From some brief reading of the relevant literature (references provided at the bottom);
a) PET scans are not typically part of standard diagnostic or management protocols for acute myeloid leukemia (AML). Their use is generally confined to cases where extramedullary disease (EMD) is suspected. Even in these scenarios, the evidence regarding their prognostic value remains inconclusive. This could evolve if future studies demonstrate a clear benefit. b) Therefore, the request by RAC for a PET scan before entering the Bisantrene trial, would (on its own) be classified as experimental under current norms (in that it is new, and also generates new data). This fundamentally alters the situation: regardless of a clinician's agreement, the procedure would still be considered investigational. Consequently, it isn’t about uptake in clinical practice but rather recruitment into a study. c) Recruitment for clinical trials is not obligatory. It often hinges on how effectively the local advocate (or "champion") encourages colleagues to participate. This is where "buy-in" becomes important - it is voluntary and influenced by perceived benefits. When the benefits are clear, engagement increases.
I say its INTERESTING because RAC (or their advisors) would have known all of this, and so I assume they were aware of the risk! I am not suggesting there is anything they could have done about it until it happened - the local Champ always has a big job to do in these things. An idea perhaps - how about a PET scan as the only doorway to the wonderful cardio-protective RC220 (the carrot)? Maybe it was a case of clinicians not appreciating the benefits of eating carrots, coz in general, clinicians will go around seeking clinical trials just so they can get their patients on better treatment - including randomised trials that offer just 50% chance of being on the active therapy arm!
The DIFFERENCE between this CLINICAL TRIAL (experiment) that RAC wanted and a future situation in discussion (a choice between 2 licensed but differently performing diagnostics), is that, the need to avoid missing a cancer lesion is universal (NOT OPTIONAL). So, as long as the intervention is licensed, available, accessible (which includes physical availability, cost, etc), non or less invasive, clinicians will default to the superior option to improve patient outcomes.
Have a look too at how such a situation could pan out in the UK, where NICE guidelines are supreme (I have added this as an extra).
Acute myeloid leukaemia in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up https://www.annalsofoncology.org/article/S0923-7534(20)36079-8/pdf
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