Global Distribution and Characteristics of Research Facilities Participating in Phase III Oncology Trials

ABSTRACT Background Research infra-structure is essential for conducting phase III cancer clinical trials as its lack precludes trial availability and its maturity may influence the portfolio of available options. Several studies have highlighted global disparities, but none has ever mapped the worldwide network of research facilities conducting such trials. Methods We extracted all research sites within recruiting phase III cancer interventional trials from the ClinicalTrials.gov database on July 23, 2024. Address components were combined and queried through the Google Maps API for standardized identification. Matched pairs were subsequently screened for inconsistencies, and Google Maps entries within 1,000 meters were grouped if they represent the same facility. We compared research facilities’ number, density (per 1M inhabitants), size, and portfolio of available trials across World Development Index regions, and modelled the number of available trials and research facilities per country with log-log linear models (elasticity coefficient [β] estimand). Findings Of 77,625 listed sites from 1,287 trials, 65,736 (84.7%) were mapped to 6,634 unique research facilities across 84 countries. We found a strong correlation between the number of research facilities and trials by country (R 2 =0.86, p-value93%, p-value90%, p-value80%, p-value93%), industry-sponsored (>90%), and systemic therapy trials (>80%). Implications of all the available evidence Global disparities in cancer clinical trials are perpetuated by constrained research infrastructure in less developed regions, reflected not only in the limited number of research facilities but also in their profiles, which often have little experience beyond industry-sponsored trials, as we have shown. While investments in research facilities are crucial and are associated with increased trial availability, particularly during the early stages of infrastructure development, they are not sufficient on their own. Complementary strategies are needed, including financial incentives to support locally designed trials (i.e., investigator-initiated grants) and sustained investment in human resources to design and conduct them. Aligning infrastructure expansion with workforce development is essential to improve both the quantity and the profile of available cancer clinical trials, enhance local leadership, and ensure that research is relevant and generalisable to diverse populations.