Operations

The Future of Global Oncology Trials

Operations

17:00, December 27 2017

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Guillaume Trusz, Clinical Trial Associate, Coherus BioSciences, focuses on the epidemiology of cancer and looks at the future of global oncology trials

It has been estimated that there are roughly 800 cancer treatments currently undergoing clinical trials or awaiting FDA approval. The sheer number of clinical trials has caused excessive levels of competition between pharmaceutical and biotech companies.

Oncology trials have shown to be very difficult as only 1-3 percent of cancer patients end up enrolling in clinical trials, and as a result it is estimated that 80 percent of clinical studies do not close on time. By studying overall cancer trends, we are able to better pinpoint particular geographical locations which then allow us to focus on a precise group of potential participants.

Europe ‘top of the list’

In 2012, the World Cancer Research Fund International ranked countries in terms of cancer frequency. Europe dominated the top of the list with four of the top five countries with the highest cancer rates. Denmark ranked first overall and first in terms of cancer rates among women. France came in second, ranking first in terms of male cancer rates, slightly edging out Australia. Excessive alcohol consumption as well as high smoking rates has contributed to a significant increase in throat, mouth, lung, and liver cancer throughout the European population. Australians on the other hand, associated with a very outdoorsy lifestyle, have above average sun and UV exposure leading to significant rates of melanoma and skin cancer. A very poor, high fat diet as well as limited physical activity left the United States being ranked sixth in the world. Having said all this, cancer is no longer considered to be a primarily Caucasian disease; its effects have significantly impacted every race.

A recent study from the Cancer Prevention Institute of California reported a significant increase in breast cancer rates among Asian-American women. The likely culprit for the increase: the adoption of a westernized lifestyle. Several sources have blamed the adoption of a fat and carbohydrate rich, high calorie diet. Genetic variations, as well as geographical adaptations among the world’s different populations have drastically shaped who we are today, and the switch from a fish and vegetable heavy Asian diet can have strong physiological effects. Moreover, the increase in alcohol consumption, a typical carcinogenic component of the western diet, can have significant downstream factors. Some scientists also look to the advancement of women: delayed childbirth and decreasing trends in breastfeeding (which lead to milk stagnation and rapid postnatal mammary gland involution) could have a strong impact on cancer rates.

Cancer rates predicted to rise in the East

Breast cancer incidence in the East is much lower than that in the West, but with the East becoming more westernized by the day, cancer rates are predicted to dramatically increase. As the burden and stigma of cancer remain relatively high in Asia, it will be interesting to follow cancer trends throughout the continent. According to a report by Pfizer, breast cancer has the highest incidence rate of all cancers among women in Asia. Mutations in the BRCA1 (breast cancer 1) and BRCA 2 (breast cancer 2) genes, as well as ALDH2 (aldehyde dehydrogenase 2) gene polymorphisms, have been linked to a significant percentage of breast cancers among the Asian population. Recent studies have noted that in a few Asia-Pacific countries, such as Korea and Malaysia, breast cancer rates have affected women at a slightly younger age than in the West (close to 50 years of age versus 60 in the West). In addition, a study from a university in Japan has suggested that breast cancer screenings through mammograms have not proven as effective in individuals with smaller and denser breast tissue (common among women of East Asian descent). Smaller fat pad size within the mammary gland (which can be attributed to a wide range of factors, including a particular point mutation within the ectodysplasin A receptor - EDAR - gene) decreases the probability of detection, hinting that breast cancer rates might be even higher than previously anticipated.

Rapid industrialization also has a significant impact on the population. Asia, as a whole, is home to some of the most polluted cities in the world, with a recent article in the Financial Times sharing that cities, such as Seoul are now dealing with record levels of air pollution. Currently, smoking is the leading contributor of lung cancer, but scientists have pointed to the growing importance and influence of air pollution; toxic smog can have drastic effects on the lungs. According to several sources, lung cancer is the highest incident cancer among Asian males, and it remains one of the toughest cancers to treat, with one of the smallest five-year survival rates.

