What we discussed in this conference has something to do with drug access and something that we’ve been talking a lot about which is financial toxicity. As you know, we have improving significantly the results in the treatment of cancer. Just taking breast cancer as an example, in the US over the last few decades the mortality has decreased in the order of 40%, that’s a very significant result. However, if you look at what happens all over the world these results are not equally distributed. More than 60% of patients that die from breast cancer die outside the US and Western Europe. So this discrepancy has many reasons; unquestionably investment in healthcare is an important aspect of this. But if you look at clinical research that is also unequally distributed all over the world, that may be an opportunity to partially solve the problem. At the same time that you improve results looking for new medicines or new techniques or new strategies to better the results on patients in general, you offer the patients new treatments by doing clinical research. If you look at the distribution of clinical research all over the world, I recently reviewed clinicaltrials.gov trials, in breast cancer, for example, or in cancer in general we have about 65,000 clinical trials in cancer registered all over the world, however, only about 1-3% of those trials are available in Africa or Latin America. Why is that? We need to make these trials available to the population and at the same time that you help developing new strategies, new drugs, new techniques, you offer these treatments to patients.

I ended the presentation, after raising the issue, with an example of a patient of mine that was diagnosed with a type of breast cancer, triple negative breast cancer locally advanced disease. She is very poor, she earns less than $100 a month, she works as a maid and lives in the outskirts of Porto Alegre having a very bad, very dangerous disease. She managed to get referred to the clinical trials unit in my hospital and there she was able to get and participate in a triple negative neoadjuvant trial with immunotherapy. She got a complete remission participating in this trial and she received exactly the same treatment on the same schedule with the same tests with the same visits as if she were in the Memorial Sloan Kettering Cancer Center in New York. So a poor maid coming out of the outskirts of Porto Alegre, and I can change that in any place of the world, was treated exactly as if she was living in Manhattan. So this is something that I call the virtuous circle of clinical research – everybody that actually participates in clinical research benefits. And that’s not only the patient, the family benefits, the physician benefits, the researcher benefits, the clinical team that works in this clinical site benefits, the institution benefits, the sponsor obviously benefits because develops the new drug and the country benefits because a number of resources get into the country because of that.

So I ended the presentation and the discussion essentially encouraging people and making them realise that even though this is not the only solution it’s one partial solution to the access problem and some of the financial toxicity that we are dealing with that are much more complicated issues but we need to start individually. This way, clinical research, can help solving some of the problems we’re facing at the present time.

So how can we improve this process?

The idea of clinical research starts very simply. A physician needs to essentially convince himself of, ‘I want to develop a clinical research site.’ Having that thought in mind, he needs to look around and see what is the context he is placed in and try to develop the clinical trial site in that regard. So the idea is that if you want to develop a clinical research site and you are in an institution you can do it. You just need to tackle the different barriers of information, of resources, of human resources, financial resources, human resources, that you need in order to attract clinical trials for your institution. But it starts with somebody saying, ‘I want to do it.’

Is this process a bigger priority in certain areas of the world?

It’s important everywhere. The other important concept of that, that most clinical trials in the world at the present time are being run with the sponsorship of the pharmaceutical industry that obviously has the financial resources and the interest of developing new drugs. But if you build an infrastructure based on trials that are supported by the pharmaceutical industry you are able to develop the experience and you qualify the staff in order to run your own clinical trials and that’s even more important. Part of the things we need to do and develop is to stimulate the development of academic clinical trials that will address the questions that are pertinent for each different region in the world. So there’s not a single country that doesn’t need to address specific healthcare questions. So the healthcare questions in Egypt are going to be addressed by Egyptians that develop a clinical trial unit and that know what the important questions in their environment are. Having the ability of supporting the staff and the infrastructure with these trials they perform for pharmaceutical industry, this is a way of eventually funding clinical trials addressing specific questions. This is true for Brazil, Latin America, Asia and all the regions in the world.

Why is this conference particularly important?

This conference actually puts together a large number of people of a specific region and it offers the opportunity to interact with experts from all over the world and helps people locally to identify specific issues just like the one I just mentioned. So if you put people together and say, ‘I want to do a clinical trial research unit. I want to develop a clinical trial,’ if you put people together and actually make them discuss these kinds of situations you certainly will address problems that will have a solution coming out of this.