Several states in Northeast India had no registered clinical trials available to cancer patients from 2007 to 2021.

A recent study revealed a disconcerting reality about India’s fight against cancer: Between July 2007 and December 2021, a mere 1988 cancer clinical trials were registered with India’s Clinical Trial Registry (CTRI). This figure pales in comparison to the sheer volume of trials conducted elsewhere globally. For instance, in 2017 alone, the USA registered 2066 interventional cancer trials, showing a significant gap in India’s cancer research landscape.

The study titled ‘Landscape of cancer clinical trials in India – a comprehensive analysis of the Clinical Trial Registry - India’ published by The Lancet is first-ever comprehensive analysis of cancer clinical trials documented in CTRI. Home to nearly a fifth of the world’s population, only 1.5% of global clinical trials take place in India. 

Key findings of the study 

1. Of 1988 cancer trials, the majority focused on treating cancer (63%) and rest of the trials aimed at optimising the operational aspects of surgery (19%), mitigating treatment-related toxicity (10.6%), or treating cancer-related symptoms (7.8%).
2. Most of the trials were investigating solid tumours as opposed to haematological malignancies. Head and neck cancer and cervical cancer, which present a significant burden in India, were notably were underrepresented in trials.
3. Delhi, Maharashtra, and Andhra Pradesh led India in the availability of clinical trials for cancer patients, with over 800 clinical trials per 100,000 cancer patients available in Maharashtra and Andhra Pradesh and over 2000 clinical trials per 100,000 cancer patients available in Delhi. 
4. Although Northeast India has a higher cancer burden as compared to the rest of the country, as per the 2020 report from the Indian National Cancer Registry Programme, the analysis shows that cancer clinical trials are scarce in the region. Several states, including Arunachal Pradesh, Meghalaya, Mizoram, Nagaland, Tripura, Ladakh, Andaman and Nicobar Islands, Dadra and Nagar Haveli and Daman and Diu, and Lakshadweep, had no registered clinical trials available to cancer patients from 2007 to 2021.

The way forward 

While much progress has been made, there remains a pressing need for clinical cancer research in India to be better aligned with the nation’s healthcare needs and disease burden, focusing on prevalent and deadly cancers while ensuring availability of clinical trials across geographic regions and disadvantaged populations.

Cancer remains a significant health concern, ranking high among causes of illness and death. The WHO Global Cancer Observatory’s data for 2020 paints a stark picture: 1.32 million new cancer cases and 0.85 million cancer-related deaths in India.

What sets India apart in the global cancer landscape is its unique pattern of cancer prevalence. Unlike many other countries where prostate and lung cancers top the list, in India lip and oral cavity cancers take the lead among males, comprising 16% of all new cancer cases in 2020.

That apart, cancer patients in India often present with late-stage malignancies. There is an urgent need to develop evidence-based and feasible solutions to manage cancers in India. A recent report from India’s National Cancer Registry Programme showed that majority of cancer patients were diagnosed at advanced stage for breast (57%), cervix uteri (60%), head and neck (67%) and stomach (51%) cancer, whereas lung cancers were most often diagnosed with distant metastases in both males (44%) and females (48%). Late-stage diagnoses contribute to poor treatment outcomes, which further widens the health disparities between India and the rest of the world.