The Guardian, Sarah Boseley, health editor, Sunday 28 October 2012
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| Drugs such as tamoxifen, discovered decades ago, provided genuine breakthroughs in cancer care unlike the latest generation of medicines, experts said. Photograph: Paul Beard Photo Agency/Alamy |
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
two-day 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 hard-hit 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. That has not happened. Instead, these therapies
have only bought a few extra months of life. If the question was whether the world
was winning the war on cancer, said Douglas Hanahan of the Swiss Institute for
Experimental Cancer Research, who outlined the latest state of drug research,
"in general, for most forms of human cancer, the answer is clearly
no".
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. 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 £91,000. 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 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, which might help patients. 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 which continue to have a huge
impact on the disease. Peto, an epidemiologist at Oxford University, 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 (£80bn) 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 have "bold ambition" and
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.
The forum
agreed to a 10-point plan including a goal to cut deaths globally, oppose
tobacco – possibly by a tax on manufacturers' profits – accelerate research and
get an essential package of cancer care to poor countries.
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50 percent of France’s drugs ‘useless’ – top French doctors
AIDS Was a Man-Made Pandemic
"THE BRIDGE OF SWORDS" – Sep 29, 2012 (Kryon channeled by Lee Carroll) - Text Version)
".. I'm in Canada and I know it, but I will tell those listening and reading in the American audience the following: Get ready! Because there are some institutions that are yet to fall, ones that don't have integrity and that could never be helped with a bail out. Again, we tell you the biggest one is big pharma, and we told you that before. It's inevitable. If not now, then in a decade. It's inevitable and they will fight to stay alive and they will not be crossing the bridge. For on the other side of the bridge is a new way, not just for medicine but for care. ...."
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