To the Editor,
We read with great interest the insightful article by Sasi et al[1], “When Less Is More: An Avenue for Academia–Industry Collaboration in Pediatric
Cancer,” which underscores the need for collaborative approaches to address inequities
in pediatric cancer care. The authors thoughtfully advocate for academia–industry
synergy in developing cost-effective, patient-accessible oncologic therapies, particularly
in low- and middle-income countries (LMICs). We wish to expand upon this important
discussion by highlighting a few complementary perspectives.
First, while the article emphasizes financial and regulatory barriers, it is equally
vital to recognize the role of patient and caregiver engagement in shaping meaningful
drug development strategies. In LMICs, where treatment abandonment and sociocultural
barriers to care are prevalent, academia–industry collaborations would benefit significantly
from integrating patient advocacy groups to ensure that innovation aligns with lived
realities and cultural acceptability.
Second, the authors rightly highlight the potential of dose de-escalation trials as
cost-saving strategies. However, we propose that dose optimization in pediatric oncology
be viewed not merely through an economic lens, but also as a scientific imperative.
Children are not small adults, and their distinct pharmacodynamics and pharmacokinetics
often support the rationale for tailored dosing strategies. Thus, low-dose regimens
should be investigated as a means of improving the therapeutic index—not just reducing
costs.
Furthermore, while Sasi et al mention regulatory and financial constraints in LMIC-based
academic trials, there is an opportunity to build upon recent reforms. In India, for
instance, the 2019 New Drugs and Clinical Trials Rules allow for a more enabling environment
for investigator-initiated studies. Aligning such reforms with state-backed funding
mechanisms and public–private partnerships could pave the way for globally relevant
academic leadership in drug development from LMICs.
We also appreciate the emphasis on real-world data but believe this warrants further
elaboration. Academic institutions in LMICs, by virtue of their large patient volumes
and diverse case mix, are uniquely positioned to generate real-world evidence. This
could complement traditional trial data and support adaptive trial designs, post-marketing
surveillance, and drug repurposing efforts.
Finally, the article alludes to the misalignment between cost-effective strategies
and pharmaceutical incentives. We propose the exploration of value-based pricing models,
preferential procurement for cost-effective innovations, and pharmacoeconomic reward
frameworks to align commercial interests with societal benefit. Such approaches could
amplify both the reach and impact of pediatric cancer therapies.
In conclusion, we commend the authors for highlighting a crucial and timely theme.
We believe that expanding the collaboration framework to include patient voices, regulatory
opportunity, scientific rationale for de-escalation, and value-based economic models
will help realize the full potential of equitable, effective pediatric oncology care.
