Page 0029

GLOBAL CANCER POLICY-MAKING

OVERCOMING CHALLENGES

IN CONDUCTING CLINICAL

TRIALS IN AFRICA

MELISSA ADDE AND IAN MAGRATH, INTERNATIONAL NETWORK FOR CANCER RESEARCH

AND TREATMENT, BRUSSELS, BELGIUM

The African Burkitt Lymphoma Strategy Group of the International Network for Cancer

Treatment and Research (INCTR) recently published the results of the first 356 patients

treated according to a uniform clinical research protocol (INCTR 03-06) from 2004

through the end of 20091.

B

urkitt lymphoma (BL) is one of the commonest to conduct clinical research in Africa.

childhood cancers in equatorial Africa and one that

can be cured with chemotherapy alone2,3. With the Challenges identified

overall objective being to improve the survival of children with The importance of an accurate diagnosis

BL, the Principal Investigators (PIs) representing four In the earlier years of the protocol, the majority of diagnoses

institutions – the Ocean Road Cancer Institute (ORCI) in were made by fine needle aspirate (FNA). Institutions were

Tanzania, the Kenyatta National Hospital (KNH) in Kenya and unable to routinely perform more sophisticated analyses

the Obafemi Awolowo University Teaching Hospitals Complex of diagnostic specimens such as immunohistochemistry (IHC)

(OAUTHC) and the University College Hospital (UCH) Ibadan to rule out other malignancies and cytology alone was used to

in Nigeria – together with INCTR personnel – treatment was make the diagnosis. In a systematic central review of many of

standardized among the four centres and it was agreed, to the FNA specimens by a panel of expert haematopathologists,

collect detailed information about clinical presentation who are part of INCTR’s Pathology Programme, it was learned

features of patients with BL, and to make a determined effort that it was possible to confirm the diagnoses in the majority of

to document treatment effects and outcomes. This led to the cases, but that some specimens were of such poor quality (or

design of the study entitled, “The Treatment and did not even include tumour cells) that the diagnosis could not

Characterization of BL in Africa”. be confirmed4,5. Because not all samples were reviewed, as

Since the time of the initial report, the group has expanded indicated in the recent publication of the data for the initial 356

to three new centres, the St Mary’s Hospital, Lacor in Uganda patients, some patients may not have had BL and therefore,

(2010), the Bugando Medical Centre (BMC) in Tanzania may have increased the number of patients listed as “treatment

(2011) and the Vanga Hospital in the Democratic Republic of failure”. We know this because when patients did not respond

Congo (DRC) (2011) and an additional 269 patients have been to treatment, they underwent tru-cut needle biopsies of tumour

enrolled on the study. In all, and a total of 625 patients have sites. Fifteen of the 625 patients had other malignancies

been enrolled as of the end of December 2012. when re-reviewed by the treating institution or reviewed by

Once the study was underway and patient accrual began, outside institutions. Review diagnoses included acute

many challenges encountered by the sites emerged. These lymphoblastic leukemia, lymphoblastic lymphoma, Hodgkin’s

related to the diagnosis, staging, treatment and follow up of lymphoma, nasopharyngeal carcinoma, neuroblastoma,

patients, the ability to perform protocol-related procedures, rhabdomyosarcoma and carcinomas not otherwise specified. It

and the social circumstances of the children and their families. is important to point out that not all samples, particularly from

Many strategies were put into place to overcome these the newer institutions, have been centrally reviewed and

challenges and we continue to learn how to improve the ability improved diagnosis is likely, therefore, would give a more

CANCER CONTROL 2013 27

Index

  1. CANCER CONTROL 2013
  2. Page 0002
  3. Page 0003
  4. Page 0004
  5. Page 0005
  6. Page 0006
  7. Page 0007
  8. Page 0008
  9. Page 0009
  10. Page 0010
  11. Page 0011
  12. Page 0012
  13. Page 0013
  14. Page 0014
  15. Page 0015
  16. Page 0016
  17. Page 0017
  18. Page 0018
  19. Page 0019
  20. Page 0020
  21. Page 0021
  22. Page 0022
  23. Page 0023
  24. Page 0024
  25. Page 0025
  26. Page 0026
  27. Page 0027
  28. Page 0028
  29. Page 0029
  30. Page 0030
  31. Page 0031
  32. Page 0032
  33. Page 0033
  34. Page 0034
  35. Page 0035
  36. Page 0036
  37. Page 0037
  38. Page 0038
  39. Page 0039
  40. Page 0040
  41. Page 0041
  42. Page 0042
  43. Page 0043
  44. Page 0044
  45. Page 0045
  46. Page 0046
  47. Page 0047
  48. Page 0048
  49. Page 0049
  50. Page 0050
  51. Page 0051
  52. Page 0052
  53. Page 0053
  54. Page 0054
  55. Page 0055
  56. Page 0056
  57. Page 0057
  58. Page 0058
  59. Page 0059
  60. Page 0060
  61. Page 0061
  62. Page 0062
  63. Page 0063
  64. Page 0064
  65. Page 0065
  66. Page 0066
  67. Page 0067
  68. Page 0068
  69. Page 0069
  70. Page 0070
  71. Page 0071
  72. Page 0072
  73. Page 0073
  74. Page 0074
  75. Page 0075
  76. Page 0076
  77. Page 0077
  78. Page 0078
  79. Page 0079
  80. Page 0080
  81. Page 0081
  82. Page 0082
  83. Page 0083
  84. Page 0084
  85. Page 0085
  86. Page 0086
  87. Page 0087
  88. Page 0088
  89. Page 0089
  90. Page 0090
  91. Page 0091
  92. Page 0092
  93. Page 0093
  94. Page 0094
  95. Page 0095
  96. Page 0096
  97. Page 0097
  98. Page 0098
  99. Page 0099
  100. Page 0100
  101. Page 0101
  102. Page 0102
  103. Page 0103
  104. Page 0104
  105. Page 0105
  106. Page 0106
  107. Page 0107
  108. Page 0108
  109. Page 0109
  110. Page 0110
  111. Page 0111
  112. Page 0112
  113. Page 0113
  114. Page 0114
  115. Page 0115
  116. Page 0116
  117. Page 0117
  118. Page 0118
  119. Page 0119
  120. Page 0120
  121. Page 0121
  122. Page 0122
  123. Page 0123
  124. Page 0124
  125. Page 0125
  126. Page 0126
  127. Page 0127
  128. Page 0128
  129. Page 0129
  130. Page 0130
  131. Page 0131
  132. Page 0132
  133. Page 0133
  134. Page 0134
  135. Page 0135
  136. Page 0136
  137. Page 0137
  138. Page 0138
  139. Page 0139
  140. Page 0140
  141. Page 0141
  142. Page 0142
  143. Page 0143
  144. Page 0144
  145. Page 0145
  146. Page 0146
  147. Page 0147
  148. Page 0148
  149. Page 0149
  150. Page 0150
  151. Page 0151
  152. Page 0152
  153. Page 0153
  154. Page 0154
  155. Page 0155
  156. Page 0156
  157. Page 0157
  158. Page 0158
  159. Page 0159
  160. Page 0160
  161. Page 0161
  162. Page 0162
  163. Page 0163
  164. Page 0164
  165. Page 0165
  166. Page 0166
  167. Page 0167
  168. Page 0168
  169. Page 0169
  170. Page 0170
  171. Page 0171
  172. Page 0172
  173. Page 0173
  174. Page 0174
  175. Page 0175
  176. Page 0176
  177. Page 0177
  178. Page 0178
  179. Page 0179
  180. Page 0180

powered by PageTiger