The Cervical Cancer Research Network: Addressing Unmet Needs in Cervical Cancer Research | David SP Tan, PhD
David SP Tan, PhD
Cervical cancer has been acknowledged by the World Health Organization (WHO) as a global health problem with a call to action issued by its director general in May 2018. Tragically, though this is a preventable disease, it remains the 4th most common cancer amongst females with a worldwide incidence of 15.6% in 2020.1 This amounts to over 600,000 women being diagnosed with cervical cancer and over 341,000 lives lost to the disease in 2020.1 Clearly, more efforts are required globally to raise awareness of the disease, improve access to human papillomavirus vaccination and screening, and ensure access to optimal treatment of established disease to reduce morbidity and improve survival.
Underpinning these international efforts to eradicate and improve outcomes for cervical cancer, is the need to enhance research capabilities in this disease so that unmet needs in each country can be identified, and best practices for prevention and intervention can be trialled and instituted in a timely manner. A key challenge in this context is enhancing diversity in clinical trials for cervical cancer. This is especially relevant in a disease with a disproportionately higher burden in low- and middle-income countries (LMICs), where clinical trials could provide life-saving therapies for women who are usually unable to access these treatments. Furthermore, a lack of ethnic diversity in cancer trials also hinders our understanding of the safety and efficacy of novel therapies across population subgroups, which is an essential step to reducing disparities and advancing equity. 2, 3 Clinical trial diversity in cervical cancer is therefore a moral and scientific imperative.
The Gynecologic Cancer InterGroup (a not for profit organization established to promote cooperation in gynecologic cancer clinical trials) – Cervical Cancer Research Network (GCIG-CCRN) was formed in 2012 to bring together researchers from LMICs interested in cervical cancer research and management to address the aforementioned issues and develop pragmatic clinical trial concepts with potentially practice changing outcomes (https://gcigtrials.org/content/ccrn-committee).4 One example of this was the phase 3 SHAPE (radical versus simple hysterectomy and pelvic node dissection with low-risk early stage cervical cancer – ClinicalTrials.gov Identifier: NCT01658930) trial that was presented at the 2023 ASCO Annual Meeting. This practice changing study showed that in early-stage, low-risk cervical cancer, the pelvic recurrence rate at 3 years with simple hysterectomy was non-inferior to radical hysterectomy, and was associated with significantly less acute surgery-related adverse events within 4 weeks of surgery.5
The CCRN have also initiated regional symposia on an annual basis to identify and connect with potential researchers in LMICs. The inaugural symposium was held in Bangkok in 2016, with subsequent meetings in Mexico City (2017), Bucharest (2018) and Johannesburg (2019). The 2020 meeting was cancelled due to the COVID19 pandemic, but eventually took place this year in Da Nang Vietnam. Our next regional symposium is planned for Morocco in early 2024 and we certainly look forward to further discussions on addressing unmet needs and research studies to improve outcomes for women with cervical cancer both in North Africa and across the globe as well.
David SP Tan
Chair, Cervical Cancer Research Network, GCIG
Gynecologic Cancer Group Singapore (GCGS)
National University Cancer Institute, Singapore, National University Hospital
Yong Loo Lin School of Medicine, National University of Singapore (NUS)
References
1. GLOBOCAN Estimates of Incidence and Mortality Worldwide for cancer, 2020
2. Schwartz AL, Alsan M, Morris AA, Halpern SD. Why Diverse Clinical Trial Participation Matters. N Engl J Med. 2023 Apr 6;388(14):1252-1254. doi: 10.1056/NEJMp2215609. Epub 2023 Apr 1. PMID: 37017480.
3. Oyer RA, Hurley P, Boehmer L, Bruinooge SS, Levit K, Barrett N, Benson A, Bernick LA, Byatt L, Charlot M, Crews J, DeLeon K, Fashoyin-Aje L, Garrett-Mayer E, Gralow JR, Green S, Guerra CE, Hamroun L, Hardy CM, Hempstead B, Jeames S, Mann M, Matin K, McCaskill-Stevens W, Merrill J, Nowakowski GS, Patel MI, Pressman A, Ramirez AG, Segura J, Segarra-Vasquez B, Hanley Williams J, Williams JE Jr, Winkfield KM, Yang ES, Zwicker V, Pierce LJ. Increasing Racial and Ethnic Diversity in Cancer Clinical Trials: An American Society of Clinical Oncology and Association of Community Cancer Centers Joint Research Statement. J Clin Oncol. 2022 Jul 1;40(19):2163-2171. doi: 10.1200/JCO.22.00754. Epub 2022 May 19. PMID: 35588469.
4. McCormack M, Gaffney D, Tan D, Bennet K, Chavez-Blanco A, Plante M. The Cervical Cancer Research Network (Gynecologic Cancer InterGroup) roadmap to expand research in low- and middle-income countries. Int J Gynecol Cancer. 2021 May;31(5):775-778. doi: 10.1136/ijgc-2021-002422. Epub 2021 Feb 25. PMID: 33632702; PMCID: PMC8108273.
5. Marie Plante, Janice S. Kwon, Sarah Ferguson, Vanessa Samouëlian, Gwenael Ferron, Amandine Maulard, Cor de Kroon, Willemien Van Driel, John Tidy, Christian Marth, Karl Tamussino, Stefan Kommoss, Frederic Goffin, Brynhildur Eyjólfsdóttir, Jae-Weon Kim, Noreen Gleeson, Juliana M Ubi, Lori Brotto, Dongsheng Tu, Lois E. Shepherd. J Clin Oncol 41, 2023 (suppl 17; abstr LBA5511. Doi: 10.1200/JCO.2023.41.17_suppl.LBA5511