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Globalisation of clinical trials in oncology: a double-edged sword?
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    Globalization of Clinical Trials – Advocating for more trials in LMICs

    The work of Payedimarri et al.1, complemented by the insights of Jenei et al.2, has prompted substantial reflection. While the burgeoning involvement of low-middle-income countries (LMICs) in industry-funded research is a commendable trend, I concur with most criticisms articulated by these authors. Specifically, the challenge of limited access to studied agents within LMICs and the consequential absence of robust post-treatment care stand as significant concerns potentially affecting the outcomes of trials examining life-prolonging agents administered at earlier treatment stages3. However, a fundamental disagreement emerges regarding the framing of this issue and, notably, the assignment of responsibility for its resolution.

    Primarily, acknowledging that a substantial portion of innovative drugs trialed in LMICs often remains inaccessible to their populations post-trial, participation in a clinical trial offers an invaluable opportunity for patients, irrespective of their randomization into the interventional or control arm. The former might potentially receive a life-prolonging therapy, while the latter typically receives treatment comparable to or, in certain instances, superior to the prevailing standard of care in LMICs. Even with a limited patient enrollment, the impact of such treatment extends to these individuals and their families. Moreover, adherence to the stipulated standards in a clinical trial ensures that care aligns with trial expectations, often ma...

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    Conflict of Interest:
    DVA has received horaria from MSD, Libbs, Novartis, Ipsen. DVA has participated in as primary or sub-investigator of clinical research studies from the following sponsors: MSD, BMS, Pfizer, Roche, IMMiX, Nanoray, AstraZeneca, Merck Serono, Regeneron, Novartis, GSK