Singapore - In the countries that form the Association of South East Asian Nations (ASEAN), cancer is a rapidly growing disease. As with everywhere else around the globe, the impact and burden of cancer in ASEAN are on the rise, alongside steadily aging societies, urbanization and lifestyle changes. According to GLOBOCAN 2018, there were 18 million new cancer cases reported globally in 2018. Nearly half of them are estimated to occur in Asia. About 1 million of them were in ASEAN countries. Among the common cancers diagnosed in ASEAN are breast, lung, liver, colorectal and cervical cancers, which affect majority of middle-aged people in the prime of their working lives – this is affecting the region’s economies and productivity.

To accelerate the fight against cancer, the Union of International Cancer Control (UICC) and Bayer brought together relevant stakeholders (policy-makers, patients, doctors, medical societies, non-governmental organizations and the healthcare industry) at the World Cancer Congress 2018 to jointly take action in improving cancer care in ASEAN countries. The goal is to facilitate an open dialogue among the relevant stakeholders and jointly work towards the establishment of a future care framework which will drive improvement of cancer care and access to innovative oncology medicines in ASEAN, with the ultimate goal of enhancing outcomes for patients and society.

Recognizing the value of innovative medicines in cancer care

Although more people are diagnosed with cancer, the good news is innovative cancer medicines along with better care, are helping cancer patients to live longer and with a better quality of life. Over the past few decades, death rates of many cancers have lowered – from a death sentence, to chronic condition, or even cured.

• In the 1970s, fewer than half of the people with cancer survived 5 years. Today, 2 out of 3 people diagnosed with can­cer survive at least 5 years.
• New therapies have contributed to significant declines in cancer death rates around the world since its peak in 1991. Approximately 73 percent of survival gains in cancer are attributable to new medicines
• In the United States, for example, treatment advances in cancer saved 23 million years of life, and added US$1.9 trillion to society based on improved productivity, extended life expectancy, and other factors between 1988 and 2000^. By 2026, it was estimated there will be more than 20 million survivors in the US, a significant increase from more than 15.5 million in the 2016.

Better treatment and improved survival mean people are able to return to their usual daily routines, resume work, and play an active role in society and the economy. Based on a review of existing literatures in the UK, more than 75% of cancer patients are able to return to work following a cancer diagnosis. Some studies in Europe and Japan have also suggested a figure of 80% or higher in certain cancer types due to innovative therapies.

Incremental advances in cancer treatment offer hope to patients

Cancer treatment has evolved from pain palliation to chronic management, with targeted therapies which halt/slow down disease progression, minimize complica­tions, improve quality of life, prevent hospitalizations and surgeries, reduce side effects, and even curative options, in best cases. New, innovative cancer treatment offers hope to patients who have limited or no other options. Incremental advances in cancer treatment make a huge difference to patients who do not respond to currently available treatments. Adding multiple lines of treatment in cancer can help patients extend their lives and improve the quality of their lives.

Sorafenib, the oral cancer treatment, developed by Bayer for advanced liver cancer or hepatocellular carcinoma (HCC), is an example of the potential reward from supporting innovation in in the difficult-to-treat liver cancer. Liver cancer is the No. 3 cancer killer in the world (over 780,000 deaths worldwide) in 2018. Asia accounts for more than 70% of the world’s incidences and deaths. Incidence and mortality rates in Southeast Asia are also ahead of the world. Sorafenib, first approved for HCC in 2007, was the first new medicine in over a decade to treat HCC. It is also the first approved systemic treatment for the first-line treatment of patients with unresectable HCC. Broad recognition of the value of a new treatment option for patients with this condition led to rapid access, which in turn encouraged further R&D to treat this patient population with high unmet need.

As many patients still experience disease progression, there remains an unmet need for additional treatment for HCC. In this context, Bayer’s oral cancer treatment regorafenib demonstrated significant overall survival benefit in second-line HCC, and on this basis has been approved in many countries around the world, including the United States, Japan, countries in the European Union, and countries in Asia Pacific including Australia, Korea, Taiwan, Singapore, Thailand, Vietnam and the Philippines.

