Access to Cancer Medicines and Clinical Trials Show Stark Variations Across Europe [ESMO Press Release]

A. Carneiro¹, T.M.S. Amaral², M. Brandao³, M. Scheffler⁴, K. Bol⁵, R. Ferrara⁶, M. Jalving⁷, G. Lo Russo⁸, I. Marquez-Rodas⁹, A. Matikas¹⁰, L. Mezquita¹¹, G. Morgan¹², C.E. Onesti¹³, S. Pilotto¹⁴, E. Saloustros¹⁵, D. Trapani^16
1Department of Clinical Sciences Lund, Oncology, Lund University, Skane University Hospital, Lund, Sweden, ²Dermatooncology Center, University Hospital Tubingen, Tuebingen, PT, Germany, ³Clinical Trial Support Unit, Institute Jules Bordet, Brussels, Belgium, ⁴Lung Cancer Group Cologne, Department I of Internal Medicine, Uniklinik Köln, Cologne, Germany, ⁵Medical Oncology Department, Herlev Hospital – National Center for Cancer Immune Therapy, Herlev, Denmark, ⁶Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy, ⁷Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands, ⁸Dipartimento Oncologia Toraco-Polmonare, Istituto Nazionale dei Tumori di Milano – Fondazione IRCCS, Milan, Italy, ⁹Medical Oncology, Hospital General Universitario Gregorio Marañon – Fundación Investigación Biomedica, Madrid, Spain, ¹⁰Oncology-Pathology Department, Karolinska University Hospital-Solna, Stockholm, Sweden, ¹¹Medical Oncology Department, Hospital Clinic y Provincial de Barcelona, Barcelona, Spain, ¹²Oncology, Skane University Hospital, Lund, Sweden, ¹³Medical Oncology department, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium, ¹⁴Section of Oncology, Department of Medicine, University of Verona School of Medicine and Verona University Hospital Trust, Verona, Italy, ¹⁵Department of Oncology, University Hospital of Larissa, Larissa, Greece, ¹⁶IRCCS, Istituto Europeo di Oncologia, Milan, Italy

Background: Clinical trials are essential for advancing cancer treatment. Yet, there is limited data on their distribution and access in Europe. To ascertain the extent of potential inequalities in access to clinical trials in Europe, we compared their distribution among European countries.

Methods: The Clinicaltrials.gov database was searched for interventional clinical trials in adults with neoplasms. Available data from phase I-III trials between 06/2009 to 06/2019 in Europe were retrieved. We considered the number of clinical trials registered in each country and one “trial-entry” was defined as one trial/country.

Results: In total, 18454 trial-entries were identified, of which 12% were phase I, 10% phase I/II, 32% phase II, 2% phase II/III and 44% phase III; 74% were industry-sponsored, 15% were academic and 11% were an academic/industry partnership. The number of trials per country varied from 2.48 in Central/Eastern Europe to 5.33/100 000 inhabitants in Northern Europe. The proportion of phase I-II trials was higher in the Southern and Western regions (13-15%) compared to Central/Eastern and Northern regions (4-9%). The number of trial-entries/100 000 inhabitants/country ranged from 0.14 (Albania) to 10.7 (Belgium). Between 2010 and 2018, the total number of trials per country in Europe increased by 33%. The increase in early-phase trials was larger (phase I-II, 61%) than in late-phase trials (phase II-III, 7%). Portugal, Ireland, Finland, Greece and Norway registered the largest percentage increase in early-phase trials, while Ireland, Spain, Norway, Italy and Belgium led the largest percentage increase in late-phase trials. Five countries dominated in terms of an increase in the absolute number of total trial-entries in both early- and late-phase trials: Spain (90/40), France (45/16), UK (45/13), Italy (38/19) and Belgium (35/12). During this period there was no significant variation in the distribution of industry and academic sponsored trials but an increase in industry/academic partnerships was observed (≈ 8%).

Conclusions: The number of clinical trials varies greatly among European regions resulting in potential asymmetries in patients’ access to clinical trials. The disparities in access to oncology trials need to be addressed by all the stakeholders.

Legal entity responsible for the study: The authors

Funding: Has not received any funding

Disclosure: T.M.S. Amaral: Honoraria (self), Travel/Accommodation/Expenses: Novartis; Honoraria (self), Travel/Accommodation/Expenses: BMS; Honoraria (self): Pierre Fabre; Honoraria (self): CeCaVa.
M. Brandao: Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche/GNE.
M. Scheffler: Advisory/Consultancy, Speaker Bureau/Expert testimony: Boehringer Ingelheim, AMGEN, AstraZeneca, BMS, Roche, Pfizer, Takeda; Research grant/Funding (self): AMGEN, Dracen.
R. Ferrara: Advisory/Consultancy: MSD.
M. Jalving: Advisory/Consultancy: MERCK, BMS, NOVARTIS, PIERRE FABRE, TESARO, ASTRA ZENECA; Research grant/Funding (self): BMS, ABBVIE, MERCK, CRISTAL THERAPEUTICS.
G. Lo Russo: Advisory/Consultancy: MSD, BMS, ASTRAZENECA; Travel/Accommodation/Expenses: BMS, ROCHE.
I. Marquez-Rodas: Advisory/Consultancy: BMS, MSD, NOVARTIS, ROCHE, PIERRE FABRE, AMGEN, ASTRA ZENECA, REGENERON, SANOFI, HIGHLIGHT THERAPEUTICS, INCYTE, GSK.
L. Mezquita: Research grant/Funding (self): Bristol-Myers Squibb, Boehringer Ingelheim; Non-remunerated activity/ies, Lectures and educational activities: Bristol-Myers Squibb, Tecnofarma, AstraZeneca, Roche; Advisory/Consultancy: Roche Diagnostics, Roche; Travel/Accommodation/Expenses: Bristol-Myers Squibb, Roche; Research grant/Funding (self), International Mentorship Program : AstraZeneca.
S. Pilotto: Advisory/Consultancy, Speaker Bureau/Expert testimony: Astra-Zeneca, Eli-Lilly, BMS, Boehringer Ingelheim, MSD and Roche.
E. Saloustros: Advisory/Consultancy: Pfizer, AstraZeneca, Roche; Speaker Bureau/Expert testimony: Pfizer, AstraZeneca, Roche, Amgen, BMS.
All other authors have declared no conflicts of interest.