Cancer, once considered the disease of high income countries (HIC), has slowly become endemic in low income countries (LMIC). Although Westernized lifestyle may be contributing to this surge in cancer incidence, the accompanying higher mortality rates in these vulnerable populations is alarming. [1] Compared to HICs, patients in LMICs present more often with locally-advanced stage or metastatic breast cancer due to patients’ and health care providers’ lack of knowledge and understanding of the disease, as well as the paucity of data on the biology of cancer in patients of African descent [2,3]. Providing cancer care in this environment has many challenges, such as lack of health infrastructure, clinical expertise, research infrastructure, human resources and non-implementation of health policies [4, 5]. To bridge the cancer geographical divide and improve quality of cancer care at affordable costs, diagnostic and therapeutic approaches are needed. Now is the time to accelerate progress in combating the looming epidemic of breast cancer in these LMICs that are least prepared to bear the burden of the disease [6, 7] .
Clinical research drives the field of oncology. Clinical trials have traditionally been carried out in relatively resource-rich locations, such as North America, even though the majority of cancer patients live in low resource settings [8]. In recent years, a shift in location of Biopharma industry-sponsored clinical trials to regions such as Eastern European, Latin American, Asian countries and South Africa has occurred largely due to national policies in these emerging markets [9–11] An expanded globalization of innovative biomarker-informed oncology clinical trials to include countries in Africa is long overdue. However, despite the significant link to African Americans in the US, there are few clinical trials conducted in Sub-Saharan Africa [12, 13, 14] (Fig. 1)
While lack of infrastructure, resources, medical expertise and incentive to the pharmaceutical industry have been cited as barriers [15], other industries including digital media and financial services, appear to be thriving on the Continent. Breakthroughs in the treatment of infectious diseases, such as HIV/AIDS in Nigeria, have greatly impacted and improved care for people living with HIV. Nigeria successfully responded to the Ebola Epidemic using a vast network of public health experts, demonstrating that clinical trials in West Africa, particularly in Nigeria, is feasible [16] and should be pursued as a global strategy to address the rising epidemic of cancer in Africa and increase health care equity.
Opportunities to unravel the root causes of disparities in cancer outcomes, based on geography and/or genetic ancestry, exist in involving Sub-Saharan Africa in conducting biomarker driven oncology clinical trials. Africa is the cradle of humanity and learning about the diversity of genomes and geography in which cancer occurs could create breakthroughs for drug development. This can also serve as a bidirectional transfer of knowledge as this could lead to implementing interventions that include Blacks made up of African American patients (as well as Blacks in other diaspora settings) in clinical trials conducted in the United States and other countries.
With the goal of leapfrogging towards quality cancer care, Nigeria partnered with the University of Chicago to initiate an oncology clinical trial program in collaboration with four institutions in Southwestern Nigeria, including the University of Ibadan, the University of Lagos, Lagos State University and Obafemi Awolowo University, Ile-Ife, Nigeria.
Prior to these partnerships, a study was conducted to assess the capacity and infrastructure available for conducting biomarker-driven clinical trials in these four institutions. The assessment was done with a checklist developed using Site Assessment Questionnaire (Pre-visit) Tool developed by the National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health USA (https://www.nidcr.nih.gov › sites › default › files › site-assessment-questio..) and the Site Assessment/Feasibility Questionnaire of Global Health Network (https://globalhealthtrials.tghn.org › site_media › media › articles › Site_Ass.).
The aim of the study was to identify areas where intervening might improve the ability to conduct innovative biomarker-driven clinical trials locally, and to build capacity that could lead to improved cancer care in Nigeria. This study was carried out with the following objectives: 1) To identify needed facilities to be put in place that will fully support the conduct of oncology clinical trials in four centers in Nigeria; 2) To document available trained manpower for oncology clinical trials in selected sites in Nigeria and 3) To identify training needs of oncology research teams in Nigeria. The outcome measures were the facilities upgraded, the number of personnel trained and the number of sites that were capable of anchoring oncology clinical trials in Nigeria.