Title : Current status of cancer immunotherapy in lebanon, Sudan, and Iraq: A descriptive and analytical pilot cross-sectional study of implementation barriers and opportunities

Background: Cancer immunotherapy, particularly Immune Checkpoint Inhibitors (ICIs), has revolutionized oncology outcomes globally. However, its adoption in developing nations and conflict-affected regions faces profound challenges. This pilot study investigates the current implementation barriers, clinical infrastructure deficits, and strategic opportunities for cancer immunotherapy in Lebanon, Sudan, and Iraq.

Methods: A descriptive and analytical cross-sectional pilot survey was administered to oncology professionals (n=23) actively practicing in oncology centers across Lebanon, Sudan, and Iraq. The survey measured key institutional metrics, including diagnostic biomarker availability (e.g., PD-L1 testing), drug supply chain stability, and the extent of patient financial toxicity.

Results: The pilot data revealed critical systemic bottlenecks. Institutional access to advanced predictive biomarkers was highly limited, with 43.5% of surveyed clinical facilities lacking routine testing infrastructure. Prohibitive out-of-pocket drug costs and a total lack of public healthcare funding emerged as universal barriers, driving severe financial toxicity for patients. In Sudan and Iraq, ongoing regional instability and infrastructure destruction further exacerbated drug supply chain disruptions. Conversely, while Lebanon demonstrated higher diagnostic awareness, severe national economic crises heavily restricted sustainable therapeutic access.

Conclusion: Implementing cancer immunotherapy in resource-constrained Levantine and Sub-Saharan environments requires a shift from global standardized protocols to resource-stratified clinical consensus guidelines. Addressing the profound equity gap in global oncology demands targeted international supply chain partnerships and immediate policy interventions to mitigate patient financial toxicity.

Keywords: Cancer Immunotherapy; Financial Toxicity; Resource-Stratified Oncology; Global Health Equity; Pilot Cross-Sectional Study; Sudan.

To be updated shortly..