Independent cancer research in low- and middle-income countries: why it matters and how to build it.

By 2030, an estimated 75% of cancer deaths will occur in low- and middle-income countries (LMICs). Weak surveillance systems and limited research infrastructure often hide the true magnitude of this burden. Thus, independent, locally led research is essential for generating high-quality data, addressing regional disease patterns, and informing context-specific strategies for cancer control. Low national investment, heavy reliance on industry-sponsored trials, and a scarcity of trained clinician scientists hinder independent cancer research in LMICs. In this narrative review, we synthesize the published literature and present a descriptive analysis of oncology trials registered on ClinicalTrials.gov (accessed July 2025), categorized by country, funding source, and tumor site and normalized to disease burden, drawing on illustrative examples from Africa, Asia, and Latin America. We highlight the transformative impact of context-sensitive research initiatives, explore disparities in sponsorship by country and tumor type, and outline ways to strengthen the research infrastructure. These include the establishment of population-based cancer registries, regional funding mechanisms, streamlined regulatory frameworks, and workforce development through formal research training and protected time. Finally, we propose strategies to enhance international collaboration and amplify LMIC participation in setting global cancer research priorities.