By 2040, cancer cases are expected to rise by 59.2% in Asia and 65.6% in Latin America. This poses a severe public health challenge for the governments, health systems, and individuals of these regions.

An estimated $8.511 billion USD went towards cancer research worldwide in 2018, but these resources aren’t equitably distributed. A lack of technology, trained personnel, funding, and diminished participation interfere with scientists’ fight against cancer in developing countries. Collaborative biotech teams that include international specialists may be the key to more inclusive cancer research. 

Disparities in cancer genomics studies

Most technology and cancer genomics research in Latin America takes place in public institutions in major cities located in Mexico, Argentina, Colombia, and Brazil. Those resources led Latin America to run 4.6% of cancer clinical trials and to produce 4% of all scientific publications worldwide. However, inadequate facilities and ethnic disparities in genomic sequencing studies of wealthy countries have caused insufficient characterization of cancer genomics among this population.

When most of a country’s medical resources are focused in just a few prominent cities, researchers have to work harder to run genomic studies. “The lack of facilities and personnel could lead to inadequate care to the affected patients,” said Dr. Katya Pulido-Diaz, a principal investigator at the Autonomous University of Baja California in Tijuana, Mexico. “Meanwhile, the absence of academic programs leaves junior researchers out of the bench.” 

Other developing countries, such as India, face this same problem. “Cancer research is not relevant because the government’s funding prioritizes other public health diseases,” said Dr. Ishani Banik, a biotech engineer from Bangalore. In the absence of options in her home country, Dr. Banik pursued her interest in molecular medicine, studying at the University of Ulm in Germany, completing her Ph.D. training in Switzerland, and a postdoctoral stay at the University of California, San Francisco.

Besides a lack of institutional resources, investigators must address other situations, such as sourcing materials and creating protocols. “At the Wellcome Sanger Institute [located in England], analysis pipelines were already set up, run, and maintained. When I came back home, we had to develop ours from scratch,” said Dr. Daniela Robles-Espinoza, a junior faculty member at the International Laboratory for Human Genome Research in Mexico. “Additionally, I discovered that reagents are more expensive because of transportation costs and import tariffs, and the delivery wait times stretch to months.” As a result, investigators in Mexico have to spend time on building facilities that allow them to participate in grants. “We have to plan the experiments to optimize spending and maximize reagent utility in agreement with our timeline,” Dr. Robles-Espinoza said.

Another issue that affects investigators in developing countries is the lack of resources to correctly preserve samples. Most genomics studies use biobanks and pathology archives to obtain tissue. DNA extracted from such samples can vary in quality, which may lead to inconsistencies in detecting mutations. Referral centers in Mexico, such as the National Institute of Cancer, have adequate infrastructure to conserve their biospecimens; however, other regional institutions or academic centers might not have this ability. “Maintaining a good quality in samples is essential to have accurate outcomes in genomics research,” said Dr. Meng Wang, a postdoctoral researcher at the University of California, San Francisco. He is part of a collaborative investigation that studies the genomics of acral melanoma, an aggressive tumor frequently found in Asian and Latino patients. “We collected samples through our collaborators from Asia, Latin America and Europe to perform the research; most of the cases of developing countries show DNA degradation, which hindered their analysis,” he said.

Finally, it is necessary to address the ethnic disparities in genomic sequencing studies, which remain primarily focused on the population of Caucasian descent. For example, only 4.6% of enrolled patients of genomic cancer studies in the U.S. have a Latino background, even though that group makes up 18.7% of the U.S. population. This inequality causes insufficient characterization of cancer genomics among the underrepresented groups, leading to bias or contradictory outcomes. An example of paradoxical findings is the data shown by some studies reporting that Latino lung cancer patients have more favorable survival rates than non-Latino white lung cancer patients; despite the fact that other studies show inferior access to healthcare among Latino populations, which can delay cancer diagnoses.

