Every day there is good news in oncology. New ways to target tumors are discovered, the hidden secrets of neoplastic cells are identified, and possible treatment targets are identified. All this is leading to progress that seemed impossible only a few years ago, in the logic of personalized treatments that arise from the most intimate characteristics of the tumor units, which make each patient different from another. And then the challenge becomes another. It is really necessary that all patients, in the various healthcare systems, are able to have access to these scientific developments.
Unfortunately we are still far from this objective, and it is precisely to address the social and health as well as scientific issue that the “Lancet Oncology Commission on Cancer Genomics and Precision Oncology” which defines the main critical issues in accessing oncology genomics and proposes a concrete path for a more equitable, sustainable and evidence-based implementation. The Commission brings together expertise in oncology, genomics, pathological anatomy, public health, health policies, economics, data science, ethics and patient advocacy and represents one of the largest evaluations of precision oncology carried out to date. The initiative was presented at the World Cancer Congress in Hong Kong.
Differences to be remedied
The experts’ work aims to define a global roadmap to make cancer genomics and precision oncology more accessible, sustainable and equitable. It all starts from an in-depth analysis of the difficulties that still limit the ability of healthcare systems to translate the scientific progress of genomics into concrete benefits for patients and proposes a new model to accompany its implementation in different healthcare contexts.
In recent decades, cancer genomics and precision oncology have transformed many aspects of cancer diagnosis and treatment, allowing increasingly detailed molecular information to be used to better classify tumors and select more appropriate therapies. However, the capacity of health systems to make these advances available in clinical practice remains profoundly uneven. According to the Commission, most healthcare systems are still not able to effectively guarantee access to the opportunities offered by precision oncology: molecular tests and innovative treatments remain concentrated above all in the richest countries and, even within them, often in the best equipped centres.
Data to share
Not only access, but also the research and data ecosystem presents serious critical issues. Genomic research, biomarker-driven clinical trials, and healthcare data that fuel precision oncology are predominantly concentrated in high-income countries and Western populations, while data ecosystems remain fragmented and poorly integrated.
“The expansion of precision oncology reflects extraordinary scientific advances that have helped save and prolong many lives. But it has also generated new complexities. Increasingly sophisticated diagnostic systems, rapidly evolving evidence, costs and complex care pathways make it increasingly difficult to ensure high-quality cancer care, especially in low-income or resource-limited settings. Our analysis also shows that patients are often faced with complex information and sometimes unrealistic expectations regarding molecular tests and innovative treatments, which may be associated with modest clinical benefits”
reports Raffaella Casolino, oncologist and research coordinator of the Commission.
Widespread innovation
“Precision oncology has opened a ‘new world’ not only in terms of efficacy and activity, but also in quality of life. Today, over 30% of patients with advanced solid tumors can receive a therapy based on biomarkers and this percentage will increase thanks to the numerous precision therapies that are currently in clinical development. Innovation, however, finds its full realization only if the disparities that still exist are eliminated or reduced. Innovation, to be such, must be offered in a fair and timely manner to all patients”
explains Massimo Di Maio, President of AIOM (Italian Association of Medical Oncology.
Not only that: while in developed areas there is debate about access, in low- and middle-income countries, the barriers are even greater and include limitations in diagnostic and laboratory capacity, insufficient financial resources, fragility of supply chains and lack of specialist skills. The Commission underlines that greater inclusion in genomic research and clinical trials must be considered not only an ethical obligation, but a scientific necessity, so that the evidence produced is truly relevant for different populations.
Five mosaics to fill
To turn evidence into action, the Commission proposes five key elements:
- a value-based, resource-stratified implementation framework;
- a tool to assess the readiness of health systems;
- a skills framework for the precision oncology workforce;
- a framework for monitoring and evaluating implementation;
- an ecosystem responsible for data sharing and learning about health systems.
This last element is particularly important because, according to the Commission, the implementation of precision oncology must proceed together with the generation of new knowledge: producing more representative evidence, filling existing gaps and responsibly using data in real life to continuously understand where and how precision oncology generates real value.
