – Establish anti-corruption authorities, enforce codes of conduct, strengthen prosecution.
• Improve Pay and Incentives – Ensure health workers receive living wages. Link incentives to ethical patient outcomes.

The Path Forward

Corruption is a universal threat to healthcare, but it manifests in unique ways across different nations and cultures. Sustainable reform requires multiparty efforts, patient engagement, transparency, and system-level changes focused on accountability and incentives. There are no quick fixes, but a multifaceted approach can slowly bend the arc towards more equitable, ethical healthcare worldwide.

You may have seen many of the aspects above, feature very highly in this country. Yes, corruption is a strong word, but seeing what our Government have been doing, it’s not hard to see why I might think like that. A sick world is very profitable for many! As always these are my opinions based on personal experiences. I’m sure many won’t agree with me. So as always, please feel free to share your own views below.

Related

Lewis Christie is an acute myeloid leukemia (AML) survivor. He is a peer mentor with the National Bone Marrow Transplant Link (nbmtLINK) and Imerman Angels, where he assists other people with cancer near his age who are either contemplating a bone marrow transplant or who have already had one. He is also a patient advisor to a company developing artificial intelligence (AI) applications to help people with cancer. He is retired from his work as an information technology professional and is now an avid reader of history books, loves to listen to music, and likes to cook.

My story begins as a 9/11 cancer survivor. I had been in a building at Ground Zero on September 11, 2001, and returned there every day afterward for over a year, breathing in the carcinogenic ash that would compromise my immune system. Then, 10 years later, at the age of 71, I was diagnosed with acute myeloid leukemia (AML).

I received my diagnosis after having a bone marrow biopsy, where a needle was inserted in my lower back to remove some fluid. The doctor evaluating the biopsy sample said that my white Blood cell count was way too high, and my red Blood cells were being squeezed out. He immediately sent me to the hospital to receive 2 Blood transfusions. There, I learned that my red Blood cell count was dangerously low.

Receiving my cancer diagnosis was devastating because I had always been in good health. Also, I had no idea what I should do next. The first oncologist I consulted advised me that my prognosis was very bad and that I only had 1 year left to live. My wife and I then scheduled appointments with other oncologists who told me to take a vacation while I could, since they also felt I had 1 year left to live. So far, there was no encouragement or path to take to survive.

Turning to bone marrow transplant for life-saving treatment

Eventually, my wife and I found an oncologist who provided some hope. I started Chemotherapy, which lasted for 14 months. When planning treatment, my oncologist said that I should think about receiving a bone marrow transplant after Chemotherapy because my cancer could come back much worse, and she typically only saw success with the Chemotherapy for about 14 months. She gave me hope that a transplant could save or prolong my life. So, my oncologist searched for a donor through the national bone marrow registry and found a donor who was a match.

In March 2014, I received the transplant. I spent 30 days in the hospital and had relatively few side effects. However, 6 months later, the transplant failed for unknown reasons. My red and white Blood counts dropped to 0. I was then put back on Chemotherapy while my doctor searched for another donor. But, unfortunately, another donor could not be found through the registry.

At that point, my oncologist advised that she had seen transplant success using stem cells from the children of the person with cancer. So, in September 2014, my younger daughter donated her stem cells. She spent a day in the hospital where they took her Blood through a machine. Her stem cells were taken out, and the rest of her Blood was returned to her body. After, I was given a Blood transfusion with her stem cells.

Recovering from my bone marrow transplant

After this transplant, the side effects were completely different from my first transplant. I could hardly walk and experienced rashes, coughing, blurred eyesight, uncontrollable hiccups, loss of appetite, muscle cramping, indigestion, numbness in my feet, and night sweats. But after 30 days, when I could walk again, I was released from the hospital.

Being home was not easy. Our home had to be thoroughly cleaned so that I would not develop an infection, and I had to be very careful of what I ate. There was a list of things I could not eat, including any deli meats, fruits like strawberries and raspberries that could not be properly washed, and any bakery products. My wife cooked all of our meals; we had absolutely no takeout food. I was also generally confined to my home for 1 year. If I went out, I had to wear gloves and a mask. I only went out to doctor visits.

After coming home, I still had low Blood counts, so I went to the cancer center weekly to receive Blood platelets to help stop me from bleeding and an injection to boost my white Blood cell count. It took months before I was feeling much better. I slowly returned to where I could start eating normally, going outside to walk, and seeing friends and relatives. I had to avoid any physical contact with them so that I wouldn’t get an infection.

Life after bone marrow transplant

It has now been nearly 11 years since I first received my leukemia diagnosis. I feel very good and back to an almost normal life. My brother got me started playing golf, and my wife and I walk every day. I used to be a runner, but that is something I am no longer able to do.

However, my cancer story does not end there. After my second transplant, I developed chronic graft-versus-host disease (GVHD), a sometimes serious disease that only affects people with cancer who have received a bone marrow transplant using donor cells. With GVHD, the donor cells attack your body. Thankfully, my case of chronic GVHD has not been very bad. The symptoms I have experienced include easily bruising, constant skin peeling, trouble swallowing, hardening and cracking of my toenails and fingernails, dry eyes, reduced lung capacity that makes it hard to breathe at times, tooth decay, and annoying white patches in my mouth. While this may sound terrible, it’s not as bad as it seems. After being through 2 transplants, I can certainly handle all of this because I am still here!

I have found that being positive is probably one key to getting better. What really helped me as I was navigating cancer treatment and survivorship was attending support groups, talking to other people with cancer who had either thought about having a bone marrow transplant or who had received one, and working as a patient advisor to a company that was developing a computer program to relieve stress in people with cancer. Now, I have a lot of good things to look forward to for the rest of my life.

The author has no relevant relationships to disclose.