Biotech as the essence of collaborative genomics cancer research

Medical and research communities from developing and more privileged countries have joined efforts and pursued collaborative research between their institutions and organizations. Collaborative research implies working together in a harmonious way and exchanging information and resources to reach a shared goal. A diversified team of researchers can promote discussion and provide multiple points of view that strengthen the investigation.

An example of collaborative research and its relevance is the Latin-American Consortium for the Investigation of Lung Cancer — a group formed by seven Latin-American countries and the U.S. — and its investigation of the EGFR mutation in non-small cell lung cancer. Using direct sequencing, a process that determines the order of the four bases that make up DNA, they genotyped 5,738 samples from Latino patients. They found that the EGFR mutation might be associated with genetic heritage, since the Peruvian population (which has a marked Native American and Asian background) showed a high frequency of the mutation. Patients with a European descent, such as the Brazilian and Mexican populations, had a  lower frequency of this mutation. Identifying the EGFR mutation allows patients to be treated with drugs that specifically target and inhibit the mutation, improving patient survival and quality of life.

“Trained specialists and technicians are essential in cancer research,” said Dr. Pulido-Díaz, the researcher from Tijuana, Mexico. While she was a Ph.D. student at the University of Piracicaba in Brazil, she built a network that proved to be beneficial once she returned home and established herself in Tijuana. “Thanks to my colleagues in Brazil, I have access to technology and resources that enhance my work,” she said. She added that collaborative projects are mutually beneficial for all institutions involved. “Privileged [institutions] provide resources (biotechnology and reagents), and developing institutes share samples, students and knowledge,” she said. “In addition, this interaction boosts academic friendship and represents opportunities to grow and consolidate areas of investigation for junior researchers and faculties.”

In India, Dr. Banik’s training was an opportunity derived from collaborative research programs between the countries where she studied. “Fellowship programs, such as the one I had, incentivize collaboration, cultural exchange, enhance work in teams, and optimize time and resources,” she said. As a result, Dr. Banik built a career that, in her case, would represent an incentive for her come country to pursue more cancer research.

Another example of the advantage of collaborative research is the experience of Dr. Wang, from the University of California, San Francisco. Currently, he is part of a group of international scientists investigating acral melanoma’s genomic landscape. “If you are interested in analyzing rare diseases, looking for partnerships is an excellent way to obtain more samples and [ensure] that different PIs get involved,” he said. He added that collaborative research helps investigators reach their goals efficiently. “In my case, our collaborators provided samples; meanwhile, the United States lab had the specialists and technology to run those samples,” he said.

Collaborative research also represents an opportunity for junior faculty members. This was the case for Dr. Robles-Espinoza when she was just starting out in her lab in Mexico. “To establish a productive collaboration in Mexico was difficult at the beginning,” she said. “Thus, I’m thankful [for] all the collaborators, we tend to be multidisciplinary to make an impactful contribution in our environment, which has less established infrastructure and research funding.” Six years after returning home, Dr. Robles-Espinoza has been reaping the fruits of her enthusiasm and hard work. This year, she received the Young Researcher award from the Society for Melanoma Research.

Perspectives and challenges

Collaborative research free of colonial science practices creates resources to reduce the cancer burden. Parallelly, creating and implementing national cancer prevention and control plans in most developing countries should facilitate scientific funding, either for academic or industry parties. These resources would help digitize administrative procedures that enable communication and accessible programs that support junior investigators. 

In addition, acknowledging researchers in developing countries will highlight their importance for their societies. “Awareness about the relevance of research and science will motivate the population’s respect; as a consequence, it will provide them with the essential utilities for their job,” Dr. Ishani Banik said. Likewise, wealthy countries should include underrepresented patients in clinical trials to reduce the genomic gap that enables diagnosis, prognosis, and treatment of all populations.

Biotechnology enhances collaborative cancer research between investigators with different backgrounds but common interests. The diversity in the researchers’ points of view and the inclusion of unrepresented populations contributes to a richer understanding of tools in the fight against cancer worldwide.

Jessica Maldonado-Mendoza Ph.D. is a Postdoctoral Scholar in the Department of Dermatology at the University of California, San Francisco.