Good morning, everybody! One of the most important, and also most expensive, areas of cancer science is clinical trials. Generally, there are two main sponsors of cancer clinical trials: the National Institutes of Health and industry. Federally sponsored trials, experts often tell me, are incredibly important because they will investigate questions that industry often is not interested in investing in.

They’re also significantly more expensive to run for the academic site. In a paper published recently in JAMA Network Open, Fred Hutch Cancer Center researcher Joe Unger showed that per patient costs were significantly higher in federally sponsored trials compared to trials with both public and private sponsors. It also found that the median drug cost for federally sponsored trials was $7.6 million.

I also spoke with Randall Holcombe, the director of the University of Vermont cancer center, earlier this week who told me that cancer centers lose money on every patient they enroll for a federally sponsored trial, and that loss has gotten significantly greater over the years. That’s partly because federal investment has lagged or gone down relative to inflation, Holcombe and Unger said.

So, it seems like the landscape for federally sponsored trials has been weakening long before Trump started his second term, which we know has had significant disruptions for the national scientific enterprise. This can represent a loss for patients who can benefit greatly from knowledge that generally would only be gained through federally sponsored trials.

Maybe that does also open space for other, nonprofit or philanthropic organizations to make a big impact in the clinical arena. The AACR just recruited its first patient in the first AACR sponsored clinical trial.