Barcelona, 19 April 2022– Research has revolutionised cancer treatment in recent years. As a result, we have come to understand that this disease is tremendously heterogeneous and we have been able to make progress in defining the molecular characteristics that make it different. On the basis of all these findings, it has been possible to make progress in precision medicine, developing treatments directed at specific molecular targets. Although many of these treatments have been approved, they are not yet applied in daily clinical practice and this is creating a major gap in accessing these precision medicines.
A recent article published in Nature Medicine, whose lead author is Dr Joaquín Mateo, head of the Translational Prostate Cancer Research Group at the Vall d’Hebron Institute of Oncology (VHIO) and oncologist at Vall d’Hebron Hospital, both of which are part of the Vall d’Hebron Campus, and in which Dr Elena Garralda, head of the Early Clinical Drug Development Group and director of the Molecular Cancer Therapy Research Unit (UITM – CaixaResearch) participated, both of which are part of the Vall d’Hebron Institute of Oncology (VHIO), has aimed to further explore the existing inequalities between the development of new treatments and their actual use in patients. “Many of these newly approved drugs are targeted at very specific patient groups, depending on the molecular profile of the tumour. We have been able to make progress by incorporating genomic technologies into clinical trials. However, these same technologies have not reached everyday clinical practice, and this means that they are not reaching patients”, explains Dr Mateo.
This situation has resulted in a gap in healthcare for patients who are unable to access drugs that have been shown to be beneficial for some subgroups of patients, or who experience delays in accessing drugs after their approval because there is a problem in accessing the tests used to identify which patients are candidates outside the umbrella of academic centres. “We therefore run the risk of creating inequity in access to precision medicine depending on where the patient is receiving treatment”, stresses Dr Joaquín Mateo.
In the article, the authors argue that a shift in the healthcare model is needed and that the patient really needs to be at the centre of such care. “A change in the way we work is needed to ensure that all patients have access to these genomic tests, irrespective of the hospital where they are being treated. For this to happen, data needs to travel more easily”, argues Dr Joaquín Mateo.
The article also raises the issue concerning the need to work with the different actors in the healthcare system, such as regulatory bodies or funding entities, to reduce the discrepancies between the recommendations in clinical practice guidelines and the actual access to a technology or drug. “This gap leads to frustration for both doctors and patients when they see that a guideline-recommended intervention is not actually available because of a problem in accessing the tests”, adds Joaquín Mateo.
In his article he also discusses the need for better training for healthcare professionals to better interpret genomic data in clinical practice and thus overcome the resistance to change. This includes improving the format in which such data is accurately reported in order to simplify its interpretation. “Finally, we stress the importance of helping patients to learn about the relevance of these areas to give the patients information and let them make up their own minds”, concludes Dr Mateo. With all these actions, the authors agree that all the efforts made in research would be transferred to real clinical practice in a more effective and timely manner, which would always result in improved outcomes for cancer patients, in view of the results achieved by the different precision medicine trials.
Joaquin Mateo, Lotte Steuten, Philippe Aftimos, Fabrice André, Mark Davies, Elena Garralda, Jan Geissler, Don Husereau, Iciar Martinez-Lopez, Nicola Normanno, Jorge S. Reis-Filho, Stephen Stefani, David M. Thomas, C. Benedikt Westphalen and Emile Voest. Delivering precision oncology to cancer patients. Nat Med 28, 658–665 (2022). https://doi.org/10.1038/s41591-022-01717-2