Elsevier

Seminars in Oncology

Volume 42, Issue 5, October 2015, Pages 693-712
Seminars in Oncology

The Globalization of Cooperative Groups

https://doi.org/10.1053/j.seminoncol.2015.07.003Get rights and content

The National Cancer Institute (NCI)-supported adult cooperative oncology research groups (now officially Network groups) have a longstanding history of participating in international collaborations throughout the world. Most frequently, the US-based cooperative groups work reciprocally with the Canadian national adult cancer clinical trial group, NCIC CTG (previously the National Cancer Institute of Canada Clinical Trials Group). Thus, Canada is the largest contributor to cooperative groups based in the United States, and vice versa. Although international collaborations have many benefits, they are most frequently utilized to enhance patient accrual to large phase III trials originating in the United States or Canada. Within the cooperative group setting, adequate attention has not been given to the study of cancers that are unique to countries outside the United States and Canada, such as those frequently associated with infections in Latin America, Asia, and Africa. Global collaborations are limited by a number of barriers, some of which are unique to the countries involved, while others are related to financial support and to US policies that restrict drug distribution outside the United States. This article serves to detail the cooperative group experience in international research and describe how international collaboration in cancer clinical trials is a promising and important area that requires greater consideration in the future.

Section snippets

Seeking Information on Globalization from Adult Cooperative Groups

The leadership of the National Clinical Trials Network (NCTN) was invited to participate in this review and asked to provide their experience on international collaborations, including information on countries, sites, investigators, and clinical trials and associated publications.

This article includes summary tables of the groups’ involvement in international collaborations, although data on patient accrual and publications are available for only those groups providing this information. Overall

Overview and the NCIC CTG Perspective

Established in 1980, the NCIC CTG has 273 phase III ongoing or completed studies, as well as 197 Investigational New Drug trials, enrolling a total of over 75,000 patients. NCIC CTG has collaborated with sites in 41 countries, across 54 trials, with 26,189 patients accrued. It is important to note the significance of the partnership with US cooperative groups and sites that contributed 18,624 of the 26,189 patients accrued through these collaborations. A summary of international participation

NSABP Experience

The list of international sites that have participated in current and past National Surgical Adjuvant Breast and Bowel Project (NSABP) studies covers the period from 1971 to the present. It includes 41 different institutions or organizations. Some of the organizations are actually themselves research groups, such as the Irish Clinical Oncology research Group (ICORG), which participated as full members of the NSABP. Overall, these sites have entered more than 14,000 patients into NSABP’s

RTOG Experience

The Radiation Therapy Oncology Group (RTOG) elected to globalize its activity in 2004. The first international site to be accepted was Tel Aviv Medical Center. Within a year, hospitals from South Korea and Australia were also invited to join as affiliates. Currently, 29 centers participate from 14 countries and 5 continents. The motivation for expanding towards an international catchment was both altruistic and pragmatic in nature. From an altruistic standpoint, enrollment of patients on RTOG

SWOG Experience

Over the past four decades, the Southwest Oncology Group (SWOG) has collaborated with 93 centers in 14 countries, including 66 sites in Canada. A total of 8,925 patients were accrued to 48 studies, including solid tumors and hematologic malignancies. Leading accruing sites were Canada (4,522), Puerto Rico (1,463), Mexico (678), and Spain (499). These studies generated the publication of 35 primary results papers. Included were the evaluation of imatinib mesylate in patients with

The Alliance Experience

The Alliance for Clinical Trials in Oncology was created as a merger between three “legacy” groups: American College of Surgeons Oncology Group (ACOSOG), Cancer and Leukemia Group B (CALGB), and North Central Cancer Treatment Group (NCCTG). The three legacy groups all had a strong history of international sites and collaborations. Among the groups, there have been numerous collaborators, involving 2 countries in Australia, 10 in Asia, 2 in North America, 3 in South America, and 21 in Europe,

Discussion

NCTN groups have a long-standing history of collaboration with international cancer units around the world. The most important incentive for these collaborations appears to be the desire to improve patient accrual of large phase III trials in the United States and Canada. Many international sites likewise benefit by the experience of working with well-organized and experienced clinical trials organizations that facilitate their access to newer and often expensive cancer treatments provided by

Acknowledgments

Supported in part by National Institutes of Health/National Cancer Institute grants U10 CA180888, U10 CA180819, UG1 CA189974, U10 CA12027, U10 CA37377, U10 CA69651, U10 CA69974, U10 CA21661, U10 CA37422, U10 CA180821, U10 CA1844; Canadian Cancer Society Research Institute (CCSRI) grant 021039; and the Bill and Melinda Gates Foundation. The authors wish to thank Sherry Breaux, MPH, Publications Operations Manager, Alliance for Clinical Trials in Oncology; Veronica Garcia, BS, SWOG Latin American

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    From the Alliance for Clinical Trials in Oncology, NCIC CTG, NRG Oncology, RTOG and SWOG adult NCTN research groups.

    Financial disclosure or conflict of interest statements for all products discussed or implied in the article: none.

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