Main Session

Sep 28

PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology

2702 - Barriers to Implementing Neoadjuvant Therapy In Clinical Trials: Insights from a Low- to Middle- Income Country

03:00pm - 04:00pm ET

Poster Hall - Exhibit Hall A

Screen: 20

POSTER

Presenter(s)

Isaiah Boateng, BS - University of Chicago, Chicago, IL

I. Boateng¹, D. K. Dietrich¹, O. I. Olopade², and A. Ntekim³; ¹University of Chicago Pritzker School of Medicine, Chicago, IL, ²Division of Hematology Oncology, University of Chicago Medical Center, Chicago, IL, ³University College Hospital, Ibadan, Nigeria

Purpose/Objective(s):

Breast cancer is the most common malignancy among women worldwide and the second leading cause of cancer-related death. The burden disproportionately affects low- and middle-income countries (LMICs). HER2+ breast cancer is an aggressive subtype with historically poor survival outcomes. Targeted chemoradiation has improved survival in high- and middle-income countries but remains under-studied in LMIC settings.

This study evaluates challenges to delivering radiotherapy for HER2+ breast cancer in LMICs using the clinical trial Assessing the Response Rate of Neo-adjuvant Taxotere and Trastuzumab in Nigerian Women with Breast Cancer (ARETTA), conducted across four major hospitals in Southwest Nigeria. ARETTA provided a framework to assess infrastructure capacity for biomarker-informed clinical trials in this setting, where insufficient infrastructure has historically been cited as a barrier.

Hypothesis: LMICs possess sufficient infrastructure, cultural support, and financial capacity to conduct biomarker-informed HER2+ breast cancer trials and provide access to radiotherapy.

Materials/Methods:

ARETTA participants who completed neoadjuvant therapy, surgery, and radiotherapy (RT) were surveyed. Site-specific translators administered a structured questionnaire assessing social barriers (e.g., cultural beliefs), infrastructural challenges (e.g., RT machine malfunction), and financial constraints.

Results:

In total n=35 participants were included in this study. The median travel time to the RT center was 2–3 hours, with 90.9% (n=30) relying on public transportation. Most participants (75.8%, n=25) initiated RT within 6–7 weeks post-surgery, meeting the guideline-recommended 8-week window. While 52.9% (n=18) experienced interruptions during RT, delays averaged 6 days after treatment initiation.

Cost was not perceived as a barrier by 93.9% (n=31), and 82.5% (n=28) reported that trial support enabled access to biomarker-informed treatment. Additionally, 97% (n=32) reported no hesitation in trial participation due to cultural perceptions or prior negative experiences (e.g. knowing someone who has had a poor experience with a clinical trial).

Conclusion:

Radiotherapy was successfully incorporated into a biomarker-informed clinical trial and delivered within guideline-recommended timelines in an LMIC setting. Trial-funded cost coverage was essential to treatment access. These findings demonstrate that multi-institutional chemoradiation trials are feasible in resource-limited settings and can help reduce global disparities in aggressive breast cancer outcomes.