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Disparities in cancer clinical trials among low‐ and middle‐income countries: A 20‐year analysis

Year: 2025

Type: article

Abstract: BACKGROUND: There are suspected disparities in clinical research (CR) development among low- and middle-income countries (LMICs). This study investigated differences in number and complexity of clinical trials (CTs) and how economic growth (EG) might contribute to these disparities. METHODS: For countries classified as LMICs in 2000, number, proportion of phase 1-2/3 and independent/pharma-sponsored CTs were documented. For correlations with EG, correlation coefficients (CC) were produced, indicating very weak, weak, moderate, strong, and very strong correlation. RESULTS: A total of 16,977 CTs were identified. Asian countries China and South Korea experienced strong EG and increases in CTs (very strong CC). South/Southeast Asian countries had strong EG but modest increases in CTs (variable CC). Most East European countries and West Asian/Southeast European Turkey experienced robust EG and increases in CTs (moderate to strong and very strong CC, respectively). South/North American Argentina, Brazil, and Mexico had inconsistent EG but increases in CTs (weak to moderate CC). Among African countries, Egypt showed strong EG with a corresponding increase in CTs (strong CC), whereas South Africa had a weak CC. Most LMICs, except for China and South Korea, relied heavily on pharma-sponsored CTs, with a persistently low proportion of early-phase (1-2) compared to late-phase (3) CTs. CONCLUSION: CR development has been unequal among LMICs. Strong EG could be a contributing factor but only to some extent. Only China and South Korea meaningfully developed independent and high-complexity CR. These data reinforce the need for initiatives to support cancer research in LMICs.

Source: Cancer

DOI: 10.1002/cncr.70067