treating the patient not the cancer
personalized medicine has the potential to tailor therapy with the best response and highest safety margin to ensure better patient care. it has the potential to improve the ability of physicians to diagnose and treat disease, and offers the potential to detect disease at an earlier stage, when it is easier to treat effectively. this is because PM treats people with cancer based on ‘who’ they are, not just ‘where’ their cancer is located, it holds promise for improving health care while also lowering costs.
this november, the cancer collaborative in collaboration with the european cancer patients coalition is launching personalized medicine awareness month in canada, to raise awareness of, and increase access to, personalized medicine and molecular testing in cancer care.
according to the canadian cancer society an estimated 220.400 new cases of cancer will be diagnosed in 2019, an average of 604 canadians diagnosed with cancer every day. and more and more canadians are living with cancer.
the hope of precision medicine is that treatments will one day be tailored to the genetic changes in each person’s cancer, therefore the cancer collaborative is calling for greater access to molecular testing to help patients get the right treatment for them, today.
- increased access and decreased waiting times for high quality molecular testing across canada;
- information to educate and empower patients and caregivers around the potential and availability of molecular testing;
- a harmonised and more efficient pathway across canada to implement and realize the promise and potential of personalized medicine
CAR-T. how much longer must canadians wait
montréal, november 4.2019– there are an ever growing number of therapeutic and diagnostic technologies being developed and coming to market in oncology. many of these have the potential to transform oncology. if these technologies can’t get to patients they can’t deliver on their promise. the federal government has made clear that innovation is a priority and provincial government’s, like quebec have invested in life sciences and innovative technologies in healthcare.
one such innovative technology is CAR-T. the first pioneering CAR T-cell therapies represent a paradigm shift in the treatment of cancer and a breakthrough for some relapsed or refractory hematological malignancies, showing durable responses and potential for long-term disease control unrivaled by conventional therapy. the first car t-cell therapy received health canada approval in september 2018 and was recommended by CADTH and INESSS with conditions in January 2019. in october 2019, the québec government announced it would reimburse CAR-T, but still no agreement has been made by Cancer Care Ontario [CCO] to make CAR-T available to canadian patients. and access delays decrease the promise of the therapeutic value of CAR T, creating an interesting dichotomy between government’s desire to cut costs but also undercutting the value simultaneously.
one of the major concerns of delivering car-t has been around site readiness, the complexity and uniqueness of car-t requires specialized centres to provide this therapy and expertise to manage the side effects. currently accredited sites to provide car-t cell [ste justine’s hospital for children [montréal, QC], the centre hospitalier de l’universite de montréal [montréal, QC], sick kids [toronto, ON] and the juravinsky cancer centre [hamilton, ON]] are ready to start treating patients, but without a negotiated price or a formal agreement to list on provincial formularies [PLA], these centres are ready to go but without a therapy to offer.
the cancer collaborative advocates for responsible pricing, but limiting drug prices shouldn’t come by limiting patients access to life saving therapies. especially when patients are being sent south of the border to receive car-t at almost double the cost.
there is a willingness on behalf of payors and decision makers to provide access to CAR T-cell therapies for paediatric and adult patients across canada in a way that is ethical, equitable but in order to make it meaningful for patients, there needs to be a better way to do this, and to expedite reimbursement so that car-t is available in canada
as continuous innovations happen in cancer care, the need to start thinking more responsibly about reimbursement and policies that promote innovation in canada while creating efficiency and value for stakeholders will be important as canada strives to seek a balance between innovation and sustainability.