Cancer clinical trials grow more slowly than expected in Brazil, study finds

A 20-year analysis shows that the country has made progress but still faces regulatory and cultural barriers, as well as reliance on the pharmaceutical industry.

Gabriela Monteiro

A woman's hand with pink-painted nails, wearing a green surgical gown, with an intravenous catheter secured to the back of the hand with a white dressing and connected to a transparent tube

Scientific progress depends in part—but not solely—on a country’s economic health. This is one of the conclusions of the study “Disparities in cancer clinical trials across low- and middle-income countries: A 20-year analysis” , published in the journal of the American Cancer Society.

The research, conducted by personnel from the Latin American Cooperative Oncology Group (LACOG) and Einstein Hospital Israelita in Brazil, was featured in a report published by Science Arena in April.

The analysis examined 16,977 clinical trials registered between 2001 and 2020 across 20 countries classified as low- and middle-income (LMICs) at the beginning of the study period.

Its primary objective was to investigate the relationship between growth in gross domestic product (GDP) per capita and the volume of oncology clinical trials, and to assess the extent to which economic growth does—or does not—account for the development of clinical research.

The correlation between GDP and clinical trial volume

Most of the countries analyzed increased their number of clinical trials during the study period. However, the strength of the relationship between economic growth and growth in clinical trial activity varied considerably.

The researchers measured this relationship using the Pearson correlation coefficient, on a scale from 0 to 1. Countries with rapidly expanding economies, such as China (0.93) and South Korea (0.97), showed a very strong correlation.

Countries with less consistent economic growth, including Brazil (0.68) and Argentina (0.51), exhibited a moderate correlation, meaning that clinical trial activity increased but did not keep pace with what might have been expected based on economic performance alone.

The findings suggest that GDP is a contributing factor, but not the sole driver of growth in clinical trial activity. India and Indonesia, for example, experienced robust economic growth yet showed very weak correlations with increases in oncology studies—0.02 and −0.20, respectively.

“Economic growth may be a contributing factor, but only up to a point. The findings underscore the need for targeted initiatives to support oncology research in low- and middle-income countries,” the study’s authors conclude.

China and South Korea: What sets the leaders apart?

Among the 20 countries analyzed, only China and South Korea succeeded in developing independent clinical research at scale—studies not sponsored by the pharmaceutical industry. Both countries increased the proportion of early-phase trials (phases 1 and 2) relative to late-phase trials (phase 3). During the second period analyzed (2011–2020), phase 1–2 studies had become predominant in both countries, an indicator of greater technological sophistication and scientific autonomy.

Their progress was not driven by economic growth alone. China undertook a sweeping regulatory reform in 2015 and, in 2018, shifted from an approval-based system to one based on registration for multinational clinical trials, dramatically reducing bureaucratic hurdles. South Korea adopted the International Council for Harmonisation’s Good Clinical Practice standards (ICH-GCP) in 2000 and established national training programs for conducting clinical studies. According to the authors, these reforms may, in themselves, explain part of the progress observed, independent of GDP growth.

Dependence on the pharmaceutical industry: A structural challenge

With the exception of China and Egypt, the vast majority of LMICs remained highly dependent on industry-sponsored clinical trials throughout both periods analyzed. In Brazil, for example, 80 percent of trials conducted between 2001 and 2010 were sponsored by the pharmaceutical industry, a figure that declined only slightly to 76 percent, in the following decade. Argentina, Chile, Colombia, and Peru all maintained industry sponsorship rates above 85 percent during the second period.

This pattern is problematic because industry-sponsored trials are typically designed to address questions more relevant to high-income countries, which represent the pharmaceutical industry’s primary commercial markets. Although such trials provide benefits to LMICs by expanding access to experimental therapies, they rarely address the specific needs of local populations or their healthcare systems.

“Researchers in low- and middle-income countries rarely play a role in the design and conduct of industry-sponsored trials and have few opportunities to serve as lead authors,” the paper notes.

The Brazilian Case: Growth Constrained by Structural Limitations

Brazil showed a moderate correlation (0.68) between GDP growth and growth in clinical trial activity, indicating that even during periods of economic expansion, research output did not increase as might have been expected. One factor highlighted by the study is the country’s relatively low investment in research and development (R&D): in 2020, Brazil allocated just 1.14 percent of its GDP to R&D, compared with 2.4 percent in China that same year.

The study also cites findings presented at the American Society of Clinical Oncology (ASCO) annual meeting in 2025, showing that Brazilian cancer patients harbor significant concerns about being used as “guinea pigs” in clinical trials. According to the authors, this cultural perception may limit patient recruitment and hinder the development of independent clinical research in the country.

Measures to foster the development of clinical research in low- and middle-income countries

1. Demystify participation in clinical trials: efforts targeting both physicians and patients can be implemented with minimum investment. Misconceptions—such as the belief that participants are being used as “guinea pigs”—reduce enrollment and hinder the development of locally driven research.
2. Implement regulatory reforms: streamlining the approval process for clinical studies can reduce both timelines and costs. The experiences of China and South Korea demonstrate that regulatory changes can accelerate scientific development independently of GDP growth.
3. Ensure fair compensation for research teams: remuneration should, at minimum, be comparable to earnings from routine clinical practice. Brain drain to high-income countries remains a persistent challenge.
4. Expand access to training: for physicians and research staff—this can be achieved with low to moderate levels of investment.
5. Secure funding for independent research: financial support not tied to the pharmaceutical industry is key for studies to address the real needs of local populations.
6. Establish and strengthen collaborative research groups: organizations such as LACOG in Latin America provide biostatistical, regulatory, and fundraising support for independent studies.
7. Reduce the outflow of skilled professionals: financial incentives and clear career-development pathways can help make local research environments more competitive.

A worsening scenario

The study’s findings take on added significance in light of projections from the International Agency for Research on Cancer (IARC), an agency of the World Health Organization (WHO), which which estimates that the global cancer burden will increase by 77 percent by 2050.

The impact is expected to be greatest in countries with lower Human Development Index (HDI) scores—the very countries that, according to the study, continue to produce lower-complexity clinical research and remain highly dependent on industry-sponsored trials.

The authors conclude that periods of economic hardship should not be a barrier to the continued development of clinical research. The measures needed to strengthen research capacity—such as regulatory reforms, workforce training, and the creation of collaborative research networks—require relatively modest investment while offering long-term benefits.

According to the authors, the study can serve as “a roadmap for LMICs seeking to achieve the highest levels of performance.”

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