Voices: A Seat at the Big Table
A Seat at the Big Table | Erin Stevens, MD
The first Gynecologic Oncology Group (GOG) meeting I went to was in January 2011, my first year of fellowship. The January meeting is in sunny San Diego, which was a stark contrast to the bleak winter New York City had that year. I was eager for a break from the clinical service and looking forward to the opportunity to learn more about the clinical trials I had been enrolling patients into for the last six months. I had attended many educational meetings before, but the SGO Annual Meeting is very different from the GOG Semi-Annual meeting.
I was sitting in Corpus Committee in the back row when I pulled out my phone and sent a quick text to my mentor.
“How do you get to sit at the big table?”
The meeting is arranged with a big table in the center of the room. Seated around the table are many of the movers and shakers in the realm of gynecologic oncology clinical trials research. And they do all of the talking—the rest of the attendees observe from rows of chairs in the back. As they rattled through updates on closed, current, and future protocols, I simply sat in awe. My phone vibrated and I surreptitiously checked it.
“You get nominated.”
“By who?” I fired back.
“Your PI.” I’m pretty sure that was followed by a comment along the lines of “slow down, young grasshopper, you’re getting ahead of yourself,” but the idea was already implanted. Too nervous to tell anyone, I kept the thought in the back of my mind. I figured I didn’t know enough about the intricacies of gynecologic oncology and still had a great deal to learn before I decided to focus on clinical trials.
Fast forward two years. As a third year fellow, I was back at the GOG Semi-Annual Meeting in San Diego in January 2013. This time, it was more rainy than sunny. In those two years, I not only enrolled patients into clinical trials but had the opportunity to write my own after being selected for the ASCO/AACR Methods in Clinical Cancer Research Workshop in Vail, CO. That course was the first time I admitted out loud that I wanted to be at the big table at GOG. This past GOG conference was a little more about meeting people and networking than the first meeting I attended. I was glad to see the faces of the people I’ve met along the way and new people who I’m looking forward to working with.
I always tell my patients that I’m biased toward clinical trials because I strongly believe they are our best shot to answer the question of what the optimal treatment is for their type of cancer. But oncology clinical trials are frustrating on so many levels. Laboratory cancer research doesn’t easily translate into clinical successes. What scientists see happen on a petri dish to a lump of cancer cells exposed to a novel treatment just doesn’t seem to work quite the same when given to a human, simply because we are composed of more than just a lump of cancer cells.
Even when we have a good drug that’s shown promise, there is a huge time commitment to completing the trial. To reach the endpoint of five year survival – well, you have to wait five years. And that doesn’t count the number of years it may take to enroll enough patients to answer the question. That’s a long time to get an answer. And it doesn’t come cheap. Running a Phase III nationwide clinical trial for oncology can cost more than $100 million dollars. While you’re waiting for that answer from the first trial, new drugs and new treatments are coming down the pipeline that may be even better. Yet you still don’t have the answer to your first question. But we forge ahead, trying to find surrogate endpoints other than overall survival. Creating novel Phase II designs that cut down on the expense and time of the trials while still answering the ultimate question – is this the drug that will ultimately lead to cure of gynecologic cancers?
I’m not at the big table–yet. But I’ll be there. Just you wait.