The SWOG Latin America Initiative
Although we started referring officially to a "SWOG Latin America Initiative" (or SLAI) only in 2009 or so, our work to foster research collaboration with colleagues and institutions in South and Central America started several years before that, and included visits to the region by then group chair Charles Coltman, MD, and then group statistician John Crowley, PhD, among others.
Those early efforts led to two SWOG clinical trials. S0701, conducted at sites in Chile, Colombia, Costa Rica, Honduras, Mexico, and Nicaragua, compared three antibiotic regimens to treat infection with Helicobacter pylori, a primary cause of gastric cancer, which is a leading cancer killer globally. The findings were a surprise: the regimens found to be most effective in previous trials run in Europe and Asia were notthe most effective in this Latin America population, suggesting regional differences must be accounted for.
The subsequent S1119 study, carried out in Lima, Peru, found H. pylori in the water sources used by patients infected with the bacterium, suggesting the water supply was one source of infection.
This second study was led by Dr. Manuel Valdivieso, SWOG’s first executive officer for international affairs. Drs. Valdivieso and Crowley, often accompanied by SWOG’s group chair (initially Dr. Larry Baker and then yours truly), led many SLAI trips in the region, forging partnerships with leading cancer researchers and institutions – many of which would go on to become SWOG member sites.
These included the Instituto Nacional De Cancerología de Mexico (INCan), which in 2010 became SWOG’s first Latin American member site. In 2020–2021, INCan made the list of SWOG’s top-accruing main member sites, the first time any institution outside the US has been on that list. INCan also has the distinction of giving us our second executive officer for international affairs, Dr. Alejandro Mohar, who had served for a number of years as INCan’s director.
Our current executive officer for international affairs, Dr. Mariana Chavez Mac Gregor, has been vigorously opening doors between US and Latin American colleagues, helping investigators on both sides learn about opportunities the SLAI offers, including opportunities for opening SWOG trials abroad.
To this end, she recently launched the SLAI Newsletter. If you haven’t yet dived into the first issue, I encourage you to do so. It highlights presentations from the spring SLAI Symposium, which focused on cancer inequities in research, opportunities for scientific collaborations for non-US investigators, and highlights from SLAI sites.
Dr. Chavez Mac Gregor is also working to reestablish face-to-face meetings for education and statistics training, after a pandemic-imposed shift to the virtual. The next such meeting is planned for early November in Montevideo, Uruguay (a city that, as of last fall, is home to three SWOG member sites). This is the yearly SLAI research course. I’ll be attending as faculty, accompanied by several other SWOG leaders.
Of course, the event you’re probably most aware of is the SLAI Symposium held at group meeting. In years past, these symposia were often invitation-only events – no more. “Now we want exactly the opposite,” says Dr. Chavez Mac Gregor, “we want to invite as many investigators as are interested.”
To aid these efforts, I’ve also invited Dr. Chavez Mac Gregor to present directly to committee leaders. She and the SLAI team are developing a matrix to summarize the capabilities and interests of each of our Latin American member sites, so that SWOG chairs and investigators can more readily identify sites that might be a good fit for specific trials being planned.
Even when sites are a good fit, however, opening trials across borders comes with a unique set of challenges. These have been a hot topic in the NCTN recently. SWOG and NRG Oncology, in particular, have been pushing hard to get the NCI to tackle barriers to international trials, including regulatory issues, privacy concerns, and drug distribution restrictions. The NCI recently convened a task force to address these obstacles.
Finally, Dr. Chavez Mac Gregor is also working to bring talented researchers from Latin America into SWOG research committees. Several have recently joined as members of our breast, symptom control and quality of life, and lung committees. “Sometimes you just have to be in the room,” she says, “and we want our investigators in Latin America to be in the room.”
The success of the SWOG Latin America Initiative has been built on the hard work of many people, some of whom I’ve mentioned above, but I also want to thank two key organizations. Cancer Research And Biostatistics (CRAB) has served as the administrative home for much of the SLAI planning and outreach over the years – with critical support from our Operations Office – and The Hope Foundation for Cancer Research has funded much of the time, travel, and infrastructure needed to make our SLAI successful.
I’ll close with a link to a story that offers one, rather entertaining, example of the challenges international collaboration can pose and of how our researchers rose to meet it. Rising to meet such challenges is what has made SLAI such a success, even if most efforts make for much less interesting reading.