Consolidation Crisis: Phase I Lung Cancer Trial Sites Shrink by 44 Percent as Research Clusters in Major U.S. Hubs

U.S. phase I lung cancer trial sites fell 44% from 2020-2024. Learn how research consolidation in major cities impacts patient access and FDA representation.

By: AXL Media

Published: Apr 21, 2026, 4:12 AM EDT

Source: Information for this report was sourced from American Association for Cancer Research (AACR)

The Dramatic Contraction of Clinical Trial Geography

The landscape of early-phase lung cancer research in the United States has undergone a profound transformation over the last five years, characterized by a sharp decline in geographic diversity. According to an analysis presented at the American Association for Cancer Research (AACR) Annual Meeting 2026, the number of unique sites hosting phase I non-small cell lung cancer (NSCLC) trials plummeted by 44 percent. Brittany Avin McKelvey, PhD, of the LUNGevity Foundation, reported that unique U.S. trial locations fell from 395 in 2020 to just 223 by the end of 2024. This contraction indicates that despite a rising demand for novel oncology therapies, the physical infrastructure for testing these agents is retreating into a smaller number of elite institutions.

Urban Concentration and the Elite Site Monopoly

While the overall number of trial locations has dwindled, the volume of research remains remarkably stable at a select group of high-capacity centers. The study found that the top 20 highest-volume clinical trial sites—predominantly located in major metropolitan areas with populations exceeding 1.9 million—maintained a steady flow of seven to 11 new trial openings annually. This concentration suggests that phase I research is increasingly becoming the exclusive domain of large academic medical centers in cities like New York, Houston, and Los Angeles. This "clustering" effect creates significant logistical barriers for patients living in rural or underserved areas, who must often travel long distances to access experimental treatments.

Infrastructural Barriers and Regulatory Complexity

Several underlying factors are driving this move toward consolidation, chief among them the escalating complexity of modern oncology protocols. As phase I trials move beyond traditional chemotherapy to complex modalities like cell therapies and multispecific antibodies, the requirements for specialized infrastructure and highly trained personnel have become prohibitive for smaller community sites. Dr. McKelvey noted that the substantial safety monitoring and regulatory compliance burdens associated with these new agents often exceed the capabilities of lower-volume clinics. This creates a self-reinforcing cycle where established sites with proven track records attract more industry sponsorship, while smaller sites a...