The Development of the International Research Community

The Development of the International Research Community

George W. Sledge, MD, FASCO

May 09, 2011

One of the more astonishing and unexpected developments of the past two decades has been the expansion of the clinical cancer research universe from a relatively few countries (the U.S., Canada, Western Europe, Japan, and Australia, to be precise) to an essentially global enterprise. This expansion has been fueled by several factors, some political, some economic, and some scientific.

The political and the economic have gone hand in hand. The fall of the Iron Curtain and the opening of China and India to modern free-market capitalism were world political events with profound economic consequences. At roughly the same time, the development of international standards for clinical trials (such as the ICH standards) allowed for the development of an international system, where pharmaceutical companies could open studies on multiple continents with a reasonable expectation that trial results in Delhi would be similarly interpretable to those obtained in Detroit. The regulatory agencies in the United States and Europe became increasingly comfortable with (some would now say prefer) data emerging from low- and middle-income countries. The development of multinational CROs allowed pharmaceutical companies to perform “swoop in/swoop out” research wherein patients who would never have been able to pay for novel drugs (or, frequently, any drugs) filled trials designed to generate revenue from the treatment of better-off patients in other countries. Some would call such research cynical, but to economists it is just the application of the principles of Adam Smith and David Ricardo to pharmaceutical research, for better and worse.

The scientific factors underlying this expansion have been somewhat slower to develop, but in the long run may prove more profound. The huge increase in clinical trials infrastructure across the world in the past two decades is real, as is its partial erosion (under the twin weights of inattention and over-regulation) in the formerly dominant United States. Infrastructure is important; there is a basic level of clinical trials infrastructure that is necessary to perform Phase II or III trials, and it now exists on several continents. This clinical trials infrastructure, particularly in the form of trained physicians, research nurses, and data managers, is a wonderful scientific development, and one that will continue to evolve in the coming years. More clinical researchers does not just mean more patients going on to more trials, it means more scientists grappling with the cancer problem. Who can say where the next great advances in cancer research will come from? Intelligence is widely distributed; opportunity is not. Greater opportunity allows us to tap into previously unmobilized intelligence, not just more patients.

But there is more here than just the opening of new clinical sites, important as that may be. I have been impressed with our ripening understanding of what this larger cancer research universe has to offer us in scientific terms. Our understanding of drug metabolism is increasingly a function of host SNP and tumor mutational analyses, with their deep roots in evolutionary biology. Studying new agents in diverse populations teaches us a great deal about how and when drugs should be used, a trend that is likely to continue. The story of EGFR mutations in lung cancer, and the effects of mutational events across populations, has been a revelation to many. Similarly, the sheer diversity of disease frequency and presentation around the world has resulted in new insights regarding cancer epidemiology, biology and treatment.

There are those who might prefer a return to the simpler world of two decades ago. I am not one of them. In a world where there are too many angry men with guns and bombs, I am happy to be part of an international “invisible college” dedicated to the eradication of an ancient scourge. Our Society is a visible manifestation of that common commitment, with its very international Annual Meeting (Chicago in June is certainly the world capital of oncology), its support for international clinical trials education, its educational programs around the world (often in conjunction with our sister societies), and its many other opportunities for interaction between cancer researchers across the continents. There will be, I am told, nineteen international Best of ASCO meetings this year, testimony to the enduring appeal of a truly global enterprise.

On a final note, this week will be my last contribution to the ASCO Global Express email newsletter as your Society’s President. Before sign-off, my thanks to all who have made this year so pleasurable to me. I am grateful to all of my international colleagues for the warmth of their support and the friendliness of their greetings during the past year, but even more for the intelligence and eloquence of their contributions to our Society. I am particularly thankful for the strong leadership that Clement Adebamowo has provided as chair of our International Affairs Committee, as well as the heroic work of Doug Pyle and his staff. It has been a real delight working with all of you, my good friends. I hope to see you in Chicago.


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Duy Q. Vu, MD

May, 11 2011 9:00 AM

Access to cancer informations for patients in the developing world,
I was appalled recently by the lack of knowledge from patients suffering from cancer in the developing countries. They don't have access to society like American cancer society for information,..,what is good about developing protocols if those patients have to suffer alone without the support of their friends, families, their societies due to the lack of awareness of what treatments are available for their condition. It is time that in order to better serve those unfortunate patients we should found a way to disseminate information through available organisms more efficiently.Like in my case, patient does not even know that they suffer from lymphedema after surgery...Is it about time to see something concrete rather than empty word ?
Duy Vu MD

Vahit Ozmen, FACS,MD

May, 11 2011 9:06 AM

As an expert pannelist of The Breast Health Global Initiative and President of Turkish Federation of Breast Diseases Societies, I am so happy that ASCO and other colleagues think that there is an absolute need for International Research Community, and we will be honored to be a part of this community. As you know, breast cancer is a global diseases and its incidence and mortality have been increasing in low-middle income countries. I hope that we will have a chance doing multicenter researches to increase breast cancer awareness, and decrease breast cancer mortality in developing countries.

Vahit Ozmen, MD, FACS

Professor of Surgery


Turkish Federation of Breast Diseases Societies

Ridha Oueslati, PhD

May, 11 2011 9:10 AM

Dear Dr George W Sledge .Jr
I am happy to have introduce ASCO Society during your direction
Best Rregards
Pr Oueslati Ridha ,
Director of Immuno-Micribio-Environnemental And Cancerogenesis Unit (IMEC) -BIZERTE- Tunisia

Adam Dicker, MD, PhD

May, 11 2011 1:33 PM

We are involved in a lung cancer trial using Stereotactic radiosurgery (SBRT) for lung cancer in China involving 10 centers across the country
We are doing the quality assurance using RTOG facilities (
Certainly a learning experience

The energy level in China is fantastic, and the collaborative atmosphere is great
We will learn a great deal from each other in this effort

Adam P. Dicker, MD, PhD
Professor and Chair of Radiation Oncology | Professor of Pharmacology and Experimental Therapeutics
Jefferson Medical College of Thomas Jefferson University

Aditya Bardia, MD, MPH

May, 16 2011 2:18 PM

Having done my medical education in India and subsequent training in US, I strongly feel that there is so much that can be gained from fruitful collaborations and exchange of ideas. The developed countries have the research infrastructure and technology, while developing countries have the masses critical to conduct clinical trials.

However, while attractive in concept, practically this is not without its challenges. Even a well developed and attractive clinical trial promising access to otherwise inaccessible drugs could be perceived as a guinea pig experiment by the patients and even providers due to differences in culture and attitude. The lack of well developed research infrastructure and high attrition rate could act as a further barrier to conducting high quality research. Finally, the move towards personalized medicine and emphasis on host genomic profile could limit the external validity of the observed results to other populations with different genotypes.

Nevertheless, the formation of an international research community has immense potential and the abilty to overcome challenges by collective brainstorming. I am very glad to see that a leading organization such as ASCO has taken an initiative in making international research community a reality. Hopefully, successful collaborations between the various organizations would benefit the scientific community at large and mankind as a whole.

Warm Regards,


Aditya Bardia MD, MPH
Clinical Fellow, Division of Medical Oncology
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, MD 21231

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