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Is Clinical Research Serving the Needs of the Global Cancer Burden? An analysis of contemporary global radiotherapy randomised controlled trials

Dodkins J, Hopman WM, Wells JC, Lievens Y, Malik RA, Pramesh CS, et al.

Int J Radiat Oncol Biol Phys, 2022 Feb 10.
PMID: 35151802 DOI: 10.1016/j.ijrobp.2022.01.053

PURPOSE: Randomized control trials (RCTs) are the cornerstone of delivering sustained improvements in cancer outcome. To inform radiotherapy research policy and prioritization, we analyze the radiotherapy RCT landscape including comparison with trials of systemic therapies over the same time period, with a specific focus on funding and disparities across income settings.
METHODS AND MATERIALS: This retrospective cohort study identified all phase three RCTs evaluating anticancer therapies published from 2014 to 2017. RCTs were classified according to anticancer modality and country of origin. Descriptive statistics were used to compare key characteristics of radiotherapy RCT studies according to study design characteristics, tumor types evaluated, types of intervention appraised, treatment intent and main funding sources.
RESULTS: The study cohort included 694 RCTs of which 64 were radiotherapy RCTs (9%) compared to 601 (87%) systemic therapy RCTs. 47% of all radiotherapy RCTs focused on two areas of evaluation; combining radiotherapy with systemic agents (25%) and changes in dose fractionation (22%). The most common cancers studied were head and neck (22%), lung (22%) and breast (14%) with cervical cancer trials only representing 3% of the cohort. 33% of radiotherapy RCTs met their primary end point. 62% of radiotherapy RCTs assessed interventions in the curative setting compared to 31% in systemic therapy RCTs. 77% of the radiotherapy RCTs were performed in high-income countries (HIC), 13% in low-and-middle-income countries (LMIC) and 11% in both HIC and LMICs. 17% of radiotherapy RCTs received funding from industry compared to 79% of systemic therapy RCTs.
CONCLUSION: This study has highlighted the need for greater investment in radiotherapy RCTs and the disparities in conduct of RCTs globally. The study emphases the urgent need for more capacity building for cancer clinical trials in LMICs and more sustainable funding sources.
Cancer Survivorship in the Indo-Pacific: Priorities for Progress

Koczwara B, Chan A, Jefford M, Lam WWT, Taylor C, Wakefield CE, et al.

JCO Glob Oncol, 2023 Jan;9:e2200305.
PMID: 36749908 DOI: 10.1200/GO.22.00305
Reply to E.C. Dee et al

Koczwara B, Chan A, Jefford M, Lam WWT, Taylor C, Wakefield CE, et al.

JCO Glob Oncol, 2023 Jun;9:e2300102.
PMID: 37290019 DOI: 10.1200/GO.23.00102
Fulltext Breast cancer early detection: A phased approach to implementation

Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Yataco JA, et al.

Cancer, 2020 May 15;126 Suppl 10(Suppl 10):2379-2393.
PMID: 32348566 DOI: 10.1002/cncr.32887

When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.