Challenges for cancer research in India: What's the way out?

We congratulate Dr. Noronha for the article “Making a case for cancer research in India” and bringing out this very important but less often discussed issue.[1] Overall scientific research in our country has not grown in parallel to the economic growth. Despite a significant increase in the number of publications, the overall global impact of Indian scientific research lags far behind in terms of citations, the number of patents, and new discoveries.[2] It is high time for all stakeholders, the scientific community, government, and industry to introspect. There is a need to promote a collaborative approach leaving behind the personal egos, inter-institutional rivalries, and bureaucratic attitude. A small step in this direction could be the development of disease-specific collaborative research networks across various institutions, including clinicians and basic scientists. These networks can formulate India-centric research questions and work together on them in both the clinical and basic science domains. Funds could be generated not only through the government support but also through philanthropic donations and contributions from pharmaceutical companies. We are living in the era of evidence-based medicine. However, if the evidence based on which our guidelines have been drafted, is applicable only in 10% of our patient population, it loses relevance in the clinical practice. Most oncology trials globally which are influencing our standard practice, are registration trials of new drugs where a highly selected and homogenous patient population is treated under a controlled environment. The real-world practice is entirely different where heterogeneity is the rule and the findings of these trials may not be completely applicable. In the Indian context, it may be even more irrelevant if Indian patient population were not a part of the global trials. There is a need to conduct more pragmatic trials, which should address the important clinical questions relevant to the specific population.[3] We do have unique challenges in treating cancer patients in India regarding disease stage, comorbidities, performance status, nutritional status, tolerance, and logistics, etc., These issues need to be addressed when designing clinical trials. There have been several excellent pragmatic trials conducted recently from India itself, which have not only answered such important clinical questions relevant in the Indian context but globally as well.[45] Another way to gain insight into our own problems is a systematic and uniform collection of real-world data. Globally, this strategy is gaining popularity. The best examples are platforms such as CancerLinQ™ (by the American Society of Clinical Oncology) and Flatiron (by Flatiron Health, a health-care information technology company).[3] Analysis of such enormous datasets could give a deep understanding of local problems and help the researchers in designing relevant clinical trials. Developing the artificial intelligence systems and computerized simulations may eventually obviate the need for some unnecessary studies or at least give a more rationalized background to the future clinical trials. Investing in such models would be beneficial not only for patients and clinicians (better clinical decision-making) but also for the policy makers (understanding the unmet needs), government (the estimation of health-care needs and gaps), regulators (a real-time estimation of effectiveness and safety of any drug or intervention), and industry (reliable data for market research). We strongly feel that cancer research system in our country needs some major reforms. Despite all challenges, Noronha et al. have very well-highlighted that as a responsible scientific community, we will have to work together to overcome these hurdles to improve cancer care in India. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.