Koral Shah, Hematology/Oncology Fellow at City of Hope, shared a post on X:
”Our study on global disparities in bladder cancer clinical trial availability is now published in Cancers.
We evaluated 611 bladder cancer trials across World Bank income groups to understand where trials are conducted and where they are not.
Countries were categorized by World Bank income classification:
- High-income countries (HICs)
- Upper middle-income countries (UMICs)
- Lower middle-income countries (LMICs)
- Low-income countries (LICs)
We grouped trials as HIC-only, non-HIC, or mixed-income trials.
Higher income, GNI, and national health expenditure were associated with trial availability:
- 75.1% of trials were ONLY in HICs or ‘HIC-only trials’
- UMICs & LMICs had lower odds of trial availability; 0 trials in LICs
- 8.0% were ‘mixed-income trials’ across HICs and non-HICs
Non-high-income countries bear higher bladder cancer mortality-to-incidence ratios, yet access is limited.
Non-HIC trials:
- least pharma funding
- least multinational collabs
- fewer basket, multi-arm, and early-phase designs
- least likely to include metastatic or UTUC dz
Mixed-income trials:
- 100% had pharma funding
- all PIs were based in HICs
- highest planned enrollment
- most likely to involve immunotherapy and novel agents
- broadest inclusion of upper-tract and metastatic disease
- least likely to be early-phase
While surgery remains the most common bladder cancer treatment, 71.0% of all trials focused on drug therapy.
All mixed-income trials were pharma-funded and focused on drug therapy.
Non-HIC trials had the greatest surgery focus (32%, p<0.001).
Bladder cancer trials are concentrated in HICs. Non-HIC trials lack early-phase design and robust sponsorship, reflecting infrastructure and funding constraints.
Mixed-income trials expand access to non-HICs but should be evaluated for improving outcomes and drug access globally.”
Title: Evaluating Worldwide Disparities in Bladder Cancer Clinical Trial Availability
Authors: Koral U. Shah, Daniela V. Castro, Xiaochen Li, Miguel Zugman, Salvador Jaime-Casas, Vitor Abreu de Goes, Peter D. Zang, Skylar Reid, Teebro Paul, Jaya Goud, Samuel Dickter, Lea Dickter, Lily Lau, Ruchi Agarwal, Aaron Lee, Nasr Chaudhary, Hedyeh Ebrahimi, Benjamin Mercier, Nazli Dizman, Cristiane D. Bergerot, Alexander Chehrazi-Raffle, Charles B. Nguyen, Abhishek Tripathi, Regina Barragan-Carrillo, Sumanta Kumar Pal
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