A comparative analysis of 11,681 US interventional cancer clinical trials registered on ClinicalTrials.gov and initiated between 2008 and 2024, comparing trial characteristics between federally sponsored (n=2,112; 18.1%) and industry-sponsored (n=9,569; 81.9%) studies.
Industry-sponsored trials were far more likely to be single-agent drug trials for cancer treatment (77.4% vs 48.6%; OR 0.28). Federal trials were more likely to study prevention (4.7% vs 1.1%; OR 4.43), supportive care (2.5% vs 0.9%; OR 2.92), multimodality regimens with radiotherapy (10.5% vs 1.4%; OR 8.22) or surgery (2.5% vs 0.2%; OR 14.09), treatment deescalation (3.1% vs 0.4%; OR 8.38), rare cancers (17.5% vs 12.1%; OR 1.54), and pediatric populations (16.1% vs 5.3%; OR 3.43).
Observational registry-based design cannot establish causality; sponsor classification is binary (federal vs. industry) and may miss mixed-funding scenarios; trial characteristics were self-reported on ClinicalTrials.gov and subject to registration error.
Federal funding fills critical gaps that industry does not address—prevention, supportive care, multimodality therapy, treatment deescalation, rare cancers, and pediatric oncology. Cuts to federal research budgets would disproportionately shrink these areas, as industry trials are unlikely to replace them.
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