3666 - Global Disparities in Current Clinical Trials in Nasopharyngeal Carcinoma

C. J. E. Jainar¹, L. E. Jacomina^1,2, E. C. Dee³, A. Lee⁴, N. Y. Lee³, M. L. K. Chua⁵, and M. B. Mejia¹; ¹Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines, ²Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, ³Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, ⁴The University of Texas MD Anderson Cancer Center, Houston, TX, ⁵Department of Head and Neck and Thoracic Cancers, Divisions of Radiation Oncology and Medical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore

Abstract Title: Global Disparities in Current Clinical Trials in Nasopharyngeal Carcinoma

Purpose/Objective(s): Nasopharyngeal carcinoma (NPC) is characterized by a distinct geographic distribution with >90% of worldwide incidence and mortality occurring in East and Southeast Asia and Northern Africa. Current clinical trials are seeking to optimize treatment strategies to improve NPC outcomes; however, little is known about their geographic distribution in relation to the well-known disease endemicity.

Materials/Methods: Using ClinicalTrials.gov, we identified phase II and III clinical trials on adult patients with NPC from 2013-2023. Trial characteristics were extracted and analyzed. Endemic countries were defined as having an age-standardized incidence rate (ASIR) higher than the world ASIR of 1.3 per 100,000 person-years using the GLOBOCAN 2022 database.

Results: There were 253 clinical trials eligible for analysis. Eighty-five trials (34%) were recruiting, 38 (15%) not yet recruiting, 31 (12%) active but not recruiting, 21 (10%) completed, and 5 (2%) terminated. Trials most commonly originated from China (199 [79%]) followed by the United States (12 [5%]) and Singapore (4 [2%]). One hundred one (40%) were single-institution trials, 126 (50%) were single-country multi-institution, and only 11 (4%) were international. Of the 29 NPC-endemic countries, only five (17%) are represented in international trials, namely, China (including Taiwan), 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 NPC-endemic countries are classified as low and lower-middle income countries. Study population consists of initial diagnosis, both early and locally advanced, in 133 (53%) trials and recurrent/metastatic in 120 (47%). Trial intervention includes chemotherapy in 155 (61%), immunotherapy/targeted therapy in 134 (53%), and radiotherapy in 116 (46%), with 2 (4%) trials involving biomarkers.

Conclusion: A significant imbalance exists in the geographic distribution of current NPC clinical trials in terms of trial origin and country locations that do not match the global disease endemicity of NPC. Lower income NPC-endemic countries are severely underrepresented. Efforts are needed to diversify trial inclusion and improve representation of NPC-endemic countries.

Abstract 3666 – Table 1

Country Locations	Single-Institution Trials (n=101)	Single-Country Multi-Institution Trials (n=126)	International Trials (n=11)
China (inc. Taiwan)	91 (90%)	106 (84%)	10 (91%)
Singapore	3 (3%)	1 (0.8%)	10 (91%)
United States	1 (1%)	4 (3%)	7 (64%)
Others	Italy, 1 (1%) Kuwait, 1 (1%) South Korea, 1 (1%) Unknown, 3 (3%)	Italy, 1 (1%) Poland, 1 (1%) Unknown, 13 (10.2%)	Canada, 3 (27%) Thailand, 3 (27%) France, 2 (18%) Australia, 1 (9%) Greece, 1 (9%) Italy, 1 (9%) Malaysia, 1 (9%) Puerto Rico, 1 (9%) Spain, 1 (9%) Tunisia, 1 (9%)