Building More Representative Cancer Trial Populations

In a recent video interview with Applied Clinical Trials, Shanthi Sivendran, MD, MSCR, MBA, senior vice president for cancer care support at the American Cancer Society, discussed the national expansion of the organization’s Access to Clinical Trials and Support (ACTS) program and its implications for improving cancer trial access and equity. Sivendran explained how the program addresses persistent barriers to trial participation—including geography, transportation, lodging, financial burden, and limited awareness—through an end-to-end model that combines education, navigation, social support, and AI-enabled trial matching. She highlighted early utilization data from the program’s initial regional launch, underscoring the scale and complexity of patient-identified barriers, and emphasized the importance of integrating support services with precision trial matching. Sivendran also addressed broader industry challenges, including trial decentralization, narrative shifts around clinical research, and the need for more representative trial populations to ensure innovation reaches patients most affected by cancer.

The interview transcript was lightly edited for clarity.

ACT: What broader industry changes are needed to ensure cancer trial populations more accurately reflect the diversity of people affected by the disease?

Sivendran: Yeah, it’s a great question. And I think this is something that is at the forefront of what a lot of our industry partners are thinking about. Especially as it’s becoming harder to get medications approved in the United States.

So having a representative population is really important. One part of that is being able to enroll more patients in the United States into clinical trials. And that has been an issue where some drugs have not been FDA approved because the majority of those trials were performed elsewhere and not considered representative of the US population.

And then there’s that same issue where a lot of these clinical trials are being conducted in urban areas and are drawing from just one part of the population.

So if you go back to that example of EGFR lung cancer, EGFR-positive lung cancer is more likely to occur in women and more likely to occur in Asian populations. You need those patients on clinical trials. You need diversity in those clinical trials so that we make sure that innovation is targeting the right population.