Improved Cancer Drugs Access Needs 'Radical Action'

Peter Russell

April 25, 2019

A new approach by the pharmaceutical industry and regulators is needed to ensure that people with cancer have faster access to innovative treatments, specialists have said.

A 10-point manifesto published by the Institute of Cancer Research (ICR) set out "radical action" needed to make drugs more affordable, prioritise genuinely innovative treatments, and overhaul the clinical trials process.

It said figures from its own research suggested that more than 16% of cancer patients experienced problems accessing a drug recommended by their doctor. The survey, carried out in the past few weeks, also found that nearly half of those who tried to enrol in clinical trials of new treatments had been unable to do so.

Prof Paul Workman, chief executive of the ICR, said: "We will only make step-change advances against cancer by giving patients access to genuinely innovative new drugs, which can attack cancer in brand new ways or as part of innovative combinations to overcome the challenge of drug resistance."

A Manifesto for Change

The manifesto called for:

  • The National Institute for Health and Care Excellence (NICE) to prioritise the most innovative cancer treatments with the greatest potential to deliver step-change advances for patients

  • Action to bring down the extremely high prices of modern cancer drugs, allowing as many patients as possible to benefit from advances in cancer treatment while not overburdening the NHS

  • Better access to biomarker testing so that drugs can be targeted at those who will benefit through 'personalised medicine'

  • Drugs testing in smaller, smarter clinical trials to generate findings more quickly and cheaply

  • Incentivising pharmaceutical companies to trial new medicines in novel combinations – including with other drugs manufactured by commercial rivals

  • A more flexible approach by drug regulators to assess evidence so that innovative treatments can reach patients more quickly

  • Access for all cancer patients to suitable clinical trials at all appropriate stages of their disease, irrespective of where they are treated

  • Improved access to precision medicine for children with cancer, so that they can benefit from the same kind of advances in treatments as adults

  • Flexibility on age limits for clinical trials to avoid denying older children and young adults access to new treatments because they are judged too young or old

  • Incentives for companies, universities, and charities to work together to turn research into innovative medicines for patients

The ICR said that innovative drugs could be fast-tracked to cancer patients if NICE were prepared to take an adaptable approach to the way it assesses treatments. Dr Eva Sharpe, head of policy and engagement at the ICR, told Medscape News UK: "Increasingly, regulators like the EMA [European Medicines Agency] and FDA [US Food and Drug Administration] are approving drugs on the basis of phase II trials to speed up patient access, so for NHS patients to benefit, NICE also needs to become increasingly flexible in assessing treatments on the basis of data from phase II trials – rather than waiting for large-scale phase III trials.

"It also needs to look at how it recognises scientific innovation. To speed up access to the most innovative treatments and incentivise development of the innovations of tomorrow, drugs with brand new mechanisms which are particularly innovative need to be given precedence."

Dr Sharpe said these changes should be accompanied by an overhaul of the clinical trials process: "We now have the technology and expertise to conduct smaller, smarter clinical trials that target drugs at those patients most likely to benefit," she said. "It is vital that we make use of these new types of trial as much as possible, to get new treatments to patients more quickly at a price that the NHS can afford."

'We've Become More Efficient': NICE

In a response, NICE said that its highest priority was to provide patients with access to innovative cancer treatments that were clinically proven and cost-effective. It said that since July 2016, it had approved 80% of cancer drugs compared with 47% in 2012-13.

Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said: "Our accelerated process saw a revolutionary CAR T-cell therapy for young people with a form of leukaemia recommended for use on the NHS within weeks of the treatment receiving its marketing authorisation."

Mr Boysen acknowledged there was more to do but said NICE's processes had become "even more efficient in the last few years" and had "resulted in getting cancer drugs which are clinically and cost-effective to those who need them faster than ever before."

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