Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

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

References

  1. Bray, F., Jemal, A., Grey, N., Ferlay, J. & Forman, D. Lancet Oncol. 13, 790–801 (2012).

    Article  Google Scholar 

  2. Allemani, C. et al. Lancet 385, 977–1010 (2015).

    Article  Google Scholar 

  3. IARC. World Cancer Report 2014 (eds. Stewart, B.W. & Wild, C.P.) (IARC, 2014); http://publications.iarc.fr/Non-Series-Publications/World-Cancer-Reports/World-Cancer-Report-2014

  4. Gyawali, B., Sullivan, R. & Booth, C. M. Lancet Oncol. 19, 288–290 (2018).

    Article  Google Scholar 

  5. Heneghan, C. et al. BMJ Open 3, e003298 (2013).

    Article  Google Scholar 

  6. Viergever, R. F. & Li, K. BMJ Open 5, e008932 (2015).

    Article  Google Scholar 

  7. Tran, V. T. & Ravaud, P. BMC Med. 14, 102 (2016).

    Article  Google Scholar 

  8. Fan, H. & Song, F. Sci. Rep. 5, 13221 (2015).

    Article  CAS  Google Scholar 

  9. Trimble, E. L. et al. J. Clin. Oncol. 27, 5109–5114 (2009).

    Article  Google Scholar 

  10. Wang, H. et al. Cancer https://doi.org/10.1002/cncr.29456 (2015).

    Article  CAS  Google Scholar 

  11. Badwe, R. et al. J. Clin. Oncol. 29, 2845–2851 (2011).

    Article  CAS  Google Scholar 

  12. Chinnock, P., Siegfried, N. & Clarke, M. PLoS Med. 2, e107 (2005).

    Article  Google Scholar 

  13. DeMonaco, H. J., Ali, A. & Hippel, Ev Pharmacotherapy 26, 323–332 (2006).

    Article  Google Scholar 

  14. D’Cruz, A. K. et al. N. Engl. J. Med. 373, 521–529 (2015).

    Article  Google Scholar 

  15. Badwe, R. et al. Lancet Oncol. 16, 1380–1388 (2015).

    Article  Google Scholar 

  16. Cavalli, F. & Atun, R. Lancet Oncol. 16, 133–134 (2015).

    Article  Google Scholar 

  17. Pantziarka, P. et al. ecancer 12, 886 (2018).

    Google Scholar 

  18. Ali, R., Toh, H.-C. & Chia, W.-K., ASCOLT Trial Investigators. Trials 12, 261 (2011).

    Article  CAS  Google Scholar 

  19. Lomas, J. Br. Med. J. 334, 129–132 (2007).

    Article  Google Scholar 

  20. Degos, L. Br. J. Haematol. 122, 539–553 (2003).

    Article  Google Scholar 

  21. Ferreccio, C. & Gage, J. Visual inspection of the uterine cervix with Acetic Acid (VIA): a critical review and selected articles (Pan American Health Organization, 2003); http://iris.paho.org/xmlui/handle/123456789/767

  22. Coyle, C. et al. Contemp. Clin. Trials 51, 56–64 (2016).

    Article  Google Scholar 

  23. Soria, J.-C. et al. Lancet 389, 917–929 (2017).

    Article  CAS  Google Scholar 

  24. Prasad, V., Kumar, H. & Mailankody, S. J. Glob. Oncol. 2, 1–3 (2015).

    PubMed  PubMed Central  Google Scholar 

  25. Binagwaho, A., Wagner, C. M. & Farmer, P. E. J. Clin. Oncol. 34, 3–5 (2016).

    Article  CAS  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bishal Gyawali.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

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

This article is cited by

Search

Quick links

Nature Briefing: Cancer

Sign up for the Nature Briefing: Cancer newsletter — what matters in cancer research, free to your inbox weekly.

Get what matters in cancer research, free to your inbox weekly. Sign up for Nature Briefing: Cancer