The True Cost of Personalised Cancer Medicine
Euroscience Open Forum (ESOF12): Scientific Session
11-15 July 2012, Dublin, Ireland (http://www.ESOF2012.org)
Organised in association with the SFI-funded Molecular Therapeutics for Cancer Strategic Research Cluster and the FP7 Collaborative Health project, RATHER.
Type: Science Programme, The Future of Medicine & Health
Host Organization: University College Dublin
Organiser: William Gallagher
Sunday 15 July 2012, 1:15pm - 2:45pm @ Wicklow Meeting Room 1
We are experiencing a revolution in the development of targeted anti-cancer agents focused against particular defects in tumours. These successes, however, bring their own challenges, such as the high cost associated with the use of contemporary therapeutics to treat cancer. Moreover, the true benefit of such 'targeted drugs' is often quite limited due to poor trial design, notably the lack of enrichment of patients for the relevant molecular lesion concerned.
To tackle this, there have been considerable efforts to develop companion diagnostic approaches that can be utilised alongside such molecular therapies to sub-stratify patients into different groupings based on predicted drug response.
While there has been classically some inertia on behalf of the pharmaceutical/biotech industry to delve into this arena, the health economic argument is coming to the fore. This session will explore the complex interplay and driving forces behind advancement in development of anti-cancer agents and associated companion diagnostics, as well as the health economic, ethical and social issues that these developments engender.
The format will comprise of short presentations from 3 speakers covering different perspectives (twenty minutes each), followed by extended discussion with audience.
Dr. Catherine Kelly ( 272KB), Mater Misericordiae University Hospital, Ireland
What Drugs Should we Give to Which Patients? - An Oncologist's Perspective
Anatomically and morphologically similar cancers can now be re-categorised into distinct subgroups reflecting unique underlying molecular and clinical heterogeneity. This is very important as, traditionally, cancers were uniformly treated with combinations of non-specific cytotoxic chemotherapy. Contemporary oncology has exploited the molecular differences that exist between cancer subtypes to develop new targeted treatments.
Targeted agents are used alone or in combination with cytotoxic chemotherapy and have increased both cancer response rates and the length of time that patients are living with advanced cancer. Recent clinical trials have examined the value of administering multiple targeted agents directed at cellular pathways involved in cancer growth and metastasis.
The results are very promising. A significant challenge is how we design clinical trials to study the efficacy of new molecular agents targeting specific biomarkers present only in very small patient subgroups.
Finally, in many instances, advanced cancer has become like a chronic disease and maintaining quality of life, while simultaneously managing treatment-associated toxicity in patients with very different cancers, co-morbidities and past exposure to different drugs, is a further challenge for oncologists and individuals living with cancer.
Dr. Iris Simon ( 202KB), Agendia, The Netherlands
Development of Personalised Molecular Diagnostics for Cancer Patients - An Industry Perspective
Personalised medicine requires the development of new tests that characterise the biology of individual patients. Most new tests will be based on the complex analysis of multiple molecular markers.
Two examples of new molecular diagnostics in colon cancer will be discussed to demonstrate the benefit, but also the complexity, of such molecular diagnostics.
ColoPrint is an example of a test that helps identifying patients with good prognosis who might not need further treatment. Genomic EGFR-pathway signatures is another example of a molecular test that can identify patients who will not respond to targeted therapies against the EGF-receptor.
New technologies and increasing knowledge allow for faster and increasingly complex analysis of large sets of data and rapid discovery of new biomarkers and tests. The benefit of molecular diagnostics is enormous on many levels; for the individual patient, for investors and stakeholders in the market, for reduced healthcare cost.
However, since molecular diagnostics are new and complex, crucial questions as to how best to validate these tests and how to reimburse and regulate them are still unanswered.
Professor Nils Wilking ( 209KB), Karolinska Institute, Sweden
What is the Economic Cost of Personalised Cancer Medicine?
The last two decades have seen a dramatic evolvement in the field of cancer medicine. A number of new drugs have been developed, some of them with very specific targets like trastuzumab and imatinib.
Thus, modern cancer therapy often includes a specific diagnostic element linked to the specific drug. As both new drugs and new diagnostics usually come at a significant cost, this has imposed a major challenge to health care systems.
We have in a number of reports studied the access of cancer drugs in Europe as well as in several non- European countries (www.comparatorreports.se). We find very large differences in access, both in relation to early as well as overall access within EU.
These differences may be explained by large differences in available health care budgets. Still, differences in reimbursement systems, health technology assessment and interpretation of medical information on a local level, may also play a significant role. This will be further discussed.
Chairperson: Professor William Gallagher ( 282KB), University College Dublin, Ireland