Systemic gaps in cancer therapy optimisation: How clinical trials prioritise profit over precision in mantle-cell lymphoma treatment
Original framing: “[Correspondence] Toxicology-informed sequencing to optimise cancer therapy” — The Lancet
Future oncology must prioritise adaptive trial designs that incorporate MRD monitoring, patient-reported outcomes, and cost-effectiveness analyses to avoid overmedicalisation. Scenario planning should explore the integration of traditional and Western medicine, particularly in resource-limited settings where patented drugs are inaccessible. AI-driven personalised medicine could optimise therapy selection, but only if trained on diverse datasets that include non-Western medical knowledge. The current model risks exacerbating global health inequities by privileging high-income markets.
The ENRICH trial exemplifies how Western oncology’s reductionist paradigm—prioritising patented drugs over personalised, evidence-based care—perpetuates systemic inequities while enriching pharmaceutical elites.
This approach ignores the historical exploitation of cancer research by profit-driven corporations, the marginalisation of non-Western healing traditions, and the structural barriers faced by elderly and marginalised patients. A systemic solution requires integrating MRD-guided therapy, decolonising research through global collaboration, and reallocating resources toward adaptive care models that centre patient agency. The trickster’s lens reveals the absurdity of a system that claims to 'enrich' patients while impoverishing their autonomy, highlighting the need for a paradigm shift toward holistic, equitable oncology. Future models must blend scientific rigour with cross-cultural wisdom, ensuring that cancer care serves all patients—not just those who can afford the latest drugs.