Yesterday you chaired a very interesting session on targeted therapies: Personalised Medicine – Myth or…

Reality.

Can you tell us a little bit about it?

Yes, this was actually a title proposed by the emerging country committee that is a committee of ESMO constituted by members, colleagues, from different parts of the world. The objective of this committee is to introduce to ESMO to needs and situations that are facing our colleagues in different parts of the world. So one of the challenges today is the issue of the high cost medicines, the so-called targeted therapies or personalised medicine, and if there is really the possibility for countries that are from low or middle resources or in under-served environments to afford these types of medicines. That was the reason for this.

Actually it was a very interesting meeting. I gave at the beginning an overview of the situation from a global perspective and one of the things that it is important to know is that today’s available knowledge about cancer only applies to 10% of the world’s population. So frequently it is really more necessary to use and to expand and to apply the existing knowledge, not only to achieve new knowledge that sometimes is very difficult to implement. That was one of the core concepts. The other concept that I think is important to share is that from the total GDP of the world 10% is allocated today for health. So each $10 that the world is producing, $1 goes to health. That equation is actually very bad; it is necessary to have health systems more efficient and also to provide to the people, not only to the patients, the idea, the view of medicine for the future is a medicine for the health, not a medicine for the sick. That was my first very short summary of my presentation.

Then the second presentation was Dr Fortunato Ciardiello from Italy, he’s a member of the board of ESMO. He did a very good description of efforts all over Europe in order to implement personalised medicine: the problems with laboratory tests, the costs and the need of, really, an organised system based in the health systems and the governments. He gave the example of France, France covers all the treatments and that is the decision of the French government but they are collecting the data. So in a given period of time they will evaluate the results of such treatments and perhaps take a decision about which is really efficient and which treatments should not be covered by the healthcare system.

Then the third intervention was actually Dr Ian Tannock from Canada, he’s an outstanding researcher. The title was Research funding and personalised medicine: are we in the right way or do we need to redefine this strategy? Actually he was very challenging because he mentioned that there is no evidence in the world that actually these new types of therapies have a very important impact in curability or in long survivors. So actually his position was that today, until today, the role and the use of personalised medicine is more in the field of research or in the field of very, very developed cancer institutes around the world, not to be used in a general way to the general population or common practitioners. I know that this is a point of discussion but it is positive to put this over the table and each country, each government, each healthcare system, each person can make an informed decision about this.

The next one was the presentation of Ian Magrath from the International Network of Cancer Research and Treatment but I think that Dr Magrath will be giving also an interview so I think that I prefer to refer the interested persons to his direct presentation.

The last one was a very nice presentation from Dr Ahmed Elzawawy, he’s the President of AORTIC. He’s a medical oncologist from Egypt and now AORTIC is the African Organisation for Research and Treatment of Cancer; it’s practically today the only really, very, very operative organisation for cancer treatment in Africa. His position is very clear, he wants to promote access to treatments but for treatments that are cost effective, for treatments that really have an added value for the person or for his or her disease, not only to have a generalised coverage of medicines that perhaps are really not making a substantial improvement for cancer care. So his presentation was also very attractive for the audience and there were also some important comments from the audience; one of the participants was Dr Peter Yu, the President of the American Society of Clinical Oncology, and he mentioned the role of education and the role of information and the collaboration between the scientific societies in different parts of the world.

This is a very important point because the forecast is an explosion of oncology in developing countries. So how are we going to educate the local people to treat better cancer?

It is important to know that diagnosis and treatment is a small part of cancer control. One important part is human development; for example, in one of our studies published in, I think, Lancet Oncology, I don’t remember, we found in Latin America a very close relationship between the GDP of the countries and breast cancer. When you have a higher GDP you have more breast cancer, of course early stage, and lower mortality and more curability. This is well, but economy, GDP, is part of human development. It is also interesting to mention that, for example, ladies with university careers or with a better education level have less breast cancer or more early stages and more curability. So cancer is related with education, cancer is strongly related with economical parameters but this is not only for diseases. I showed on one of my slides the survival for the Titanic, according to the classes. The first class survival after the Titanic sunk was 60-something percent, 40-something percent in second class, 28% in third class. This means that economy and development is related with everything for our survival, not only health and diseases. That is something very bad. The idea is that the right of a person, because health is a human right, the right of health and cancer care should not be related with the place or the country in which she or he is living. It’s a human right and we need to push the civil society and the governments in order to have equal rights for all persons in the world in order to have the appropriate access to good cancer care. That is a statement that was very clearly defined by John Seffrin, the CEO of the American Cancer Society several times.