Cancer specialists say drugs that were hailed as breakthroughs a few years ago are not living up to expectations.
Progress against cancer is stalling, with the latest targeted cancer drugs failing to live up to expectations and priced so high that treatment is becoming unaffordable even in rich countries, according to experts at a meeting of nearly 100 eminent cancer specialists from around the world.
At the meeting in Lugano, Switzerland, the doctors agreed a 10-point declaration, to be published early next year, which will chart the way forward for cancer care around the globe. Much needs to be done, they believe, to improve treatment, care and prevention both in the developed world and in poor countries, where cancer rates are rising even faster. They agreed to embark on an ambitious plan to get essential cancer care to those who are dying early in developing countries, in the same way that Aids doctors took on the fight to get HIV treatment into Africa.
The meeting of the World Oncology Forum, organised by the European School of Oncology and attended by experts such as epidemiologists Sir Richard Peto and Prof Michel Coleman as well as the government’s national cancer director, Sir Mike Richards, agreed urgent action was needed on many fronts.
Only a few years ago, many cancer experts thought the arrival of targeted medicines, designed to attack the genetic makeup of the tumour, would make dramatic inroads into cancer deaths. But the excitement generated by targeted drugs, which interfere with specific molecules involved in tumour growth and suppression, has been short—lived.
Doctors reported apparently miraculous results from the use of the BRAF—inhibitor vemurafenib in advanced malignant melanoma, a usually fatal form of skin cancer, said Douglas Hanahan of the Swiss Institute for Experimental Cancer Research. Within two weeks, the tumours had melted away. “But six months later, [the cancer] is back with a vengeance,” he said.
Other drugs working in a similar way — including erlotinib (Tarceva) for a form of lung cancer, bevacizumab (Avastin) for breast, colorectal and other cancers, and sunitinib (Sutent) for renal cell carcinoma and gastrointestinal sarcoma — have also not done so well, said Hanahan. Resistance to the drugs builds up, sometimes very quickly. “All came on line with great expectations. The reality check is they are all working in the important first step, but we have a long way to go in terms of winning the war.” The future is probably using these drugs together or in combination with other, older types of drugs, but the price is likely to be prohibitive. A year’s treatment with vemurafenib alone would cost GBP91,000. Even though the manufacturer, Roche, has offered an undisclosed discount to the Department of Health, the National Institute for Health and Clinical Excellence said in June it was too much for the UK health service (NHS) to pay. No health service will be able to afford to put a patient on two or three such drugs at the same time.
Doctors at the meeting said pharmaceutical industry prices were unsustainable — and the pursuit of profits stopped companies taking part in trials of combinations of their drugs with those of their competitors. They were also said to be not interested in testing their drugs combined with older drugs that are out of patent. Prof Alexander Eggermont, general director of the Gustave Roussy Cancer Institute in France, said the “economic models of molecular medicine are very uncertain, because if you don’t produce cures, you don’t know if it is going to sell”.
Decades ago, genuine breakthrough drugs were discovered. Peto pointed out that five years of tamoxifen reduces mortality in most breast cancers by a third and the benefits continue even after a woman stops taking it. It now appears that taking it for 10 years is even more effective. Nobody knows why resistance does not develop, as it does with the new drugs.
But the meeting agreed that while changes are needed in research, regulation and funding to speed progress on new drugs for intractable cancers, a great deal could and must be done now to tackle cancer in less well—off countries where children and women, in particular, are dying of preventable and curable diseases.
“The divide is such that in Canada almost 90% [of children with leukaemia] can hope to survive while in the poorest countries of the world, 90% are expected to die,” said Prof Felicia Knaul, director of the Harvard University global equity initiative. Between a third and a half of all cancers — 2.4m to 3.7m a year — are preventable, said Knaul, and 80% of those are in lower— and middle—income countries. Preventing and treating them would offer potential productivity savings globally of more than $130bn a year — far more than the cost of treatment.
Cheap vaccines and basic screening can prevent and detect cervical cancer, which kills young women and mothers; cheap hepatitis B vaccination protects against liver cancer; and screening picks up breast cancer early. The dire shortage of morphine and other opioid drugs in developing countries to relieve suffering from cancer pain must be addressed, the doctors said.
Rifat Atun, professor of international health management at Imperial College Business School, called on doctors and scientists to follow the lead of clinicians involved in the Aids response.
“Prevention is important and we need to do it. That does not mean we should not be providing treatment,” he said. A decade ago, people said it was not possible to get antiretroviral drugs to patients with HIV in Africa. There are now more than 8 million people in lower—income countries on them.
Copyright: Guardian News & Media 2012