Cancer research in lower- and middle-income countries (LMICs): How can we improve? : Indian Journal of Cancer

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Cancer research in lower- and middle-income countries (LMICs)

How can we improve?

Akhade, Amol

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Indian Journal of Cancer 59(2):p 157-158, Apr–Jun 2022. | DOI: 10.4103/ijc.ijc_662_22
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Currently, we are in era of precision oncology. Genomic data extracted from the cancer tissue at diagnosis or on progression is the new buzz word in oncology research. Such data, at an individual patient level, proves to be an important tool for treatment planning, with respect to both prognosis and choices of targeted anticancer drugs. If such data can be collected and pooled at a national level, it can be useful for clinical trial planning, resource allotment, and clinical guideline planning at a national level.

In this issue of Indian Journal of Cancer, we have two articles focusing on collection of such genomic data.

Mehra et al.[1] from Medanta hospital have presented 56 colorectal cancer patients' data with respect to KRAS mutation status. They carried out mutation analysis using NGS platform-Ion Torrent personal genome machine. It is a retrospective study and it is the first of its kind done on the Indian population, as per the authors.

Another study is from Turkey by Basdemirci et al.,[2] in which they have studied KRAS and NRAS mutations in lung cancer patients. The authors found that the frequency of KRAS gene mutation was higher than the rates of similar mutations in both Asian and Western countries. The study has data of 64 patients, and samples were collected by bronchoscopy. This is the first study to evaluate the extended spectrum of KRAS and NRAS mutations in lung cancer patients from Turkey.

Even though both these studies are a welcome step toward obtaining genomic data, the very fact that both are first of its kind studies in the respective populations should lead to lot of introspection. Small number of patients and single-center data are the basic problems of such research studies coming from LMICs like India and Turkey. A simple search on PubMed about recent publications of cancer research data from LMICs will reflect paucity of quality data.

There are many reasons for the same.

NGS on tissue or on blood sample is a costly test, and only a small percentage of cancer patients in India undergo NGS. This is in contrast to high-income countries like USA or UK, where almost all patients have NGS at baseline.

Dedicated time given to research alone, separate from clinical work, is not feasible for oncologists in LMICs. There is not much monitory incentive for research. We do not have the concept of clinician scientists, even at the university tertiary cancer hospitals. Getting sufficient funds for investigator-initiated trials is very difficult. Lack of necessary infrastructure and manpower for doing clinical trials and data collection is another hurdle.

So, the only way by which we can have substantial data is to do collaborative studies and have a common data pool. Culture of collaborative multicentric studies is robust in European countries as well as in UK and USA. They have collaborative study groups focusing on one particular cancer for decades and generate quality data pertaining to one particular cancer (e.g., ESPAC for pancreatic cancer or Breast International Group for breast cancer). Such efforts do not exist in India as well as in most of the LMICs. We hardly have any collaborative cancer organizations which are dedicated to cancer research, focusing on one particular cancer.

In today's era, electronic data keeping is available in most of the tertiary cancer centers. Hence, data pooling should not be difficult. Onus of doing research should not lie on few prominent tertiary cancer centers alone. Second-tier cancer centers and community oncologists can work together with oncologists from tertiary cancer centers and have significant and substantial data generation.

In times of global inequality in cancer care, most of the cancer care policies come from high-income countries. Oncologists from LMICs need to collaborate and produce high-quality data, so as to have voice and say in global oncology field and policy decisions. If we want to be heard, then our data needs to speak louder.


1. Mehra S, Tiwari AK, Mehta SP, Sachdev R, Rajvanshi C, Chauhan R, et al The utility of the Ion Torrent PGM next generation sequencing for analysis of the most commonly mutated genes among patients with colorectal cancer in India Indian J Cancer. 2022;59:218–22
2. Basdemirci M, Zamani A, Zamani AG, Findik S, Yildirim MS. Extended-spectrum of KRAS and NRAS mutations in lung cancer tissue specimens obtained with bronchoscopy Indian J Cancer. 2022;59:236–43
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