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Personalised Cancer Care – A Global Perspective scandal that the European Commission is refusing to address the issue, notably by tackling the issue of monopolies and abuse of market position.” 4 Cancer Drugs – Some Facts The 20 leading oncology brands generated global sales just shy of US$50 billion in 2012 with an overall expansion of US$63 billion by 2018. 5 The cost of cancer drugs has more than doubled in the past decade. Of the 12 cancer drugs approved in 2012 by the US Food and Drug Administration (FDA) for cancer, 11 were priced at more than US$100,000 per patient per year. 6 Innovative cancer drugs are developed with public and private investment in cancer research. The pharmaceutical industry spends US$6.5–8 billion per year on cancer research, but public investment in cancer research (i.e. governmental and charitable) is at much lower levels and, frequently, research and development of cancer drugs is mainly driven by commercial considerations rather than by public health priorities. where cancer is eliminated as a major life-threatening disease for future generations, UICC is committed to participating in building collaboration and cooperation to address barriers in access to cancer drugs worldwide. 10 Barriers to Access Drug costs: The high price of patent-protected cancer drugs makes them unaffordable for many countries. Patent enforcement by pharmaceutical companies in underprivileged countries can also inhibit access. Insufficient public funding of health: Governments in some countries do not provide reimbursement for essential cancer drugs. This means that patients have to pay for drugs themselves. Poor infrastructure: Many countries lack the facilities necessary to enable complex cancer drug regimens to be administered safely and effectively. America’s biopharma research companies are testing 771 medicines and vaccines to fight the many types of cancer affecting millions of patients worldwide. Approximately half of the investigational products in late-stage development are targeted therapies. 7 Irrational use of cancer drugs: There is a dearth of adequately trained health professionals who are competent to prescribe and administer cancer drugs. In addition, many countries lack national evidence-based treatment guidelines for the rational selection of cancer drugs. The price of targeted therapies has been set very high, and as more targeted therapies enter the market and are used as long-term maintenance therapy, the overall cost of cancer care will increase significantly. Under the current circumstances, targeted therapies will become unaffordable for many countries, even for the most developed. Bureaucratic policies: In many countries national opiate policies are too restrictive, which limits the availability of morphine and other pain- relieving drugs. It is estimated that 80 % of cancer patients who suffer severe pain have no access to opiates. World Health Organization Position The World Health Organization (WHO) estimates that nearly one-third of the world’s population does not have access to full and effective treatment with the medicines they need – this rises to over 50 % in the most underprivileged parts of the world. Even in highly developed countries, access to some drugs and the best available therapy is not guaranteed for everyone. 8 Counterfeit medicines: In developed countries sales of counterfeit drugs represent less than 1 % of the pharmaceutical market. This rises to 10–30 % in parts of Asia and Latin America and up to 70 % in some African countries. Overcoming Barriers Some pharmaceutical companies have established drug donation programmes to address access problems in underprivileged countries. Although useful in the short term, these programmes are not a long-term solution to cancer drug access. • WHO has developed a list of essential cancer medicines, which is updated and revised biennially. This list is used to guide procurement of cancer drugs in many underprivileged and developing countries. Currently it is under full review. This review was requested by UICC and Dana Farber, before WHO decided to update all the medications included in the list. ESMO, ASCO, National Comprehensive Cancer Network (NCCN) International and others are collaborating in this important task. • Cancer therapies represent one of the great ‘missing links’ in cancer control efforts in low- and middle-income countries (LMIC). Access barriers to cancer drugs are especially striking in light of the many research advances of recent years, which have significantly elevated the role of systemic therapy in the management of many priority cancers. There is little or no international funding for cancer treatment compared to the billions of dollars that are used for other health-related purposes. • Recycling existing drugs for cancer therapy; delivering low-cost cancer care. Drug repurposing is a strategy with fascinating potential for cutting the cost of cancer care as well as significantly affecting patient outcomes. The Repurposing Drugs in Oncology (ReDO) project, an international collaboration between researchers working for not-for-profit, patient-centred organisations in Europe and the US, aims to accelerate the repurposing of non-cancer drugs for new indications in oncology. 11 • More cost-effective options. Several ways might be considered, such as modifying modes of administration, using shorter but still effective courses or doses, finding new combinations or WHO has previously produced recommendations on the essential drugs required for cancer therapy, and over the last 5 years several new anti- cancer drugs have been aggressively marketed. Most of these are costly and produce only limited benefits. 9 WHO divided currently available anti-cancer drugs into three priority groups (curable, increased curability-adjuvant and prolong survival). Curable cancers and those cancers where the cost–benefit ratio clearly favours drug treatment can be managed appropriately with regimens based on only 17 drugs. All of these are available, at relatively low cost, as generic preparations and the wide availability of these drugs should be the first priority, especially for LMIC. 9 Union for International Cancer Control Position Worldwide access to the best possible cancer treatment, care and support is a top UICC priority. To deliver on its vision of a world E u ropean On col ogy & Hae matolo gy 105