Nov 16, 2020
By Geraldine Carroll, ASCO Publishing
Oncologists in Africa have long felt the frustration over the lack of clinical trials on a continent that has 17% of the world’s population and is losing far too many patients to cancer.1 By 2030, it is estimated that deaths from the disease in sub-Saharan Africa will increase by 85%.2 In a special two-part series of articles published in JCO Global Oncology (JCO GO), experts take a closer look at oncology care and research on the continent. The series begins by addressing operational issues and challenges affecting oncology clinical trials in Africa. The second part of the series further highlights the landscape and status of recently completed and ongoing clinical trials in Africa, including trials that address HIV-associated malignancies, breast cancer, and capacity building.
Building Capacity for Clinical Trials
Folakemi Odedina, PhD, served as guest editor of the JCO GO special series. Dr. Odedina is a professor at the University of Florida and the contact principal investigator of the Florida-California CaRE2 Health Equity Center, a National Institutes of Health/National Cancer Institute (NCI)-funded PACHE center focused on addressing cancer health disparities in Black and Latinx populations. She is also the principal investigator of the Prostate Cancer Transatlantic Consortium (CaPTC).
The absence of national cancer policies in some African nations, inadequate biomedical research infrastructure, regulatory concerns, poor research funding, and shortage of a trained biomedical research workforce have posed significant barriers to conducting clinical trials in Africa.
“The question has long been: Are the countries in Africa ready (for clinical trials); do they have the infrastructure to be able to do the trials, and do we have the biomedical workforce to do the trials?” Dr. Odedina said.
She noted that the majority of cancers in Africa are diagnosed at a late stage. This is compounded by the fact that stakeholders who fund trials do not prioritize clinical trials, focusing on the barriers instead of working with African investigators to overcome them, thereby costing countless lives that could have been saved by clinical trials. It has also dampened investment in oncology care and research.
Dr. Odedina is determined to reverse this trend. “Africa needs to be ready to conduct clinical trials… to attract companies that want to come into Africa with goodwill to support clinical trials,” she said.
Going Beyond Treatment Trials
One of the most fundamental problems impacting cancer care in the region is the primary focus on treatment trials to the exclusion of other trials, such as behavioral trials that study specific intervention programs on prevention, risk reduction, or survivorship, Dr. Odedina said, adding that “trials that focus on quality of life of survivors… just don’t exist in Africa.”
“If we are not doing all of these different trials, how can we find the best interventions for this population?” she said.
One way that cancer care could be improved is by using existing health care facilities and networks already in place to fight infectious disease and HIV/AIDS, which have been the focus of major eradication efforts.
“You don’t address a problem by putting everything in a silo,” Dr. Odedina said. “There needs to be a meeting of the minds.”
Another challenge facing the oncology care community in Africa, she said, is the efficacy of new cancer therapies in Black patient populations. She said that the lack of representation of Black patients in clinical trials in the United States raises questions about the use of such therapies among Black patients in Africa.
“Africa has the largest population of [Black patients]. If we don’t understand how these drugs work in [this patient population] in the U.S. because [Black patients] are underrepresented, and you take the same drugs to highly populated Black regions in Africa… where many won’t know how those drugs work, I would question why these drugs are being accepted when they have not been proven to be effective in Black patients,” Dr. Odedina said.
Investment, Advocacy for the Future
As the pandemic has swept into Africa, COVID-19 trials have helped focus more attention and investment in its health infrastructure. Dr. Odedina hopes that this investment can be leveraged for oncology trials. Furthermore, she hopes the JCO GO series will bring much-needed attention to the state of oncology care and research in Africa. “I hope the publication of these two series will show others that we cannot bury our heads in the sand and wait until tomorrow,” she said. “The next step is advocacy and working with policymakers. There has to be a radical change. This is one of the reasons why a lot of us who are in the diaspora are working very closely with investigators in Africa.”
Dr. Odedina believes the future of clinical trials is being driven by the African Clinical Trials Consortium (ACTC), which was established in 2018 to bring together research sites and investigators to share best practices and develop strategies for the management of trials in Africa. She noted that ACTC received funding from the NCI Center for Global Health to train the oncology clinical trials workforce from several African countries at the University of Cape Town, and that the focus is currently on developing regional centers of excellence for clinical trials.
Ophira Ginsburg, MSc, MD, FRCPC, associate editor of JCO GO, and associate professor in the Section for Global Health, Department of Population Health at New York University School of Medicine, said she was delighted to serve as associate editor of the special series. “Our aim is to meet the growing needs of health professionals and policymakers seeking the best evidence for cancer control relevant to populations in resource-constrained settings globally,” Dr. Ginsburg said.
- United Nations. Population. Accessed Sept 8, 2020.
- Bray F, Jemal A, Grey N, et al. Global cancer transitions according to the Human Development Index (2008-2030). Lancet Oncol. 2012;13:790-801.