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Odedina FT, Shamley D, Okoye I, Ezeani A, Ndlovu N, Dei-Adomakoh Y, Meza K, Agaba R, Fathi P, Askins N. Landscape of Oncology Clinical Trials in Africa. JCO Glob Oncol 2021; 6:932-941. [PMID: 32614728 PMCID: PMC7392757 DOI: 10.1200/jgo.19.00189] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The burden of cancer in Africa is of significant concern for several reasons, including that incidence of cancer in Africa continues to rise while Africa is also dealing with communicable diseases. To combat cancer in Africa, oncology clinical trials are needed to develop innovative interventions for cancer prevention, screening, diagnosis, treatment, and survivorship. Unfortunately, there is a paucity of clinical trials in Africa and it is difficult for African clinicians to get information on open oncology clinical trials and impossible for African patients with cancer to access this information. The primary objective of this study was to identify open oncology clinical trials in Africa. METHODS This project was part of a large-scale study to develop an African Virtual Platform for Oncology Clinical Trials Registry. The study was a quantitative, web-based, retrospective review of clinical trials registries. RESULTS A total of 109 open oncology clinical trials were identified. Most of the trials were in Egypt, South Africa, Algeria, and Kenya. The top cancer types for oncology clinical trials in Africa were breast, cervical, and lung cancers. The top sponsor of oncology clinical trials in Africa was academic institutions, especially institutions in the United States. CONCLUSION The paucity of clinical trials in Africa will continue to magnify the global disparities of cancer in the African population. Clinical trials are needed to ensure therapeutic interventions are safe and effective in the African population. In the era of personalized and precision health, it no longer suffices to assume that drugs developed in North America, Europe, or Asia will be effective in the African population.
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Affiliation(s)
- Folakemi T Odedina
- University of Florida, Orlando, FL.,Prostate Cancer Transatlantic Consortium, Orlando, FL
| | | | - Ifeoma Okoye
- Prostate Cancer Transatlantic Consortium, Orlando, FL.,University of Nigeria, Nsukka, Nigeria
| | - Adaora Ezeani
- University of Florida, Orlando, FL.,Prostate Cancer Transatlantic Consortium, Orlando, FL
| | - Ntokozo Ndlovu
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Kimberly Meza
- Prostate Cancer Transatlantic Consortium, Orlando, FL
| | - Ruth Agaba
- Prostate Cancer Transatlantic Consortium, Orlando, FL
| | - Parisa Fathi
- University of Florida, Orlando, FL.,Prostate Cancer Transatlantic Consortium, Orlando, FL
| | - Nissa Askins
- University of Florida, Orlando, FL.,Prostate Cancer Transatlantic Consortium, Orlando, FL
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Tang M, Joensuu H, Simes RJ, Price TJ, Yip S, Hague W, Sjoquist KM, Zalcberg J. Challenges of international oncology trial collaboration-a call to action. Br J Cancer 2019; 121:515-521. [PMID: 31378784 PMCID: PMC6889481 DOI: 10.1038/s41416-019-0532-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 11/25/2022] Open
Abstract
International collaboration in oncology trials has the potential to enhance clinical trial activity by expediting the recruitment of large patient populations, testing treatments in diverse populations and facilitating the study of rare tumours or specific molecular subtypes. However, a number of challenges continue to hinder the efficient and productive conduct of both commercial and non-commercial international clinical trials. These challenges include complex and burdensome regulatory requirements, the high cost of conducting trials, and logistical challenges associated with ethics review, drug supply and biospecimen collection and management. We propose solutions to promote oncology trial collaboration, such as regulatory reform, harmonisation of trial initiation and management processes and greater recognition and funding of academic (non-commercial) clinical trials. It is only through coordinated effort and leadership from researchers, regulators and those responsible for health systems that the full potential of international trial collaboration can be realised.
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Affiliation(s)
- Monica Tang
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Robert J Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Timothy J Price
- The Queen Elizabeth Hospital and University of Adelaide, Adelaide, SA, Australia
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Wendy Hague
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Katrin M Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - John Zalcberg
- Alfred Health and the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Fiorin de Vasconcellos V, Rcc Bonadio R, Avanço G, Negrão MV, Pimenta Riechelmann R. Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status. BMC Palliat Care 2019; 18:42. [PMID: 31109330 PMCID: PMC6528308 DOI: 10.1186/s12904-019-0427-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC. Methods We analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3–4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality. Results Two hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1–507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P < 0.001) were significantly associated with 30-day mortality. Conclusions Patients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients.
