This article has been funded and authored by AstraZeneca.
Greg Rossi discusses the imperative to address cancer in Europe with early detection, precision medicine and equitable access. Stressing the need for urgent action to make cancer a manageable condition, highlighting disparities and the importance of innovation.
Greg Rossi, SVP Head of Oncology Europe and Canada at AstraZeneca.
Advances in science and technology have enabled us to believe in a future where cancer has been eliminated as a cause of death. As our understanding of the genetics and drivers of cancer has leapt ahead in recent decades, so has the discovery and development of precision medicines and treatment combinations that exploit the vulnerabilities of the disease.
Many of the innovations required to improve cancer survival rates exist today; however, despite huge progress in tackling the disease, cancer remains the second most common cause of death in Europe, accounting for one in five deaths.[1] Without decisive action, cancer will be the leading cause of death in the region by 2035.[2]
The forthcoming EU and national elections are a crucial opportunity to renew political commitments to cancer as a health priority. Tangible, urgent action at regional and national levels, focused on unleashing earlier and personalised treatment for all people with cancer, could make 2024 an historical inflection point in our battle against this devastating disease.
Implementation of early detection strategies is vital
The stage at which cancer is diagnosed is one of the most important determinants of a person’s survival outcomes. If diagnosed early, patients are often treated with curative intent and have a better long-term prognosis. For example, the five-year survival rate for early-stage lung cancer is between 68-92%, compared to less than 10% for late-stage cases.[3],[4]
In December 2022, the EU Council adopted new cancer screening recommendations to revise and reinforce the importance of screening for breast, cervical and colorectal cancer, as well as expand recommendations to lung, prostate and gastric cancer, the latter under certain circ*mstances. Full implementation of these recommendations must be completed, as well as ensuring equitable uptake. Together with broader early detection strategies, we can radically transform early diagnosis rates for many forms of cancer and give more patients the chance of accessing treatment.
Precision medicine: The future is now
Between 2018 and 2020, one in five (22%) medicines that received regulatory approval by the European Medicines Agency (EMA) were targeted therapies for specific biomarkers, with the majority (15 out of 26) approved for treating cancer.[5]Precision medicine is not only the future of cancer treatment – it is here now.
Precision medicine enables cancer cells to be specifically targeted, reducing side effects and damage to healthy tissue, and offering a potentially optimal treatment choice for each person, therefore providing patients with greater chances of remission and survival. But to unlock the increasing number of innovative treatment options for an increasing number of patients, we must ensure that a robust and sustainable diagnostic testing infrastructure and workforce is in place.
The technology to achieve this at pace and scale is emerging but not yet widely available. For example, Next-Generation Sequencing (NGS) is a technology used to determine genetic characteristics of a given cancer. Rather than the traditional approach of single-gene testing, where single tests are conducted to assess each gene individually, NGS can detect multiple mutations in a single test, in a relatively short period of time, at lower cost and using less cancer tissue.[6],[7] However, the uptake of NGS in Europe has been slow, and access remains heterogenous, with it primarily only available in centres of excellence and research centres.[6]
With increasingly advanced diagnostics on the horizon, such as computational pathology and multimodal testing, health systems must plan now for rapid, evidence-based adoption of cancer characterisation technology to fully realise the benefits of precision medicine for patients and cancer care systems.
Equitable access to quality care and innovative treatment
A recent OECD report, Beating Cancer Inequalities intheEU, highlights significant differences in cancer mortality rates both between and within countries.[8] For example, cancer mortality rates vary 1.6-fold across EU countries and is consistently higher in Central and Eastern European countries.[8] When looking within countries, rates vary by at least 30% between regions in France, Germany, Poland and Spain.[8]
Unequal access to quality cancer care is a key driver of this and there are many factors at play. From a demographics standpoint for example, people with low education levels are 15% less likely to access breast cancer screening than those with high education levels.[8] From a health system resource perspective, inadequate geographical distribution of the workforce and radiotherapy equipment is creating gaps in access to cancer care between urban and remote populations in Cyprus, Greece, Norway, Spain and Sweden.[8]
Addressing barriers that impede patient access to cancer medicines is another area that is vital for enhancing the quality of care for people with cancer:
- On average, it takes the EMA 426 days to approve a new active substance compared to 244 days in the US, 306 in Canada, 313 in Japan and 315 in Australia.[9]
- On average, only 50% of EMA-approved medicines are available in all EU-member states, with some patients waiting over 500 days after EMA approval to gain access.[10]
For people living with cancer in Europe, these statistics could have devastating consequences, depending on which country they happen to live in. The EU regulation on Health Technology Appraisals (HTA) is one initiative that aims to address some of these challenges, but for this to be successful, we must work together to find an efficient framework for evaluation. We must also find common ground on the right evidence, trial design, endpoints, magnitude of benefit and methodology to help reduce uncertainty and accelerate timelines.
Eliminating cancer as a cause of death
Policymakers face difficult decisions in what is a dynamic geopolitical and economic climate. But cancer has touched the lives of all of us in some shape or form, and we are moving towards winning the battle against this disease. With ambitious political will and decisive action, coupled with evidence-based investments in infrastructure, workforce and medicines as part of an integrated social, healthcare, science and industrial policy, together we can make the vision of eliminating cancer as a cause of death a reality.
References
[1] World Health Organization. Cancer. Available at https://www.who.int/europe/health-topics/cancer#tab=tab_1. Accessed May 2024.
[2] European Parliament and the Council. Europe’s Beating Cancer Plan. Available at https://health.ec.europa.eu/system/files/2022-02/eu_cancer-plan_en_0.pdf. Accessed May 2024.
[3] Heist RS, Engelman JA. SnapShot: non-small cell lung cancer. Cancer Cell. 2012;21(3):448.e2.
[4] Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11(1):39-51.
[5] Bakker E, Starokozhko V, Kraaijvanger JWM, Heerspink HJL, Mol PGM. Precision medicine in regulatory decision making: Biomarkers used for patient selection in European Public Assessment Reports from 2018 to 2020. Clin Transl Sci. 2023;16(11):2394-2412.
[6] OHE. The Case for Expanding Uptake of Next-Generation Sequencing for Lung Cancer in Europe. Available at https://www.ohe.org/wp-content/uploads/2023/06/OHE-Consulting-Report-the-case-for-NGS-in-lung-cancer_FINAL.pdf. Accessed May 2024.
[7] Qin D. Next-Generation Sequencing and Its Clinical Application. Cancer Biol Med. 2019;16(1):4-10.
[8] OECD. Beating Cancer Inequalities in the EU. Available at https://www.oecd-ilibrary.org/docserver/14fdc89a-en.pdf. Accessed May 2024.
[9] CIRS, RD Briefing 81, New approvals in six regulatory authorities 2011-2020. Available at: https://www.cirsci.org/publications/cirs-rd-briefing-81-new-drug-approvals-in-six-major-authorities-2011-2020/. Accessed May 2024.
[10] EFPIA Patients W.A.I.T. Indicator 2022 Survey. Available at: https://www.efpia.eu/media/s4qf1eqo/efpia_patient_wait_indicator_final_report.pdf. Accessed May 2024.
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