Laying the foundations for next-generation precision oncology

On Target

Elena Garralda

Vall d' Hebron Institute of Oncology, Barcelona, Spain
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Several ESMO initiatives highlight the need for closing the gap between fast cancer research and a lack of accessibility to treatments in the real world

The pace of change in oncology is breathtaking. As we celebrate the myriad advances presented at the ESMO Congress 2023, with many practice-changing results from clinical trials such as MARIPOSA and MARIPOSA2, ALINA, PSMAfore, EV-302/KEYNOTE-A39, much work still needs to be done to collectively improve outcomes for an increasing number of our patients as we ring in the next generation of personalised medicine in oncology.

Shortly before the event, results of a study led by colleagues at Memorial Sloan Kettering Cancer Center, New York, showed that almost half of oncology medicines approved since 1998 are precision therapies (Cancer Discov. 2023 Oct 18). This study represents a story of two tales: it illustrates how precision oncology therapies have emerged as a mainstay of current oncology care and also exposes important challenges.

As an example, the study authors observed that, despite the dramatic growth in the field, there was a drop in approvals of precision oncology therapies from the Food and Drug Administration in 2021 and 2022. They suggest that this might indicate reaching the peak of single genomic biomarker-based precision medicine the way we know it today.

To move the field further forward, the authors point to an increased focus on the development of targeted treatments effective in patients whose tumours are driven by alterations in common tumour suppressor genes or transcription factors, as well as more selective and ‘kinder’ combinatorial strategies targeting multiple genomic alterations. Furthermore, novel diagnostic platforms and the incorporation of new “omics” technologies could also allow for the development of other types of precision oncology therapies.

While ESMO 2023 superbly represented the strong foundations for the next generation of precision oncology in a multitude of cancer types and disease settings, the cost of these agents can be extremely expensive. Not surprisingly, the degree of insurance coverage often influences whether a patient will receive them and precision medicine still remains inaccessible to many.

Dedicated to ensuring that an increasing number of patients everywhere can access and benefit from more effective and personalised treatments, ESMO and other professional societies are championing important changes at multi-stakeholder levels.

In addition to the Society’s commitment to working with EU policymakers on how best to ensure equitable access to transformative therapies entering clinical practice today, the ESMO Scale for Clinical Actionability of molecular Targets (ESCAT) and the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) serve as support tools for reimbursement issues and will help to guide the shaping of future policies aimed at addressing access to oncology medicines across the EU and beyond.

These important undertakings will certainly help address a discrepancy between listening to groundbreaking presentations at the Congress, with many potentially practice-changing results, and returning to our clinics and seeing patients who would probably not be able to derive benefit from these advances in the short-term.

But it is not only a matter of equal access to, and affordability of, new anti-cancer medicines. There are many other aspects that we need to address, prepare for, and solve moving forward.

At the ESMO Congress this year, ESMO Director of Public Policy Jean-Yves Blay announced the ESMO’s Public Policy Manifesto on key issues for oncology, to be published early 2024. He highlighted new insights into potential cancer risks from air pollution and the need for mitigation strategies, and the role of cancer prevention in improving the resilience of Europe’s health systems.

What makes ESMO great is that it rightly places the current and future interests of both cancer patients and cancer survivors everywhere at the heart of everything it does. As do we all.

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