(P 158) GLOBAL INEQUITIES IN CHONDROSARCOMA CLINICAL TRIALS: A COMPREHENSIVE ANALYSIS ACROSS THREE DECADES

Objective: Chondrosarcoma (CS) is the second most common malignant bone tumor after osteosarcoma, accounting for 20–30% of all malignant bone tumors. Despite recent advances in molecular understanding and targeted therapies, clinical progress has been hampered by low trial activity and limited global representation. This study aims to evaluate the global landscape of chondrosarcoma clinical trials over the past three decades, identifying geographic, economic, and demographic disparities.

Methods: We conducted a systematic analysis of chondrosarcoma-related clinical trials registered on ClinicalTrials.gov between 1992 and 2025. Trials were identified using disease-specific search terms and manually screened for relevance. Extracted variables included study type, phase, geographic location, World Bank income classification, sponsor, primary outcomes, and trial status. Descriptive statistics were used to summarize trial characteristics.

Results: Out of 123 studies, 17.9% were focused exclusively on chondrosarcoma. The USA was the most represented country, 88 studies (42.5%), followed by France (8.2%), the UK (6.3%), and Spain (5.8%). Alarmingly, only 4 (3.2%) were conducted in low and middle-income countries (LMICs) and only 7 (5.6%) studies in upper-middle-income countries. A total of 37 trials (30.1%) included all three age groups: children, adults, and older adults. Recruitment status varied, with 23 trials (18.7%) actively recruiting, 56 (45.5%) completed, and 10 (8.1%) terminated—predominantly due to challenges in participant accrual. Interventional trials accounted for 107 studies (87%) of the total, though most lacked randomization. Early-phase trials predominated, comprising 35 studies (28.5%) in phase 1 and phase 1/2, and 49 (39.8%) in phase 2. Late-phase and post-marketing studies were sparse, representing only 8 studies (6.5%) of the total. The majority of studies, 95 (77%), were academia-sponsored trials. The median sample size was 54 participants (IQR 26–130).

Conclusion: Chondrosarcoma clinical trials are predominantly sponsored by academic institutions and are heavily concentrated in high-income countries. Upper-middle-income and low- and lower-middle-income countries remain profoundly underrepresented, limiting global equity and generalizability. Expanding geographic diversity and fostering broader sponsorship—including industry and international partnerships—are critical to advancing research in this rare malignancy.