Highlights
The current paradigm of clinical cancer research often restricts access to vital biospecimens, slowing the progress of precision medicine. Analysis of 29 breast cancer registrational trials between 2017 and 2024 found that none resulted in biomarker research that refined or restricted a drug’s approved indication post-market. To address this, 53 international experts recommend a multidimensional stakeholder approach, including regulatory mandates for data sharing and academic coleadership in trial design.
The Silent Bottleneck in Precision Oncology
Precision oncology relies on the fundamental premise that molecular insights can match the right patient with the right therapy. This promise is built upon the collection and analysis of biospecimens—tissue biopsies, blood, and other fluids—from patients participating in clinical trials. However, a growing divide has emerged between the collection of these materials and the public dissemination of the insights they contain. While trial participants frequently provide specimens with the expectation of contributing to scientific progress, the resulting data is often held exclusively by sponsoring pharmaceutical companies, frequently remaining unpublished or underutilized.
Evidence Review: Analyzing the Gap in Breast Cancer Research
In a Special Communication published in JAMA Oncology, a coalition of 53 academic investigators and patient representatives conducted a comprehensive review of the translational landscape in breast cancer research. The team evaluated 29 registrational clinical trials that led to the approval of new drugs for breast cancer treatment between 2017 and 2024. The objective was to determine how often biomarker research associated with these trials actually led to refined clinical indications or improved patient selection criteria.
The Disconnect Between Collection and Publication
The findings were stark. Despite the high volume of biospecimens collected, the study found that published biomarker results from these registrational trials are remarkably rare. Most importantly, not a single one of the 29 registrational studies resulted in subsequent biomarker research that restricted the drug’s approved indication to a more responsive subpopulation. This suggests that while biospecimens are being used to support initial regulatory approval, their potential to further refine treatment strategies—identifying who might not need the drug or who might experience excessive toxicity—is largely untapped by the wider scientific community.
The Structural Barriers to Data Sharing
The lack of data sharing is not merely a technical hurdle but a structural one. Currently, pharmaceutical sponsors often maintain total control over the biospecimen repositories and the associated clinical data. Academic investigators, even those leading the clinical trials, may have limited access to the raw data or the samples for independent validation or exploratory research. This ‘closed-loop’ system prioritizes regulatory success over the broader scientific understanding of drug mechanisms and patient heterogeneity.Furthermore, the informed consent process often fails to explicitly state that samples will be shared with the broader academic community. This ambiguity can lead to a ‘data graveyard’ where specimens sit in storage long after a trial is completed, their potential to save lives locked away behind corporate proprietary interests.
A Roadmap for Reform: Four Strategies to Unlock Trial Data
To maximize the value of clinical data and biospecimens, the authors propose four transformative strategies designed to align the goals of industry, academia, and patients.
1. Establishing Coleadership Structures
The design and conduct of clinical trials should involve a coleadership model where academic investigators and patient representatives have an equal seat at the table with pharmaceutical sponsors. This ensures that the research agenda includes translational goals that are relevant to clinical practice, rather than just regulatory approval.
2. Transparent and Inclusive Informed Consent
Informed consent forms must be modernized. They should explicitly state that data and biospecimens will be shared with academic researchers for future, independent studies. Patients should be informed that their contribution is not just for one specific drug’s approval but for the advancement of the field as a whole.
3. Regulatory Mandates for Data Sharing
The authors suggest that regulatory agencies, such as the FDA and EMA, should make the sharing of clinical data and biospecimen access a condition for drug approval. By integrating data transparency into the regulatory framework, the industry would be incentivized to create accessible pipelines for external researchers.
4. Enabling Independent Translational Research
Access to biospecimens and translational data should be granted for independent studies aimed at identifying biomarkers of efficacy and toxicity. This would allow the scientific community to conduct cross-trial comparisons and meta-analyses that are currently impossible, potentially identifying new therapeutic targets or identifying patients at risk for severe adverse events.
Conclusion: Honoring the Patient’s Contribution
The ethical core of clinical research is the patient’s altruism. When a patient provides a tissue sample, they do so with the hope of helping others. Failing to share the data derived from that sample is a breach of that unspoken contract. Improving the sharing of clinical data and biospecimens is not just a scientific necessity; it is a moral imperative. By moving toward a more collaborative, multidimensional stakeholder approach, the oncology community can accelerate the transition from ‘one-size-fits-all’ treatments to truly personalized care. The roadmap provided by Wildiers et al. serves as a call to action for the pharmaceutical industry, academia, and regulators to dismantle the silos that currently hinder progress in the fight against cancer.
References
Wildiers H, Adam V, O’Reilly S, et al. Enhancing Clinical Cancer Research Through Sharing of Data and Biospecimens. JAMA Oncol. Published online December 18, 2024. doi:10.1001/jamaoncol.2025.5376.
