Cancer, Clinical Trials, and Canada: Our Contribution to Worldwide Randomized Controlled Trials

Abstract

Canada has a long tradition of leading practice-changing clinical trials in oncology. Here, we describe methodology, results, and interpretation of oncology RCTs with Canadian involvement compared to RCTs from other high-income countries (HICs). A literature search identified all RCTs evaluating anti-cancer therapies published 2014–2017. RCTs were classified based on the country affiliation of first authors. The study cohort included 636 HIC-led RCTs; 155 (24%) had Canadian authors. Three-quarters (112/155, 72%) of Canadian RCTs were conducted in the palliative setting, compared to two thirds (299/481, 62%) of RCTs from other HICs (p = 0.022). Canadian RCTs were more likely than those from other HICs to be supported by industry (85% vs. 69%, p < 0.001). The proportion of positive Canadian trials that met the ESMO-MCBS threshold for substantial clinical benefit was comparable to RCTs without Canadian authors (29% vs. 32%, p = 0.137). Thirteen percent (20/155) of all Canadian trials were affiliated with the Canadian Cancer Trials Group (CCTG). Canada plays a meaningful role in the global cancer research ecosystem but is overly reliant on industry support. The very low proportion of trials that identify a new treatment with substantial clinical benefit is worrisome. A renewed investment in cancer clinical trials is needed in Canada.

Oil-free Microfluidic Spheroid Generation for Cancer Drug Testing

“…However, Sharma et al discovered in 2021 that only 13% of all Canadian clinical trials identified significant cancer treatment advances. 4 Therefore, there is a well-defined need to develop more accurate cancer models for drug development.…”

Advancing Academic Cancer Clinical Trials Recruitment in Canada

“…Clinical trials are essential for advancing scientific knowledge and identifying better treatment for patients. Canadians have long benefited from access to and results from practice-changing cancer clinical trials sponsored by the academic investigator community [1][2][3]. However, that access is threatened by increased complexity of ethical and regulatory processes, rising costs, and limited supports available for the conduct of academic trials [4].…”