Post by Admin on Feb 7, 2024 1:14:45 GMT
Cancer research equity: innovations for the many, not the few
The Lancet
Published:February 03, 2024DOI:https://doi.org/10.1016/S0140-6736(24)00196-X
www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00196-X/fulltext
Cancer research continues to deliver hugely successful innovations. Each year brings more and better therapeutic drugs. New medical technologies, such as CAR T-cell therapy, are improving outcomes and our understanding of cancer has never been so advanced. Yet, globally the number of cancer deaths has increased by 40% in just over a decade. According to new estimates, more than 35 million new cancer cases are predicted in 2050 (a 77% increase from the 20 million cases in 2022), mostly in countries with a low or medium Human Development Index. World Cancer Day, on Feb 4, is a time to celebrate the great advances of cancer research, but also an opportunity to acknowledge that these advances do not reach all. For the third year running, the theme is “Close the Gap”, highlighting the persistent disparities in cancer care. In large part, these disparities are due to a lack both of access to cancer services and of political will to implement effective public health policies, as well as socioeconomic inequities. But could research better serve the needs of patients with cancer worldwide?
A first step would be to recalibrate research priorities to maximise benefit for patients. Cancer drug development is vital. However, the pharmaceutical companies that dominate the research agenda are incentivised to focus on new drugs and sophisticated therapies (such as cellular and gene therapies) that are neither accessible to, nor affordable for most patients globally. This is not to argue against the need for access to the most effective care for everyone in all settings. Health equity demands equity in the access to the best cancer management. But the structure of the cancer research ecosystem means that the study of simple practice-changing innovations that could greatly benefit patients, such as treatment de-escalation or re-purposing of licensed drugs, is neglected. Furthermore, the need to achieve regulatory approval or commercial advantage means that many oncology studies are designed with short-term endpoints and give primacy to statistical significance, which does not always equate to clinical importance. As noted by Common Sense Oncology, a focus on new cancer drugs comes at the expense of investigating different approaches to surgery and radiotherapy. Surgery and radiotherapy can cure many more patients than can cancer medicines (given their importance in the treatment of solid tumours), yet receive much less research funding.
Although the largest gains in cancer control can be achieved in areas with the poorest cancer outcomes, less research is done in low-income and middle-income countries (LMICs) than in high-income countries (HICs). To close the gap in cancer outcomes, this must change. Many patients are diagnosed with incurable disease and would benefit hugely from research into early diagnosis, cancer screening, and palliative care services. For example, in Africa, where most men affected by prostate cancer are diagnosed with late disease, the effectiveness of population-based prostate-specific antigen testing has never been assessed. Research study populations are largely based on patients of White ancestry in HICs and the results might not always be generalisable or transferable without careful regard to biological, cultural, or environmental differences. Local expertise and understanding is needed to adapt cancer control tools to local contexts and inappropriate implementation might result in poor outcomes.
Making these changes will require more equitable funding from international research initiatives, to not only support neglected research priorities, but also to strengthen cancer research infrastructure and capacity in LMICs. International collaborative groups can provide the resources for investigator-initiated trials to address clinically important questions that are not necessarily of interest to commercial entities. The increasing number of international clinical trials and of cooperative research groups, such as the European Organisation for Research and Treatment of Cancer and the National Cancer Institute cooperative group, is an encouraging sign. However, there is still a long way to go.
Perhaps the idea of innovation in cancer research needs to be redefined. Innovation centred on maximising the benefits of existing interventions will probably have a much greater effect on patient care than developing another expensive drug for an indication that already has a reasonable standard of care. Innovative collaborations can help. Innovative advocacy can help the push for more equitable cancer care. In this spirit, this year, The Lancet Group is establishing oncology as a priority through our In Focus initiative, renewing our commitment to prioritising innovative research, in all its forms, that directly benefits the lives of patients everywhere.
The Lancet
Published:February 03, 2024DOI:https://doi.org/10.1016/S0140-6736(24)00196-X
www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00196-X/fulltext
Cancer research continues to deliver hugely successful innovations. Each year brings more and better therapeutic drugs. New medical technologies, such as CAR T-cell therapy, are improving outcomes and our understanding of cancer has never been so advanced. Yet, globally the number of cancer deaths has increased by 40% in just over a decade. According to new estimates, more than 35 million new cancer cases are predicted in 2050 (a 77% increase from the 20 million cases in 2022), mostly in countries with a low or medium Human Development Index. World Cancer Day, on Feb 4, is a time to celebrate the great advances of cancer research, but also an opportunity to acknowledge that these advances do not reach all. For the third year running, the theme is “Close the Gap”, highlighting the persistent disparities in cancer care. In large part, these disparities are due to a lack both of access to cancer services and of political will to implement effective public health policies, as well as socioeconomic inequities. But could research better serve the needs of patients with cancer worldwide?
A first step would be to recalibrate research priorities to maximise benefit for patients. Cancer drug development is vital. However, the pharmaceutical companies that dominate the research agenda are incentivised to focus on new drugs and sophisticated therapies (such as cellular and gene therapies) that are neither accessible to, nor affordable for most patients globally. This is not to argue against the need for access to the most effective care for everyone in all settings. Health equity demands equity in the access to the best cancer management. But the structure of the cancer research ecosystem means that the study of simple practice-changing innovations that could greatly benefit patients, such as treatment de-escalation or re-purposing of licensed drugs, is neglected. Furthermore, the need to achieve regulatory approval or commercial advantage means that many oncology studies are designed with short-term endpoints and give primacy to statistical significance, which does not always equate to clinical importance. As noted by Common Sense Oncology, a focus on new cancer drugs comes at the expense of investigating different approaches to surgery and radiotherapy. Surgery and radiotherapy can cure many more patients than can cancer medicines (given their importance in the treatment of solid tumours), yet receive much less research funding.
Although the largest gains in cancer control can be achieved in areas with the poorest cancer outcomes, less research is done in low-income and middle-income countries (LMICs) than in high-income countries (HICs). To close the gap in cancer outcomes, this must change. Many patients are diagnosed with incurable disease and would benefit hugely from research into early diagnosis, cancer screening, and palliative care services. For example, in Africa, where most men affected by prostate cancer are diagnosed with late disease, the effectiveness of population-based prostate-specific antigen testing has never been assessed. Research study populations are largely based on patients of White ancestry in HICs and the results might not always be generalisable or transferable without careful regard to biological, cultural, or environmental differences. Local expertise and understanding is needed to adapt cancer control tools to local contexts and inappropriate implementation might result in poor outcomes.
Making these changes will require more equitable funding from international research initiatives, to not only support neglected research priorities, but also to strengthen cancer research infrastructure and capacity in LMICs. International collaborative groups can provide the resources for investigator-initiated trials to address clinically important questions that are not necessarily of interest to commercial entities. The increasing number of international clinical trials and of cooperative research groups, such as the European Organisation for Research and Treatment of Cancer and the National Cancer Institute cooperative group, is an encouraging sign. However, there is still a long way to go.
Perhaps the idea of innovation in cancer research needs to be redefined. Innovation centred on maximising the benefits of existing interventions will probably have a much greater effect on patient care than developing another expensive drug for an indication that already has a reasonable standard of care. Innovative collaborations can help. Innovative advocacy can help the push for more equitable cancer care. In this spirit, this year, The Lancet Group is establishing oncology as a priority through our In Focus initiative, renewing our commitment to prioritising innovative research, in all its forms, that directly benefits the lives of patients everywhere.