Global disparities in current clinical trials in cervical cancer.

5530 Background: Cervical cancer is one of the most disproportionately distributed cancers worldwide, with highest incidence and mortality rates occurring in low- and middle-income countries (LMICs). Although clinical trials provide the crucial foundation for the development of standards of care, oncology research is disproportionately concentrated in high-income settings. Methods: We assessed the current global landscape of cervical cancer clinical trials to determine whether trial activity aligns with disease burden and to characterize various disparities in trial representation. Interventional phase II and III cervical cancer clinical trials registered on ClinicalTrials.gov between January 1, 2014, and December 31, 2025, were identified. Trials were further categorized by intervention class, patient population, funding source, and location. Representation of trials in relation to disease burden for cervical cancer was determined using trial-to-age-standardized incidence rate (ASIR) from Global Cancer Observatory estimates. Countries were classified by World Bank Income Level and disease burden, where high burden countries had an ASIR above the global ASIR of 14.1. Non-parametric statistical tests were used to compare trial-to-ASIR ratios across groups. Results: A total of 269 eligible trials were included. Most studies were phase II (62.5%) and evaluated systemic or combination therapies (83.6%). The majority of trials were institutionally funded (55.0%), with industry sponsorship accounting for 33.5% of studies. Clinical trial activity was concentrated in a small number of countries, with single-country trials conducted predominantly in China (60.2%) and the United States (13.0%), while multinational trials were largely conducted in high-income countries. When adjusted for disease burden, most high-burden countries had few or no trials relative to incidence, resulting in significantly lower trials per ASIR compared with non–high-burden countries (P < .001). Significant disparities were also observed across income groups, with high-income countries demonstrating substantially higher trial-to-ASIR ratios than lower-income countries (P < .001). Conclusions: The global distribution of cervical cancer clinical trials remains misaligned with disease burden, with high-burden and lower-income countries underrepresented in research participation. Funding patterns and trial sponsorship may further influence where trials are conducted. Addressing these disparities will be essential to ensure equitable evidence generation and improve global cervical cancer care.