Spain is the European leader in clinical trials against cancer, ahead of the United Kingdom, Germany and Italy and just behind France. However, the translation into innovations is the pending account that weighs down the knowledge generated in our country.
This Tuesday, September 24, is World Cancer Research Day, a date that commemorates the efforts of scientists and health professionals around the world to tackle this group of diseases that already constitute the leading cause of death in our country.
Talking about cancer research means bringing together many concepts and areas of knowledge. This includes everything from basic studies of tumor cells in university laboratories to testing new drugs in public and private hospitals.
It is this last stage, that of clinical trials, which generally reflects the state of research in a country.
According to the Clinicaltrials.gov database, In our country there are 1,722 active clinical trials (whether or not they recruit patients). This is a figure slightly lower than the 1,766 in France but much higher than the 1,422 in Italy, the 1,261 in the United Kingdom or the 1,244 in Germany.
“We are a very powerful country in terms of research,” he comments. Marta Puyolscientific director of the Spanish Association against Cancer. “We are in the top 10 in terms of publications [científicas] on cancer. In the clinic, we attract many clinical trials because we have a perfect ecosystem: great researchers and an unbeatable hospital system, both public and private.”
In fact, a report by the AECC on cancer research in our country highlighted that Spanish researchers have been coordinators of the European projects in which they have participated in more than 70% of cases.
The second edition of this report, published in 2022, analyzed in depth the characteristics of cancer research in our country.
Scientific publications on cancer had increased by almost 15% in the years immediately preceding the pandemic, a figure similar to that of Italy and Portugal and higher than that of France, the Netherlands or Germany.
Of course, 50% of these studies are published in the most prestigious journals, a figure significantly lower than that of the last three countries mentioned.
Immuno-oncology leads the field with the fastest growing number of publications and, by cancer type, breast (2,202), colorectal (1,968) and lung (1,733) cancers generate the most articles.
These figures are proportionally similar to those of most global research, but In our country there is a greater prevalence in the investigation of colon, melanoma and hematological tumors such as lymphoma and myeloma..
In terms of the number of clinical trials, lung cancer (294) is in the lead, followed by breast cancer (242) and colorectal cancer (145). Madrid and Catalonia host more than half of the patients recruited in clinical trials.
“The Spanish population is very sensitive to the issue of clinical trials,” he explains. Enric Carcerenydoctor at the Institut Català d’Oncologia-Badalona and vice-president of the Spanish Lung Cancer Group.
“Most of the time, patients are in favor of participation, not only because they have more treatment options, but also because they offer it altruistically: so that future patients can benefit.”
Phase 1 trials
One of the main benefits of clinical trials is to facilitate access to therapeutic innovations. However, there was still work to be done in this regard: most trials refer to the late stages of drug development, and there were still very few in the early stages.
“There has been a huge effort on the part of health centres to be able to participate in the trials, and of doctors to dedicate time to it, because it is a burden that public institutions do not take into account,” explains the oncologist.
In recent years, he continues, the number of centers with infrastructure to conduct clinical trials in the early stages has increased. “In mine, we opened a phase 1 trial unit and we already have 12 in progress, which allows us to offer more innovative treatments to our patients.”
In this “asset” there is also a “flow”. While in countries such as the United States, France or the Netherlands at least half of clinical trials are carried out outside the pharmaceutical industry, in Spain they represent less than a third, and this figure has increased in recent years: from 23% in 2010 to 32% in 2019, according to the AECC report.
These studies They are important not only because they have nothing to do with commercial interests but because they go beyond the study of a drug and look for a treatment strategy, or the use of diagnostic and monitoring devices, etc.
Here, the main sources of funding are administrations and philanthropy. Carcereny points out that “in the countries around us there is greater public investment” and that, in the specific field of lung cancer, the stigma of associating the tumor with tobacco consumption is also harmful, “which has an impact on obtaining funding.”
However, the scientific director of the AECC, Marta Puyol, recalls that “there has been a significant increase in the last four years in public and private funding (by foundations) to carry out these trials.”
“Even the Carlos III Health Institute has launched a specific call for clinical trials independent of industry.”
During the period 2015-2020, according to the AECC report, Investment in cancer research projects beyond industry amounts to €692 million. Among them, 205 corresponded to the European Horizon2020 program. The investment of the Spanish Research Agency and the philanthropic activity each amount to 140 million euros.
The Carlos III Health Institute has dedicated 128 million euros to independent research during this period, and the CDTI (Centre for Technological Development and Innovation) has accumulated – part of this money in the form of loans – 79 million euros.
Beyond clinical research, Marta Puyol highlights that the big pending problem in Spain is innovation, that is, transforming knowledge into advances that benefit the patient.
“In Spain we are very good at converting money into results, but we are very bad at converting results into money, that is, into innovations that reach patients.”
Very often, discoveries made in the early stages fail to be tested in patients.”In mice, we have cured cancer several times“, he illustrates. But the path since these first tests is strewn with pitfalls.
This problem comes, in part, from the deficiencies of the culture of innovation in companies (many centers generate it at a forced pace), but also in part from the way in which researchers are evaluated: “This is done only through articles, but not from the patents generated. When you publish a result, you can no longer patent it.
There is another underlying problem: the precariousness of research. “Young people do not see that they can make a career out of it and have job stability,” laments the scientific director of the AECC.
Enric Carcereny delves into it. “There is a lack of recognition. We need to recognize those who do research and give them resources. Have favorable legislation that helps improve access to clinical trials and cooperative groups that can develop them.”
Because, as Marta Puyol reminds us, “a country without research is a country that does not grow.”
