Guest article: Lydie Meheus, Belgian AntiCancer Fund
To fight cancer, Europe needs a whole-of-government approach that puts patients’ needs at the centre, driving change for the benefit of citizens and reducing the suffering caused by cancer. The Anticancer Fund believes it is of prime importance that treatment-related actions are designed with these goals front and centre.
Since the Joint Research Centre (JRC) plans to issue European guidelines for cancer these should be underpinned by clinical benefit data such as overall survival, toxicity and other patient-relevant outcome data (which are currently lacking or limited at the time of EMA approval). The Knowledge Centre on Cancer must gather this invaluable evidence through independent comparative effectiveness research in combination with treatment optimization. However, the infrastructure for such crucial clinical research requires public funding. Collaborative groups and comprehensive cancer centres could play a major role in this. In the case of rare cancers, high-quality disease registries could provide evidence, but they require financial support and European governance. Does the JRC intend to expand its role and expertise to address this need?
Approval of innovative drugs does not always imply true value for patients
As Emer Cooke, Executive Director of the European Medicines Agency, clearly explained in a recent public hearing, optimally designed trials are required to support the innovation and breakthroughs, and to inform the optimal use of medicine and the choices of doctors and patients. Knowing that almost half of the approved cancer drugs do not deliver considerable patient value (DAVIS et al., 2017, BMJ) the Cancer Inequalities Registry and initiatives for equal access to the latest innovative treatments must prioritize treatments that demonstrate substantial clinical benefit. In the context of the Essential Medicines List, a technical report of the WHO on cancer medicines (2019) suggests using the European Society for Medical Oncology’s Magnitude of Clinical Benefit Scale and/or prioritise medicines that meet or exceed the 4-6 month survival benefit.
What is personalised medicine?
The new Partnership on Personalised Medicine will make recommendations for the roll-out of personalised medicine approaches in medical practice. This is elaborated in the Cancer diagnostics and Treatment for All flagship initiative as use of “Next generation sequencing” (NGS) to apply therapeutic approaches based on cancer profiles. Unfortunately at present, solid evidence of clinical benefit for NGS-based treatment choices is limited and more clinical research is required prior to implementation. Perhaps the meaning of personalised medicine needs further clarification, since the Horizon 2020 Advisory Group defines it much more broadly as a medical model using characterisation of individuals’ phenotypes and genotypes. Should shared decision-making based on individualized information not be given more priority?
Cancer treatment is not only about drugs
The EBCP puts major emphasis on drugs which is in line with media attention and communication from pharmaceutical SME’s and industry. However, high-quality surgical resection is the approach that results in the best patient outcomes by far, while evidence is growing that radiotherapy can even be curative for oligometastatic disease. Multidisciplinary treatments deserves more attention in Europe’s plan to tackle cancer. Europe should push for treatments that deliver tangible benefits for patients and must invest in appropriate infrastructure to measure value to the patient. The data will be crucial for the Europe’s Beating Cancer Plan implementation group.