title: Exclusion of Gastrointestinal Cancer Patients With Prior Cancer From Clinical Trials: Is This Justified?
abstract: Strict eligibility criteria are necessary to maintain patient safety and scientific validity in clinical trials. However, this may lead to impaired generalizability of results. As survival in gastrointestinal (GI) cancer relates mainly to the GI malignancy, we hypothesized that previous cancers do not impact on survival and are not a rational exclusion criterion.
  
  
  
  Patients treated with chemotherapy for a GI cancer in 2006 were identified from the electronic patient record at the Royal Marsden Hospital, London. Chart review was performed and patient age, gender, GI cancer stage, prior cancer stage, clinical trial availability/eligibility, and dates of cancer recurrence, death, and last follow-up were collated.
  
  
  
  A total of 697 patients were identified. Fifty-four patients (8%) had a prior cancer; commonly breast (26%), prostate (17%), or colon (9%); most were stage I (42%) or II (37%). Two hundred ninety-seven (65%) patients had GI cancer recurrence, 7 (12%) patients had relapse of a prior cancer. Five hundred four (72%) patients have died, 170 (24%) are alive with no cancer, and 23 (3%) patients are alive with cancer. A total of 476 (94%) died of GI cancer, 2 (0.3%) of their prior cancer. Of all patients, 489 (70%) had an available trial, but 30% of patients with a prior cancer were ineligible for this reason. Overall and GI-cancer-specific survival were comparable for patients with/without a prior cancer.
  
  
  
  Survival for patients with a GI cancer requiring chemotherapy relates to the GI cancer and rarely a prior cancer. These patients should not be excluded from clinical trial participation.
authors.affiliation: Department of Gastrointestinal Oncology, Royal Marsden Hospital, Sutton, UK.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Smyth
authors.affiliation: Department of Gastrointestinal Oncology, Royal Marsden Hospital, Sutton, UK.
authors.forename: Noelia
authors.initials: N
authors.lastname: Tarazona
authors.affiliation: Royal Marsden Hospital, Sutton, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Peckitt
authors.affiliation: Royal Marsden Hospital, Sutton, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Armstrong
authors.affiliation: Heartlands Hospital, Bordesley Green East, Birmingham, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Mansukhani
authors.affiliation: Department of Gastrointestinal Oncology, Royal Marsden Hospital, Sutton, UK.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: Department of Gastrointestinal Oncology, Royal Marsden Hospital, Sutton, UK. Electronic address: ian.chau@rmh.nhs.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Chau
mesh_terms: D000368:Aged; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016609:Neoplasms, Second Primary / Q000188:drug therapy* / Q000401:mortality; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Colorectal neoplasms; Esophageal neoplasms; Gastrointestinal neoplasms; Pancreatic neoplasms; Stomach neoplasms