In recent years, thyroid cancer has been placed in the spotlight, with the recent trends of thyroid cancer diagnosis in South Korea being called an “epidemic.” However, several studies have pointed to the overdetection and overdiagnosis of the disease. In addition, the rapid waves of development have helped curb high gastric cancer rates throughout the continent. Realizing the underdiagnoses of breast cancer and acknowledging as well as further understanding the increasing environmental effects on lung cancer will be instrumental for future oncology trials in Asia.

A Snapshot of Cancer in sub-Saharan Africa

Another geographic area that could be of high interest would be the East African Community. As the average lifespan of individuals living in Africa increases, primarily due to modern medicine and improved quality of life, cancer has been appearing at a more prominent rate. As we grow older, the cells in our bodies accumulate mutations and with the wrong mutation combinations, our cells can gain the possibility of dividing uncontrollably. Cancer rates below the equator might not be as prominent as in the northern hemisphere, but the probability of dying from cancer is quite the opposite. Affordability as well as accessibility to the needed care remain the two main deciding factors.

In a somewhat recent Clinton Global Initiative Report, it was mentioned that there were 633 physicians in Rwanda, serving a population of more than 10 million (with numbers having only slightly improved since). Rwanda has struggled to meet the demands and needs of its cancer patients and numerous individuals began seeking care in neighboring Uganda. When Uganda’s only radiation machine broke down in early 2017, this left people in Uganda, Burundi, Rwanda, and South Sudan without the necessary cancer treatment. As a result, Kenya became the region’s main provider of cancer radiation therapy, but how long will it be able to handle such a large patient volume?

Where will the next Oncology Trials take place?

Most clinical trials on the African continent consist of studies focusing on the human immunodeficiency virus (HIV) and affiliated diseases, such as opportunistic infections, but as cancer rates become more prevalent, cancer trials will be on the rise. In the past, cancers pertaining to infectious agents, such as Kaposi sarcoma and non-Hodgkin’s lymphoma (which can be caused by HIV) as well as cervical cancer (which is predominantly caused by the human papilloma virus, HPV) have been some of the most frequently diagnosed. However, in recent years, rates of prostate and breast cancer (two of the most diagnosed cancers in the first world) have dramatically increased. As a consequence, East Africa could become a significant player in the world of oncology, with Kenya now offering a multinational cancer patient base.

The American Cancer Society currently estimates that one in two males, and one in three females will develop some form of cancer at one point in their lifetime. With cancer rates having such a drastic impact on the human race, strategically identifying specific regions of viable clinical trial participants within Asia-Pacific as well as the African continent will be key in our ongoing fight towards viable cures and precision medicine.

 

References:

1) American Cancer Society (2016). Lifetime Risk of Developing or Dying from Cancer. (https://www.cancer.org/cancer/cancer-basics/lifetime-probability-of-developing-or-dying-from-cancer.html). Accessed: May 25th, 2017.

2) American Cancer Society (2011). Cancer in Africa. Atlanta, GA, American Cancer Society, 2011

3) Cancer Prevention Institute of California (2017). Breast Cancer Rates Increasing Among Asian Americans. (http://www.cpic.org/news-media/press-releases/2017/BreastCancerAmongAsians.aspx)

4) Chang et al. (2017). ALDH2 Polymorphism and Alcohol-Related Cancers in Asians: a Public Health Perspective. Journal of Biomedical Science 24:19. doi: 0.1186/s12929-017-0327-y

5) ClinicalTrials.gov (https://clinicaltrials.gov). Accessed: May 25th, 2017.

6) Kamberov et al. (2013). Modeling Recent Human Evolution in Mice by Expression of a Selected EDAR Variant.Cell, 152 (4), 691-702. doi:10.1016/j.cell.2013.01.016.

7) Kim H., Choi D.H. (2013). Distribution of BRCA1 and BRCA2 Mutations in Asian Patients with Breast Cancer.J Breast Cancer, 16(4): 357–365. doi:  10.4048/jbc.2013.16.4.357

8) Lee et al. (2017). Performance of a Subsidized Mammographic Screening Programme in Malaysia, a middle-income Asian country.BMC Public Health.doi:10.1186/s12889-017-4015-3

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