[Reporter’s View| Global trials turn eyes toward Asia

The key theme at the recent European Society for Medical Oncology Asia Congress ‘ESMO ASIA 2025’ held in Singapore went beyond simply global pharmaceutical companies presenting data on Asian subgroups.

What became clear at the meeting was a deeper shift: the center of gravity for where clinical outcomes are generated, and where investment and development strategies follow those outcomes, is moving toward Asia.

One of the most illustrative examples of this trend was AstraZeneca’s presentation at ESMO Asia. 

According to the company, 60–70% of patients enrolled in gastrointestinal cancer clinical trials are now being recruited in Asia. Trial designs are increasingly built around Asian data, with approximately 50 active clinical trial sites operating across the region.

This signifies that, beyond mere participation rates, the core evidence determining the reliability of clinical outcomes is being generated in Asia. This is why projections indicate that incorporating Asia-centric data will become inevitable in future discussions regarding new drug approvals and reimbursement.

The message global pharmaceutical companies are sending is now clear. Asia is no longer merely a site for secondary analysis in global clinical trials; it is becoming the point where clinical outcomes are first generated and where new drug development strategies originate. This signals that the day when the weight of primary endpoints shifts to Asia, rather than being relegated to subgroup analyses, is not far off.

Within this wave of change, Korea's role becomes increasingly crucial. As long as Asia remains a diverse region rather than a monolithic entity, which country and which company will be chosen as a strategic partner ultimately depends on each company's level of preparedness. The question of what position Korea will occupy within this Asia-centered restructuring of clinical trials and investment has now become an unavoidable challenge.

The shift in clinical outcomes naturally leads to changes in global pharmaceutical companies' investment strategies. From early development to late-stage trials, combination strategies, and follow-up studies, there is a clear move to place Asia at the center. In effect, clinical development and capital are relocating together. Essentially, a structure is forming where clinical trials and investment move simultaneously.

A particularly noticeable change in this process amid China's growing presence. China is no longer merely a country with a large patient population. Building on national-level expansion of clinical infrastructure, regulatory innovation, and capital investment, it is rapidly accumulating the capability to independently drive development from early-stage clinical trials through to late-stage Phase III trials. Cases are also increasing where global pharmaceutical companies design clinical strategies by partnering with Chinese biotech firms for development.

China's strengths extend beyond speed and scale. In specific mechanisms of action and indications, scenarios are emerging where China becomes the starting point for global development. This suggests that clinical trials and investments shifting to Asia could converge back to China.

Korea has long established itself as a reliable clinical trial execution country in global trials. Rapid patient recruitment and excellent medical infrastructure are clear strengths. However, as China strengthens its design and leadership capabilities, maintaining a strategic presence through execution capabilities alone becomes difficult.

What global pharmaceutical companies seek in Asia is not merely a large patient pool, but partners capable of jointly discussing development strategies. Engagement at the clinical design stage, interpretive capabilities for specific patient populations, and a research ecosystem capable of leading follow-up studies are becoming increasingly important.

Korea possesses the conditions to move beyond being a mere participant and take on roles in clinical design, interpretation, and expansion. Its specialized clinical capabilities centered around large tertiary hospitals, accumulated experience with specific cancers and patient groups, and rapid data production speed are competitive even within Asia. The problem is that this capability remains confined to individual researchers or institutions and is not consolidated into a national-level strategy.

The shift to Asia does not offer equal opportunities to all countries. While many nations conduct clinical trials, only a limited number accumulate results and sustain investment. As China rapidly moves to become a leading developer, what Korea needs is not a question of how much to participate, but a choice of how deeply to engage.