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Summary: Clinical trials are subject to an ever-evolving landscape of treatment options, regulatory requirements, socioeconomic conditions, and paradigms of scientific research. In this opinion paper, we illustrate current methods and topics with a focus on clinical trial designs, conduct and modes of collaboration. The example of successful clinical breast cancer research in Austria demonstrates the opportunities, but also the challenges for academic research. We also investigate potential pitfalls, and suggest new ideas and strategies on how to increase practicability along with transparency and fairness, but ultimately also scientific and clinical relevance of clinical trials in oncology. [ABSTRACT FROM AUTHOR]