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Challenges and opportunities for cancer clinical trials in low- and middle-income countries

Low- and middle-income countries share the greatest burden of cancer mortality globally but lag behind high-income countries in terms of clinical trials. Here we discuss the challenges facing low- and middle-income countries and the opportunities for conducting trials of affordable, accessible and effective interventions relevant to the local population.

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Fig. 1: Identifying opportunities for co-development from the perspective of HICs and LMICs.


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We thank R. Viergever for sharing the codes for the estimation of the number of trials in HICs and LMICs6, and K. Beckers for help with the figure. B.G.’s work is supported by a Conquer Cancer Global Oncology Young Investigator Award. Any opinions, findings, and conclusions expressed in this material are those of the author(s) and do not necessarily reflect those of the American Society of Clinical Oncology or Conquer Cancer.

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Correspondence to Bishal Gyawali.

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N.A. has consulting contract with Bristol-Myers Squibb, has received funding from Bristol-Myers Squibb for a trial as well as drugs for two trials, and has received drugs for a trial from Pierre Fabre.

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Gyawali, B., Bouche, G., Crisp, N. et al. Challenges and opportunities for cancer clinical trials in low- and middle-income countries. Nat Cancer 1, 142–145 (2020).

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