Global Disparities in Current Clinical Trials in Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is characterized by a distinct geographic distribution, with more than 90% of worldwide incidence and mortality occurring in East/Southeast Asia and Northern Africa. Clinical trials that inform evidence-based care must represent the target population of NPC; however, little is known about their geographic distribution and the extent to which they investigate radiation therapy (RT), which plays a central role in NPC management.

Using ClinicalTrials.gov, we characterized phase 2 and 3 clinical trials on adult patients with NPC from 2013 to 2023. Endemic countries were defined as having an age-standardized incidence rate higher than the world age-standardized incidence rate of 1.3 per 100,000 person-years using the Global Cancer Observatory (GLOBOCAN) 2022 database.

There were 266 clinical trials eligible for analysis. Trial interventions were immunotherapy/targeted therapy in 133 (50%), chemotherapy in 79 (30%), and RT in 25 (9%). Trials most commonly originated from China (80%), followed by the United States (4.5%) and Singapore (1.5%). Of the 29 NPC-endemic countries, only 5 (17%) are represented in the 11 international trials-China (including Taiwan, Hong Kong, and Macau), Malaysia, Singapore, Thailand, and Tunisia-4 (80%) of which are high- and upper-middle-income countries. In contrast, 18 (75%) out of the 24 underrepresented endemic countries are lower-income. Trials per absolute NPC incidence were significantly fewer in endemic versus nonendemic countries (P < .001) and in lower- versus higher-income countries (P < .001). Similar disparities were observed in the subset of trials that primarily tested RT.

The current NPC clinical trial landscape demonstrates significant disparities that do not reflect the global distribution of disease burden and the central role of RT. Lower-income endemic countries are severely underrepresented. Enhanced regional and global collaboration is critical in fostering the inclusion of both patients and researchers from lower-resourced settings in clinical trials and in the global NPC dialogue.