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

Nature Cancer volume 1, pages 142–145 (2020)Cite this article

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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.

Cancer is a global health problem. It is estimated that by 2030, more than 20 million cancer cases will have been diagnosed each year, with the majority of cases occurring in low- and middle-income countries (LMICs) (defined by the World Bank as countries with a gross national income per capita of US$1,025 or less (low-income) or $1,026 and $3,995 (lower-middle income))1. Key differences between LMICs and high-income countries (HICs) become apparent when cancer mortality rates are considered. Although analyses are often hampered by limitations in population coverage and data collection, among countries with reliable age-adjusted survival data, 5-year survival is lower for many LMICs than for HICs for a number of common cancers, including cancers of the breast, colon and rectum2.

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

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Acknowledgements

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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Author notes

  1. These authors contributed equally: Bishal Gyawali, Gauthier Bouche.

Authors and Affiliations

  1. Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Canada

    Bishal Gyawali

  2. Anticancer Fund, Strombeek-Bever, Belgium

    Gauthier Bouche

  3. The House of Lords of the United Kingdom, London, UK

    Nigel Crisp

  4. Department of Pediatric Hematology-Oncology, L’Assistance publique–Hôpitaux de Marseille, La Timone Children Hospital, Marseille, France

    Nicolas André

  5. Aix-Marseille University, Institut Paoli-Calmettes, SMARTc, Marseille, France

    Nicolas André

Authors
  1. Bishal Gyawali
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  2. Gauthier Bouche
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  3. Nigel Crisp
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  4. Nicolas André
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Corresponding author

Correspondence to Bishal Gyawali.

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Competing interests

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). https://doi.org/10.1038/s43018-020-0030-x

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