Across 91 gastric, gastroesophageal junction and esophageal cancer phase 2 and phase 3 trials, EU participation is concentrated in a small set of oncology hubs. Hospital Universitari Vall d’Hebron leads the site ranking with participation in 28 of 91 trials, while France has the largest site footprint with 385 of 1,796 site placements. Germany carries the highest country-level planned participant allocation at 2,159 patients, and small molecules remain the most common modality, appearing in 63 of 91 trials.
Hospital Universitari Vall d’Hebron is the leading EU site, appearing in 28 of 91 trials, equal to 30.8% of the analyzed phase 2 and phase 3 cohort. The top 10 list is dominated by Spain, France, Italy and Germany, indicating that late-development gastric, gastroesophageal junction and esophageal cancer trials cluster around established gastrointestinal oncology centers.
The leading EU sites are not simply high-volume national centers; they are recurring late-development oncology nodes. A sponsor building a gastric, GEJ or esophageal cancer phase 2 or phase 3 feasibility plan would likely treat these centers as priority feasibility targets because each appears in at least 15 of 91 trials, equal to 16.5% or more of the cohort.
France has the largest site footprint, accounting for 385 of 1,796 site placements, or 21.4%. Germany, Spain and Italy follow, showing that operational access is spread across several large oncology markets rather than concentrated in one country.
France offers the broadest site network, but Germany, Spain and Italy are close enough to form a practical four-country core for EU site feasibility. Together, France, Germany, Spain and Italy account for 1,188 of 1,796 site placements, equal to 66.1% of the total site footprint.
Germany has the highest country-level planned participant allocation with 2,159 participants. The Netherlands follows closely with 2,000 planned participants, despite a smaller site footprint than France, Germany, Spain and Italy.
| Country | Planned participants | Site placements |
|---|---|---|
| Germany | 2,159 | 317 |
| Netherlands | 2,000 | 132 |
| France | 1,975 | 385 |
| Spain | 1,550 | 279 |
| Belgium | 1,019 | 68 |
| Italy | 913 | 207 |
The Netherlands stands out because it has fewer site placements than France, Germany or Spain but still carries 2,000 planned participants. This suggests that feasibility planning should not rely only on site counts; country-level patient allocation can reveal high-capacity recruitment markets even when the visible site footprint is smaller.
Disease-specific gastric, gastroesophageal junction and esophageal oncology trials make up 60 of 91 trials, or 65.9%. Multi-tumor oncology studies that include gastric, GEJ or esophageal cancer account for 28 of 91 trials, or 30.8%, and represent the largest planned participant pool with 13,613 participants.
The cohort is anchored in disease-specific upper gastrointestinal oncology, but almost one-third of trials are multi-tumor studies. This matters operationally because site selection may need to account for both specialist gastric and esophageal cancer units and broader early-to-late oncology trial platforms that enroll biomarker-defined or tumor-agnostic populations.
Small molecules are the most common modality, appearing in 63 of 91 trials, or 69.2%. Monoclonal antibodies appear in 53 trials, antibody-drug conjugates in 22 trials, radiopharmaceuticals in 7 trials and bispecific antibodies in 5 trials.
The modality mix shows that gastric, GEJ and esophageal cancer development is still strongly anchored in small molecules and monoclonal antibodies, but antibody-drug conjugates are already present in 22 of 91 trials. For site feasibility, this points to a need for centers that can support both conventional systemic oncology and infusion-heavy biologic or targeted therapy protocols.
Combination treatment is used in 70 of 91 trials, equal to 76.9%. Single-modality or simpler intervention designs account for 21 of 91 trials, equal to 23.1%.
The high combination-treatment rate increases operational complexity for sites because protocols may require more intensive pharmacy coordination, infusion scheduling, biomarker workflows and adverse-event management. Site experience with combination oncology regimens is therefore a practical differentiator in this disease area.
CRO or vendor support appears in 37 of 91 trials, equal to 40.7%. Use rises sharply with country complexity: 6 of 47 single-country trials use CRO/vendor support, compared with 16 of 24 trials involving 2–4 countries and 15 of 20 trials involving 5 or more countries.
The operational threshold is clear: once trials move beyond one country, CRO/vendor use becomes common. CRO/vendor support rises from 12.8% in single-country trials to 66.7% in 2–4 country trials and 75.0% in trials spanning 5 or more countries, suggesting that cross-country coordination is the strongest driver of outsourcing.
IQVIA appears most often, with involvement in 13 trials. PPD appears in 10 trials, ICON in 9 trials, and Medidata and Parexel each appear in 8 trials.
The CRO/vendor landscape is led by large global clinical operations providers and technology vendors. IQVIA, PPD, ICON, Medidata and Parexel together appear 48 times across the analyzed trial set, reflecting the operational and data-management burden of multinational phase 2 and phase 3 upper gastrointestinal oncology trials.
The EU gastric, GEJ and esophageal cancer phase 2 and phase 3 trial landscape is led by a concentrated group of high-frequency oncology sites, with Hospital Universitari Vall d’Hebron participating in 28 of 91 trials. France has the broadest site footprint with 385 of 1,796 site placements, while Germany has the largest planned participant allocation at 2,159.
The modality profile is mixed but still anchored in small molecules and monoclonal antibodies, which appear in 63 and 53 trials respectively. Antibody-drug conjugates are present in 22 trials, suggesting that sites with infusion capacity, biomarker workflows and complex oncology pharmacy support are increasingly important.
CRO/vendor use is strongly linked to geographic complexity. Only 6 of 47 single-country trials use CRO/vendor support, compared with 16 of 24 trials involving 2–4 countries and 15 of 20 trials involving 5 or more countries. For sponsors, the practical implication is that EU site strategy, country allocation and outsourcing strategy should be planned together rather than separately.