Clinical Trials Leave Many ALL Patients Behind: Emily K. Curran, MD

Clinical trial access remains one of the most persistent barriers in cancer care, according to Emily K. Curran, MD, an associate professor of internal medicine at the University of Cincinnati College of Medicine, whose work focuses on the care of patients with leukemia.

Although trials are essential for advancing new treatments, Curran noted that strict eligibility criteria, put in place for safety, often exclude patients with impaired kidney function, even when a treatment is not renally cleared or in prior lines of therapy. In practice, this leaves clinicians making treatment decisions for real-world patients without the benefit of trial data to guide them.

Curran also pointed to a selection bias built into the trial system itself. Patients who enroll tend to be those willing and able to participate, and mistrust of clinical research means some communities remain underrepresented. Geography compounds the problem: patients living hours from a trial site may be unable to commit to visits spanning multiple consecutive days, even when institutions offer support such as discounted hotel stays.

For rare diseases such as acute lymphoblastic leukemia (ALL), Curran said community oncologists often lack hands-on experience with newer agents and regimens. Practical nuances, such as when to hold or dose-reduce a drug, rarely make it into published manuscripts. Compounding this, the pace of change in the field means that by the time findings are published, treatment approaches may have already evolved, leaving published literature outdated almost as soon as it appears.

Looking ahead, Curran pointed to decentralized clinical trials as a promising solution, allowing patients to receive care locally through their own oncologists, supplemented by virtual or occasional in-person visits rather than requiring travel to a central site. She also emphasized the need to reexamine eligibility criteria that may be overly restrictive relative to a drug’s actual mechanism.

Finally, Curran highlighted the importance of strengthening partnerships between community and academic centers. Because not every patient diagnosed with ALL can access a high-volume specialty center, she said academic institutions should serve as accessible resources for community practitioners managing rare disease cases, helping extend expert-guided care to patients regardless of where they live.