Scaling-Up Research in Childhood Cancer in Low- and Middle-Income Countries

Area of Science:

• Global Health
• Pediatric Oncology
• Health Disparities

Background:

• Childhood cancer outcomes are drastically lower in low- and middle-income countries (LMICs) compared to high-income countries (HICs).
• Disparities are driven by limited healthcare access, resources, delayed diagnosis, and genetic ancestry influencing disease biology.
• Direct translation of HIC protocols leads to high treatment-related mortality (TRM) in LMICs, necessitating locally validated regimens.

Purpose of the Study:

• To address the survival gap in childhood cancer between LMICs and HICs.
• To advocate for a paradigm shift from protocol translation to context-specific clinical research in LMICs.
• To identify key strategies for improving pediatric cancer care and outcomes in resource-constrained settings.

Main Methods:

• Prioritizing Implementation and Comparative Effectiveness studies to validate adapted treatments.
• Conducting local genomic characterization for equitable risk allocation.
• Repurposing novel agents through dosage and schedule adjustments for feasibility and reduced toxicity.

Main Results:

• Current research capacity in LMICs is hindered by limited training, overwhelmed specialists, and misaligned regulatory oversight.
• Pharmaceutical industry strategies often favor trials in HICs, exacerbating research gaps.
• A need for locally relevant evidence to inform public health policy and improve survival rates.

Conclusions:

• A shift towards context-specific clinical research, including implementation and comparative effectiveness studies, is essential.
• Local genomic characterization and repurposing of novel agents are key initiatives.
• Strengthening international collaboration and multi-stakeholder dialogue is vital to generate evidence and ensure equitable access to optimal cancer care for all children.