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Personalised Medicine Editorial Personalised Cancer Care – A Global Perspective Eduardo Cazap Past-President, Union for International Cancer Control (UICC), Geneva; Founding President, Latin-American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires; Executive Committee, National Cancer Institute, Ministry of Health, Buenos Aires, Argentina Abstract Much debate surrounds the matter of personalised medicine. The problem of new treatments at high costs is usually mentioned in relation with inequalities and problems of access to care. But there is also an urgent need to discuss the impossibility for many healthcare systems in the world to provide myriad new diagnostic procedures and treatments to all populations. In this editorial, the current situation from a global perspective will be analysed and the position of some of the leading cancer organisations will be presented. We also discuss some possible actions to be developed to overcome this urgent and contradictory situation. Keywords Personalised medicine, global, cancer care, limited resources, cancer drugs, developing countries, precision medicine, access to care Disclosures: Eduardo Cazap has no conflicts of interest to declare. No funding was received in the publication of this article. Received: 10 December 2014 Accepted: 11 December 2014 Citation: European Oncology & Haematology, 2014;10(2):104–6 Correspondence: Eduardo Cazap, Sociedad Latino Americana y del Caribe de Oncologia Medica (SLACOM), Av. Córdoba 2415, 5th Floor, C1120AAG Buenos Aires, Argentina. E: ecazap@slacom.org There has been much discussion in the cancer community around so- called ‘personalised medicine’. Controversy exists over its definition and about the likely impact personalised medicines will have on patients of different settings, genetic backgrounds and resources. There are also different names proposed: personalised medicine, precision medicine, molecular medicine and targeted therapies are some of them, and the imprecise definition adds some confusion to the subject. We need to take into account different views according to the position of each player in the cancer care continuum: from the patient–doctor relationship to the criteria of medical societies and, moreover, public health perspectives. Each one has diverse considerations and deserves a separate evaluation. Likewise, it is also relevant to reflect on different levels of analysis: from a global scale to regional or national guidelines and recommendations; from scientific societies’ perspectives to a clinical level. In this editorial, the topic from a global public health perspective will be considered. We are not considering this subject as a controversy between science and economy, or an argument against the urgent need for more and better knowledge on the mechanisms and processes in the development of cancer. We consider that this is a discussion about the best possible and more rational use of existing resources for cancer care and control and an analysis for better strategies. We also present some reflections on how to strategise and implement the existing available knowledge (that today only applies to around 10 % of the world’s population) to be applicable to a broader portion of the globe. Today, an individual’s odds of surviving cancer is strongly correlated with where that person lives. Whereas in the US the 5-year survival rate for 104 patients with breast cancer is 84 %, in the Gambia, breast cancer survival is just 12.5 %. 1 Interestingly, gains in survival have not always been due to very expensive treatments. Frequently, increased survival has been achieved by cancer treatments that are relatively low cost. On the other hand, the curability rate obtained with the new targeted therapies is low or non-existent. The European Society of Medical Oncology (ESMO) produced an editorial on the matter, defining personalised cancer medicine and making general considerations and recommendations on professionals’ and patients’ education. 2 Similarly, the American Society of Clinical Oncology (ASCO) President, Dr Peter Yu, stated: “Although we have generated more effective therapies in the treatment of cancer through the knowledge we have gained in clinical trials, we have not always focused as much attention on how to apply that knowledge to individual patients to realize the goal of personalized medicine. I believe the best clinical results are achieved for each patient when the patient’s personal values and goals are met. That is really what quality of care is all about: achieving outcomes that matter to patients.” 3 The European parliament recently debated the matter of life-saving medicines and the excessively high pricing in certain member states. Speaking in the context of the debate, health spokesperson Michele Rivasi, who initiated the discussions, said: “The astronomical prices of some life-saving medicines is meaning those suffering from these illnesses are unable to afford their treatment. This is a scandal in itself but it is an even greater © Touc h ME d ic al ME d ia 2014