Study Reveals Stark Disparities in RCC Clinical Trial Access Worldwide

Regina Barragan-Carrillo, MD, postdoctoral fellow at the genitourinary clinic at the medical oncology and medical therapeutics at City of Hope Comprehensive Cancer Center in Duarte, CA, evaluates the current state of the global availability of clinical trials for patients with renal cell carcinoma (RCC).

A recent analysis has highlighted the stark inequities in the global distribution of RCC clinical trials, with high-income countries (HICs) dominating research access while low- and middle-income countries (LMICs) are largely excluded. The study, published in the Journal of Clinical Oncology, examined 357 RCC trials from 2019 to 2024 and found that 76% were conducted exclusively in HICs, whereas lower-middle-income countries (LMICs) hosted only 3%, and low-income countries (LICs) had 0 trials.

The research utilized the National Clinical Trials database, categorizing countries by income level and analyzing trial characteristics, including sponsorship, phase, cancer stage, and end points. Key findings revealed that 80% of trials focused on metastatic RCC, and 52% enrolled patients with clear cell RCC. A total of 47% were academic-sponsored, while pharmaceutical companies funded 64% of trials in non-HICs—though these were predominantly late-phase (phase 3 or 4) studies, delaying early-phase research in underserved regions.

“The biggest takeaway from this abstract is that access to renal cell carcinoma clinical trials is heavily skewed towards high-income countries, while low- and middle-income countries are largely left behind,” explains Barragan-Carrillo.

This disparity has real-world consequences with patients in LMICs facing delayed access to novel therapies, worse survival outcomes, and limited data on drug efficacy in diverse populations. Barragan-Carrillo emphasizes that while pharmaceutical companies are present in non-HICs, their focus on late-phase trials means cutting-edge treatments are tested in HICs first, perpetuating a cycle of exclusion.

“This creates a huge delay in bringing new therapies to patients located in underserved areas. While pharma is technically present in non-high-income countries, research is happening much later in the process, after the drugs have already been tested in high-income populations, which is not exactly equitable,” adds Barragan-Carrillo.

Reference

Barragan-Carrillo R, Zugman M, Castro D, et al. Assessing global disparities in clinical trial availability for renal cell carcinoma (RCC). J Clin Oncol. 2025;43(suppl 5):449. doi:10.1200/JCO.2025.43.5_suppl.449