Localized Therapy: The Most Overlooked Opportunity in Global Cancer Care

Executive Summary

Global cancer care has become increasingly complex, expensive, and systemically burdensome. Despite remarkable innovations in molecular targets and immuno-oncology, many patients worldwide still face challenges linked not to the drug, but to the way drugs are delivered. Toxicity, accessibility, treatment interruptions, and limited applicability to older or medically fragile populations remain persistent barriers.

Localized therapy — treatments that act directly at the disease site rather than throughout the entire body — represents the most overlooked opportunity to address these challenges. By enhancing tumor-directed exposure, reducing systemic toxicity, and enabling simpler care models, localized therapies have the potential to fundamentally reshape global oncology access and outcomes.

The Unmet Need: Systemic Therapy Is Not Always the Most Practical Solution

Systemic therapies have transformed oncology, but they bring substantial limitations when applied across global populations:

1. High Toxicity Limits Real-World Applicability

Many promising systemic agents are too toxic for older adults or those with comorbidities — precisely the populations most affected by cancer (Hurria et al., JCO, 2014).

2. Infusion-Based Models Strain Health Systems

Systemic treatments often require complex infrastructure: infusion centers, frequent monitoring, oncology-trained staff, and hospital-based supportive care. This creates significant barriers in low- and middle-income countries (LMICs) and in overstretched Western systems (Atun et al., The Lancet, 2015).

3. Drug Exposure Does Not Always Match Disease Burden

Tumors often sit behind biological, metabolic, or anatomical barriers that limit the ability of systemically administered drugs to effectively reach the site of need (Jain, Cancer Research, 2005).

4. Systemic Costs Are Difficult to Sustain

Treatment costs have risen exponentially, with oncology drugs representing one of the fastest-growing segments of global pharmaceutical expenditure (IQVIA Oncology Trends Report, 2023).

These limitations highlight a fundamental truth: global oncology needs therapies that are not only effective but also accessible, tolerable, and deliverable in diverse real-world settings.

Localized Therapy: A High-Impact Solution Hiding in Plain Sight

Localized therapy refers to approaches designed to deliver treatment precisely where disease exists — rather than exposing the entire body unnecessarily. This concept spans a broad range of modalities and is not limited to any particular technology or therapeutic class.

Core advantages of localized therapies include:

1. Higher Local Exposure With Lower Systemic Burden

By acting where the tumor resides, localized therapies enable:

• reduction in systemic side effects

• safer treatment in older or frail patients

• improved treatment adherence

• a better therapeutic index overall

This principle has been validated across multiple specialties, including oncology, neurology, inflammatory disease, and infectious disease.

2. Greater Global Accessibility

Localized therapies are often:

• easier to administer

• deliverable in outpatient or community settings

• less dependent on cold-chain logistics

• compatible with lower-income healthcare environments

In LMICs, where oncologist density is low and infusion access limited, localized approaches can offer a more realistic path to expanding cancer care (Sullivan et al., The Lancet Oncology, 2015).

3. Better Alignment With Patient Priorities

Patients consistently prefer treatments that minimize toxicity and disruption to daily life. Localized therapy can:

• reduce hospital visits

• shorten treatment duration

• lower overall stress and treatment anxiety

• preserve functional independence

Real-world surveys show that tolerability and convenience are among the top drivers of patient satisfaction in oncology (Basch et al., JAMA, 2017).

4. Enhanced Compatibility With Precision Medicine

Precision medicine is not just about matching drugs to mutations; it is about matching therapies to patient reality. Localization increases the precision of drug exposure, enabling:

• safer combination approaches

• better synergy with radiotherapy

• more targeted adjunctive interventions

• lower systemic toxicity for sensitive populations

This is particularly valuable in diseases where local control strongly predicts outcome — such as lung, head and neck, and certain CNS tumors.

Why Localized Therapy Is Underutilized — And Why That Will Change

Despite its advantages, localized therapy remains underexploited due to:

1. Historical Focus on Systemic Drug Discovery

The biopharmaceutical model has long prioritized novel molecules over novel delivery.

2. Technological Constraints in the Past

Older delivery methods lacked the precision, reproducibility, and stability required for modern oncology.

3. Limited Incentives for Reformulation

Before 505(b)(2) and similar pathways, reformulating validated drugs was less commercially attractive.

4. Lack of Awareness Among Decision Makers

Many healthcare ecosystems still equate “innovation” with expensive systemic therapies rather than smarter, more targeted approaches.

These barriers are quickly dissolving. Advances in device engineering, non-invasive delivery routes, formulation science, and regulatory frameworks have opened the door to a new class of safe, practical, and accessible oncology treatments.

The Global Case for Localized Therapy

Localized treatments offer benefits across diverse settings:

High-income countries

• Reduce pressure on infusion centers

• Lower toxicity-related hospitalizations

• Improve adherence and quality of life

• Enable more efficient use of oncology staff

Middle-income countries

• Provide scalable, outpatient-friendly alternatives

• Reduce dependence on high-cost systemic biologics

• Improve access where radiotherapy and surgery are available but systemic infrastructure is limited

Low-income countries

• Offer practical treatment options

• Reduce the need for specialized oncology teams

• Overcome some barriers of systemic drug distribution

• Support scalable national cancer control programs

Localized therapy is one of the few innovation categories that meaningfully improves equity while improving outcomes.

Why Delivery Innovation Will Drive the Next Decade of Impact

The next era of global oncology will be shaped by solutions that combine:

• better delivery

• lower toxicity

• broader access

• improved convenience

• reduced cost-of-care

Localized therapy is uniquely positioned to deliver on all these imperatives. It represents a paradigm shift toward practical precision medicine — innovation grounded in human biology, health system reality, and patient experience.

Conclusion

The global oncology community is entering a period where delivery matters as much as — and often more than — molecular novelty. Localized therapy offers the opportunity to expand access, reduce toxicity, improve patient experience, and deliver meaningful therapeutic gains without relying solely on expensive systemic strategies.

By focusing on treating the disease where it lives, rather than treating the entire body, we unlock an entirely new dimension of precision medicine — one that is clinically impactful, economically sustainable, and globally equitable.

Localized therapy isn’t incremental.It is transformational — and it is long overdue.

Selected References

• Hurria A. et al., Journal of Clinical Oncology, 2014

• Atun R. et al., The Lancet, 2015

• Jain R., Cancer Research, 2005

• Basch E. et al., JAMA, 2017

• Sullivan R. et al., The Lancet Oncology, 2015

• IQVIA Institute, Global Oncology Trends Report, 2023