Without effective infection prevention and treatment, the cancer care ecosystem begins to unravel. Chemotherapy becomes unsafe, stem cell transplants stall, immune-based therapies lose feasibility, and clinical trials risk disruption. In short, the future of oncology depends on the strength of antimicrobial protection.
A Hidden Global Health Crisis
The numbers tell a stark story. Antimicrobial resistance (AMR) contributed to nearly 4.95 million deaths in 2019, and forecasts warn of 39 million cumulative deaths within the next 25 years. Despite this enormous burden, resistant infections remain almost invisible in oncology research—a blind spot that endangers patients and jeopardizes innovation.
Infection is already the second leading cause of death among cancer patients, after disease progression. Recent multicentre studies in the U.S. show that resistant pathogens occur up to three times more frequently in cancer outpatients than in the general population, while hospitalized cancer patients experience 1.5 to 2 times higher AMR rates.
The risks are even greater for patients with haematological malignancies, which represent 6.6% of all cancer diagnoses and 7.2% of related deaths globally. Both the disease and its treatments cause profound immunosuppression, leaving survival heavily dependent on timely access to effective antimicrobials.
Trials vs. Reality: A Dangerous Disconnect
A review of haematology-oncology studies reveals major inconsistencies in how infections are reported. Microbiological and resistance data are often missing altogether. Real-world studies show bloodstream infection rates ranging from 22% to 45%, driven largely by multidrug-resistant gram-negative bacteria—especially extended-spectrum beta-lactamase-producing Enterobacteriaceae—and vancomycin-resistant enterococci in heavily treated patients.
However, clinical trial data present a different, incomplete picture. Among 27 haematology-oncology trials, infections were frequent but typically classified as respiratory infections (50.6%) and sepsis-related complications (16.2%). Targeted therapies carried the highest infection burden, affecting over 40% of participants, yet none of the trials systematically tracked AMR data or colonization rates.
This omission obscures the true clinical and operational impact of resistant infections. Trials seldom clarify whether infections contributed to mortality or treatment discontinuation, leaving the role of AMR invisible in oncology development.
Geographic Gaps and Real-World Risks
The problem is compounded by geographic imbalance. Most oncology trials are conducted in Europe, North America, and East Asia, while real-world studies—which report higher AMR prevalence—come from Argentina, India, Turkey, Pakistan, and China.
This mismatch creates a profound disconnect between evidence generation and real-world patient conditions. In regions with high AMR rates, cancer patients face greater non-relapse mortality, treatment delays, and limited access to immunosuppressive regimens.
For sponsors, it means rising risks of trial attrition, protocol failure, and regulatory delays in emerging, high-growth oncology markets. For the innovation ecosystem, it translates into blind spots that threaten both patient safety and commercial sustainability.
The Strategic Risk to Cancer Innovation
Unchecked antimicrobial resistance could erode the foundations of modern oncology. It not only threatens patients but also undermines the viability of entire cancer pipelines. Severe, treatment-resistant infections can delay or derail trials, diminish therapy effectiveness, and reduce the market lifespan of oncology assets.
For pharmaceutical companies, ignoring AMR is no longer a clinical oversight—it’s a strategic risk. Failing to address it could mean lost revenue, slower market access, and compromised therapeutic performance.
Building Antimicrobial Resistance Readiness
To safeguard progress, the oncology sector must treat AMR not as a peripheral issue but as a core design principle for innovation. Industry, regulators, and policymakers should act across five priority areas:
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Embed AMR-readiness into clinical development:
Incorporate baseline colonization screening, regional prophylaxis, and infection surveillance into trial design—especially in high-AMR regions. -
Strengthen microbiology and surveillance infrastructure:
Support diagnostics, laboratory capacity, and resistance monitoring at trial sites; link data to adverse event reporting. -
Partner on stewardship and prevention:
Embed antibiotic stewardship programs in trials to minimize misuse and protect the microbiome; adapt prophylaxis to regional resistance patterns. -
Diversify supportive care portfolios:
Invest in adjunctive products such as anti-infectives, vaccines, and pathogen-specific monoclonal antibodies; explore integrated oncology–infection prevention solutions. -
Leverage real-world evidence and analytics:
Use predictive models to detect early infection signals; demonstrate AMR’s impact on survival, adherence, and cost-effectiveness using real-world data.
Securing the Future of Cancer Care
The battle against antimicrobial resistance is inseparable from the future of oncology. Inaction will cost lives, stall clinical progress, and shrink the global innovation horizon.
By embedding AMR-readiness into cancer research and development today, the global health community can preserve both patient survival and scientific progress.
The time for action is now—because the fight against antimicrobial resistance is, ultimately, a fight for the future of cancer care itself.