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The Front Line


The Front Line: Charles D. Blanke, MD, SWOG Chair


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Expansion within the SWOG Latin America Initiative

September 29, 2017 - Back in 2009, we launched our SWOG Latin America Initiative (SLAI), with several goals. A major one was our intention to expand access to our NCI cancer clinical trials to a growing pool of patients in need. While people diagnosed with cancer in the U.S., Canada, and Europe typically have oodles of studies to choose from, those in the southern regions have many fewer available. And itís not like there arenít lots of problematic neoplasms to study, including cervical, biliary, and gastric cancers, among others.

Eight years in, we can count SLAI member sites in Colombia, Mexico, and Peru. We hope to expand our reach. This month, we met with leading cancer officials from Uruguay and Chile, and we invited sites in those countries to join us as members. We have added important SWOG infrastructure to support our plans. Years ago, we created a Latin America specialist position at the San Antonio operations office, a coordinator who helps SLAI sites with membership applications, as well as trial activations, auditing, and other duties necessary to manage federally-funded cancer trials. In May of this year, our partners at Cancer Research And Biostatistics (CRAB) added SLAI program event and communications duties to an existing staff position.

I mentioned other goals for SLAI. SWOG strongly believes in education and training. The training portion of this program truly is robust. We have tutored more than 400 cancer physicians and researchers across Latin America in the last two years alone, through formal statistical and clinical trials courses. We hope to expand that effort as well, through a dedicated planning grant.

We hope our Latin American members conduct their own trials, and we want them to accrue well to SWOG studies. In fact, through both mechanisms, we hope to learn about tumors seen commonly in our largest US minority. International accrual in general remains difficult for our members, though Latin America members have put 207 patients on study. The barriers arenít so much language or culture, but laws and logistics. Director of Operations Dana Sparks says that several enrollment challenges exist for SLAI members, chief among them restrictions on the import and export of cancer drugs that make it very hard to get investigational treatments to sites. Too, there is often lack of insurance funding for trial expenses, which creates a significant disincentive to patients considering enrollment. Finally, many Latin America sites do not as routinely employ biostatisticians or clinical research associates Ė two roles so critical in the conduct of clinical trials.

Fully realizing the vision of SLAI will continue to take a sustained and focused effort. We need to breach the big barriers of drug distribution and dollars, and get continued support from NCI, and perhaps the FDA, to better succeed. We need to carefully pick and promote trials that have minimal barriers, perhaps studies employing other modalities besides drugs. We also need our SLAI partners to have a seat at the table, which is why even those not meeting accrual requirements for full BOG membership will still have non-voting representation.

Meaningful, lasting change takes time and commitment. I remain convinced we will realize our goal.

The deadline is fast approaching for submission of abstracts for the ASCO Genitourinary Cancers Symposium. Please send draft abstracts to SWOG Publications Manager Pat Arlauskas at arlauskp@ohsu.edu for pre-processing in compliance with SWOG, NIH, and industry policy/guidelines no later than October 3.

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