Cancer / clinical trials in the early 2000s

[fov]

I'm working on a time travel story where the protagonist can see how actions she takes in the early 2000s play out in 2019.

I have a character (a woman in her forties or fifties) diagnosed with cancer, and the protagonist knows she's supposed to die in 2006. Sometime between 2001 and 2006, the protag gets the sick character into a clinical trial. If she gets the real drug she's still alive in 2019 (and preferably cancer-free); if she gets the placebo she dies.

Does anyone have suggestions for what the cancer and trial could be? It doesn't necessarily need to be a real drug, but I want it to be believable in terms of what treatments were available in the early 2000s. I was going to give the character lung cancer, but since that's a fairly lethal cancer I'm not sure if she would still be alive 13 years later, even if the clinical trial works well for her.

Thank you!

 

[MaeZe]

Take some cancers that are curable today and work backwards to find when treatment for said cancers began.

 

[neandermagnon]

I worked in an admin role at a breast cancer clinic in the early 00's. Tamoxifen was the big game changing drug of the day. Although by then it was not a trial drug any more. You'll have to look up the technical details; I wasn't involved in the medical side of things. I mostly went to the various different hospital labs/departments for things like xrays, test results etc. Back then, if you had stage 1-2 cancer you had a good chance of surviving (not just from Tamoxifen though, surgery was also done, plus other treatments - I don't know the precise details). Stage 3 less so, stage 4 unlikely. A bigger survival factor was catching the cancer early. Also, I don't think Tamoxifen works on every single kind of breast cancer, although again, I don't remember the details, being a clinic clerk not medical staff. (I did have to decipher doctors' handwriting and have a familiarity with medical terminology - one of the doctors handwriting was so terrible it looked the same upside down as it did the right way up.)

If you want something being researched at that time you could look into other drugs of the same type, see when they were licenced for use. Clinical trials take 5 years or so, assuming all the trials go well, before they're used generally. So if your story takes place in 2003, look for things that were licenced for use from around 2005-2010

NOTE: all the above applies to the UK and NHS.

Have you considered having your MC get the character to see a doctor sooner? i.e. catch it in stage 2 not stage 3? Given what I know, this would do more to tip the balance in a character's favour than getting them on a clinical trial. Although there's nothing wrong with the clinical trial idea - just wanted to throw the idea out there in case it helps.

IMPORTANT NOTE: the above is based on what I knew in the early 00's - there are treatments being developed now that are having more success at treating even stage 4 cancers - one that involve the immune system (kind of like a vaccine, where you prime the immune system to destroy the cancer) - these were in the theoretical stage when I was at uni (I graduated in 2000) and researchers were working on them, however the actual development takes a long time, before you get to the clinical trial stage. AFAIK this type of treatment is still in the clinical trial phase, but they look promising. I could be behind the times though as I haven't read up on this topic recently.

 

[Unimportant]

Do you want her to be in a phase I or 2 clinical trial and get bloody lucky, or do you want her in a phase 3 or 4 clinical trial?

ETA: not sure of the exact timeline, so you'd need to look it up, but thalidomide for multiple myeloma and other haematological malignancies might give you the most bang for your buck, story-wise, since thalidomide has such a notorious history.

ETA: Ah, here you go: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573415/ Approved by the FDA in 2006 for MM. Does that fit your timeline?

 

[Chris P]

For the U.S., try poking around https://clinicaltrials.gov. I've not explored that site very much, but I would be very surprised if they didn't include trials from that time period.

 

[waylander]

Dasatinib, approved in 2006 so in trials in your time period https://en.wikipedia.org/wiki/Dasatinib

 

[P.K. Torrens]

perspective here from a surgical oncologist

Nothing exists for solid organ cancer as you need.

Mid 2010’s pembrolizumab (keytruda) came out for melanoma, which is THE miracle drug. And even that has response rates like:
- 30% patients respond with an additional 9 months of life benefit (average)
- of those 30%, 10% will get the tail effect (3% overall) where they can get 36months + response

Cancer drugs for the majority of cancers aren’t that great at prolonging life eh. Unless you’re talking lymphoma or leukaemia, radiation and surgery is what gives you “cure”.

If you’re going to find a drug that fits, you may find something in leukaemia or lymphoma literature. A good example is Glivec (Imatinib), and I’m pretty sure that came out early 2000’s. That was a bit of a game changer

 

[Unimportant]

perspective here from a surgical oncologist

Nothing exists for solid organ cancer as you need.

Mid 2010’s pembrolizumab (keytruda) came out for melanoma, which is THE miracle drug. And even that has response rates like:
- 30% patients respond with an additional 9 months of life benefit (average)
- of those 30%, 10% will get the tail effect (3% overall) where they can get 36months + response

Cancer drugs for the majority of cancers aren’t that great at prolonging life eh. Unless you’re talking lymphoma or leukaemia, radiation and surgery is what gives you “cure”.

If you’re going to find a drug that fits, you may find something in leukaemia or lymphoma literature. A good example is Glivec (Imatinib), and I’m pretty sure that came out early 2000’s. That was a bit of a game changer

Agreed that Imatinib was a stand-out breakthrough drug, but the clinical trials started in 1998 and it was FDA approved in 2001 -- so the timeline may be a little too early for the OP?

And agreed that haematological cancers are likely to be the best target disorder for this particular storyline.

 

[fov]

Thanks so much for the great suggestions! I'll look into these.

Have you considered having your MC get the character to see a doctor sooner? i.e. catch it in stage 2 not stage 3? Given what I know, this would do more to tip the balance in a character's favour than getting them on a clinical trial. Although there's nothing wrong with the clinical trial idea - just wanted to throw the idea out there in case it helps.

I did consider having the MC help get the cancer detected earlier (and it was originally going to be breast cancer), but I was having trouble reconciling it with the story. I also like the randomness of a trial where you might get the cure or might get the placebo, but it makes sense that surgery and chemo/radiation are more of a predictor for survival than medication. Leukemia or lymphoma seem like they could work better, for that reason.

Or another thought is that even with the tumor removed and chemo/radiation, the cancer returned, but the drug prevented the recurrence? But no need to over-complicate it if I can make it work with leukemia or lymphoma.

Do you want her to be in a phase I or 2 clinical trial and get bloody lucky, or do you want her in a phase 3 or 4 clinical trial?

I hadn't considered this, and I'm not sure if it matters for the story, but this is a good question and I'll give it some thought.

Thank you again! I had no idea where to look for this and now I have some good starting points.

 

[Unimportant]

I also like the randomness of a trial where you might get the cure or might get the placebo

Um, no. That's unethical. Clinical trials aren't structured that way. Clinical trials testing new cancer drugs in patients will generally have the control group getting the standard treatment and the test group getting the standard treatment plus the new drug.

In early phases where they're just looking at safety, then, yes, they'll give healthy people either the drug or a placebo, but that's to test for side effects. Even in intervention trials where, for example, they're giving schoolkids fortified milk versus normal milk to look at bone growth, as soon as they see a significant difference they have to stop the trial because it's unethical to withhold the fortified milk from the control group.

 

[veinglory]

There has been a lot of progress on Leukemia during this time. Perhaps a tyrosine kinase inhibitor (TKI) treatment.

 

[waylander]

There has been a lot of progress on Leukemia during this time. Perhaps a tyrosine kinase inhibitor (TKI) treatment.

That is how Dasatinib works