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Affiliation(s)
- Vitor Fiorin de Vasconcellos
- Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil.
| | - Renata Rcc Bonadio
- Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil
| | - Guilherme Avanço
- Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil
| | - Marcelo Vailati Negrão
- Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil.,Department of Thoracic/Head and Neck Medical Oncology, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 432, Houston, TX, 77030, USA
| | - Rachel Pimenta Riechelmann
- Department of Clinical Oncology, AC Camargo Cancer Center, R. Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil
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Fox L, Toms C, Kernaghan S, Snowdon C, Bliss JM. Conducting non-commercial international clinical trials: the ICR-CTSU experience. Trials 2017; 18:440. [PMID: 28950887 PMCID: PMC5615436 DOI: 10.1186/s13063-017-2176-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/11/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Academic clinical trials play a fundamental role in the development of new treatments, the repurposing of existing treatments and in addressing areas of unmet clinical need. With cancer treatments increasingly targeted at molecular subtypes, and with priority placed on developing new treatments for rare tumour types, the need for international trial participation to access sufficient patient numbers for successful trial conduct is growing. However, lack of harmonisation of international legal, ethical and financial systems can make this challenging and the cost and effort of conducting trials internationally can be considered prohibitive, particularly where the sample size is comparatively small. METHODS The Institute of Cancer Research - Clinical Trials and Statistics Unit (ICR-CTSU) is a UK-based academic clinical trials unit that specialises in the design, conduct and analysis of clinical trials of cancer treatments with an expanding portfolio of trials in molecular subtypes of breast and urological cancers and in other rare cancer types. Implementing appropriate mechanisms to enable international participation has therefore been imperative. In this article, we explain how we have approached the challenges involved and describe examples of successful international trial conduct, achieved through robust collaborations with academic and industry partners. CONCLUSION Conducting academic trials internationally is challenging but can and should be achieved through appropriate governance mechanisms and strong collaborations.
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Affiliation(s)
- Lisa Fox
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
| | - Christy Toms
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
| | - Sarah Kernaghan
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
| | - Claire Snowdon
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
| | - Judith M. Bliss
- The Institute of Cancer Research Clinical Trials and Statistics Unit, ICR Clinical Trials and Statistics Unit (ICR-CTSU), 15 Cotswold Road, Sutton, Surrey SM2 5NG UK
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Le QT, Welch JJ, Vermorken JB, Rischin D, Mehanna H. Formation of an international intergroup to coordinate clinical trials in head and neck cancers: HNCIG. Oral Oncol 2017. [PMID: 28648362 DOI: 10.1016/j.oraloncology.2017.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Clinical trials in head and neck cancer (HNC) face multiple challenges including low global incidence, excessive patient comorbidity rate, high treatment-related toxicity and more recently a changing tumor biology landscape. As clinical trials evolve to address new knowledge about HNC biology, the overall pool of eligible patients for each trial becomes smaller, leading to more accrual challenges. These challenges have led to the formation of the Head and Neck Cancer Intergroup (HNCIG) comprised of large HNC international and national cooperative groups and sites with the goal of facilitating the conduct of high quality clinical trials in a timely manner to improve outcomes in HNC. This article describes the objectives, structure, and activities of the HNCIG.
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Affiliation(s)
- Quynh Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
| | - John J Welch
- Center for Global Health, National Cancer Institute, Bethesda, MD, USA.
| | - Jan B Vermorken
- Antwerp University Hospital, Edegem, and University of Antwerp, Antwerp, Belgium.
| | - Danny Rischin
- Peter McCallum Cancer Centre & University of Melbourne, Melbourne, Victoria, Australia.
| | - Hisham Mehanna
- Institute of Head & Neck Studies and Education, University of Birmingham, Birmingham, UK.
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The Impact of an International Network (Gynecologic Cancer InterGroup) for Clinical Research on Global Capacity for Gynecologic Cancer Clinical Trials. Int J Gynecol Cancer 2017; 27:813-818. [PMID: 28441253 DOI: 10.1097/igc.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to demonstrate that the construction of the Gynecologic Cancer InterGroup (GCIG) has increased collaboration and accrual to high-quality phase 3 trials at a global level. MATERIALS AND METHODS The GCIG is a collaboration of 29 international cooperative clinical trial groups committed to conduct of high-quality phase 3 trials among women with gynecologic cancer. A complete bibliography of the reported phase 3 trials has been developed and is available on the GCIG Web site http://www.gciggroup.com. A "GCIG trial" is a trial in which any 2 or more GCIG member groups are formally involved. We reviewed the output of the GCIG from 1997 to 2015 with respect to member participation and quality of publication (impact factor and citation index). The publications are considered in 3 cohorts, 1997 to 2002, 2003 to 2008, and 2009 to 2014, for the purposes of comparison and progress. A social network map has been developed for these publications to identify how the GCIG has increased capacity for clinical trials globally. RESULTS Using a global map, the number of member groups in the GCIG has increased in each of the 3 periods. The total annual number of publications and citations within the 1997 to 2015 period has increased significantly. The average number of citations per publication is demonstrated in each of the 3 periods. The steady increase in the number of citations is used as a proxy for the impact of the publications. The impact factor of the journal and the number of citations are reported for the 10 most highly cited publications. Finally, using a social networking methodology, networking has visibly and numerically increased in each of the 3 periods. CONCLUSIONS Evidence supports that the construction of the GCIG has increased collaboration and accrual to high-quality phase 3 trials at a global level among women with gynecologic cancer.
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