Expanding Cancer Clinical Trials in Africa

In Africa, cancer has become a major public health concern, accounting for over 700,000 deaths annually, with predictions of over one million deaths by 2030 (Ngoma et al., 2024). Numerous reasons, such as population growth, longer life expectancy and behavioural variables like obesity and smoking, are to blame for Africa’s rising cancer incidence. Approximately one-third of cancer-related deaths are attributable to the five primary nutritional and behavioural risk factors, which are: high body mass index, inadequate consumption of fruits and vegetables, physical inactivity, tobacco use, and alcohol use (Jemal et al., 2012; Olabode Omotoso et al., 2023). This burden is particularly heavy in low and middle-income countries, accounting for 70% of global cancer mortality cases. This is especially true given that the average cancer survival rate in the WHO African region is currently only 12%, significantly lower than the average of over 80% in high-income nations. Despite this growing public health crisis, cancer is still considered a low priority compared with other diseases such as malaria and HIV/AIDS.

According to the World Health Organization (WHO) in 2023, Africa experiences 1.1 million new cancer cases annually, with breast, cervical, prostate, colorectal, and liver cancers representing about 50% of the new adult cancer cases. Developing innovative strategies for cancer prevention, early diagnosis, and access to affordable anticancer treatments that are tailored to each region will be vital to successfully combating cancer in Africa. Expanding avenues for advanced clinical trials across the continent is one of the most significant strategies.

Oncology clinical trials are vital, as these studies investigate both the safety and effectiveness of prospective therapies and translate these novel findings into improved health outcomes for patients. Africans’ access to the best cancer prevention, diagnostic, and treatment options is restricted by their underrepresentation in these clinical studies worldwide. Compared to other African nations, South Africa and Egypt are home to notably larger numbers of clinical trials. Egypt is second only to South Africa on the African continent in terms of the number of pharmaceutical company-sponsored clinical trials it hosts. Clinicaltrials.gov lists several current cancer trials, such as those for non-Hodgkin lymphoma funded by Sohag University in Egypt, the prevalence of HER2-low breast cancer throughout Egypt funded by AstraZeneca, and an observational study on breast cancer sponsored by Yale University in Soweto, South Africa. Overall, the distribution of cancer trials remains poor across the continent, and without sufficient representation of Africans in cancer biomedical research, treatment decisions cannot be made for them.

Several initiatives are underway to build Africa’s research capacity to conduct cancer trials. Among the challenges they encounter are inadequate oversight and evaluation of these research endeavours. Nonetheless, expanding research capacity relies on both national and international collaborative cancer research efforts. Clinical trials in Africa must be overseen by an independent and efficient regulatory and ethical body to guarantee participant safety and the accuracy of clinical data. Weak regulatory standards have encouraged an ineffective system of drug registration procedures that cause delays, which is a significant barrier to the start-up and success of clinical trials. Clinical trial hosting opportunities across various African countries have grown owing to investments made in monitoring by human research ethics committees and Medicines regulatory authorities. But today, more than ever, it is imperative to form strategic alliances with the goal of achieving standardised, accredited clinical research centres that can conduct studies in compliance with GCP and local guidelines.

Given that many African nations have achieved notable progress in the fight against infectious diseases, there may be a chance for them to apply their infrastructure and expertise to the fight against non-communicable diseases, particularly cancer. Cancer research has to be given top priority by African governments and partners to support this shift. Funding organisations should also make an effort to expand the recipients’ network throughout Africa. Ultimately, investment in African researchers’ education and training is required to expand the overall population of African cancer researchers and decrease the focus of research expertise in a limited number of cancer institutes.