Global oncology clinical trials account for 41% of new trial starts in 2024 and include 45,000 sites worldwide.[1] In 2024, 306,000 entities participated in them, which is an increase of 10% compared to 2023 and 15% compared to 2019.[1] Times to patient engagement increased between 2019 and 2023: Phase I by 39% (by 5 months), Phase II by 23% (by 6 months), and Phase III by 16% (by 3 months).[1] Oncology trials have twice as long lead times compared to other therapeutic areas.[1] The median time from ethics committee approval to the first randomized patient in the global phase III APHINITY trial was 118 days (range, 13–463 days).[3] Prior to 2008, it took more than 2 years to activate a phase III trial, but changes such as central IRBs and standard templates reduced the median time by 50% for phase III and 30% for early phases.[2] The Association of American Cancer Institutes suggests recommendations such as defining "operationally ready" documents to expedite activation.[1][4] NCI-designated centers target a 90-day time from submission to activation.[4]