Sorafenib and regorafenib are a proven systemic treatment sequence to significantly improve overall survival in HCC. Based on data from the Phase III RESORCE study, the median survival time from the start of prior sorafenib treatment to death was 26 months in patients receiving regorafenib versus 19.2 months in those receiving placebo. This is an example of how sequential treatment of two innovative cancer medicines may lead to incremental improvements in survival.

Unmet needs in access and cancer care in ASEAN

Given the significant benefits, it is vital that patients in need have access to new, innovative cancer medicines. Cancer policies and awareness in the ASEAN nations differ country-to-country due to the unique local healthcare systems. In particular, there is little uniformity when it comes to frameworks for access to innovative cancer medicines, leading to delays and access disparities for patients across ASEAN countries. There are also gaps in knowledge and awareness of cancer among the general public, lack of alignment in care priorities and delivery infrastructure, as well as a lack of early diagnosis and in enhancing treatment outcomes.

In some countries, there are still room for improvement in reimbursement frameworks and decision processes, to support the effective use of medicines among clinically-eligible patients, ultimately avoiding treatment delays and substantial loss of life years.

Furthermore, there are disparities in health plans that do not – or only partially – cover the provision of cancer drugs, while some price control mechanisms and policies can also result in restricted patient access. Consequently, some patients find themselves having to pay for all expenses out-of-pocket, despite the majority not having sufficient funds to cover their treatment.

Advocating for better access and cancer care in ASEAN

It is vital that new, innovative cancer drugs reach patients in ASEAN countries who are in need without undue delay. With the incidences of cancer predicted to continue increasing, and to improve the current standard of care, ASEAN countries would need to evaluate and prioritize the removal of access delays and barriers to innovative cancer therapies for patients. Particularly for HCC, there should be at least one first-line innovative treatment for liver cancer accessible for clinically-eligible HCC patients. This, in tandem with measures such as improving cancer awareness, prevention and early diagnosis, will effectively relieve the cancer burden in ASEAN, ultimately benefitting patients and society.

Stronger collaboration among stakeholders

Public and private healthcare sectors, along with non-governmental organizations must collaborate more strongly to combat access barriers to innovative cancer medicines in ASEAN. Many people in ASEAN are without adequate access to cancer care. The challenges faced by countries over access to medicines are multi-faceted and require contributions from all stakeholders. There is a clear need for governments to extend financial protection through social health insurance and publicly-supported cancer care to relieve patients from cost burden of cancer treatments. Patient-assistance programs (PAP) supported by companies together with partners from local healthcare systems and NGOs will also help to close such healthcare gaps.

In Malaysia, for example, Bayer launched BayPAP, a PAP which provides medication assistance to liver cancer patients suitable for treatment with sorafenib in 2009. A second PAP was launched in 2014 to assist patients with colorectal and gastrointestinal stromal tumour cancers who are treated with regorafenib. In 2018, Bayer together with the healthcare services provider, Zuellig Pharma enhanced the PAP with the BayPAP Web App, to gives patients easy access to a one-stop web-based medication assistance resource which significantly reduces the lead time for the redemption of free medication from a few weeks to just 3 days. The app also provides doctor with easier access to their patients’ healthcare review and follow-ups which ultimately help facilitate better treatment outcomes. BayPAP has successfully benefitted over 300 patients to date.

In Vietnam, Bayer sponsored a PAP managed by the Bright Future Fund (BFF), a member of UICC, to provide Vietnamese patients suffering from HCC or advanced renal cell carcinoma (RCC) with better access to sorafenib. Approved by Vietnam Ministry of Health, the PAP was launched in 2016, and it has since provided partial funding to patients who are diagnosed with HCC or RCC, and are prescribed with the targeted oral cancer drug. Within its first year of implementation, the PAP supported 852 HCC patients and 52 RCC patients across 19 hospitals and medical centers.  

Cancer is an incredibly complex set of diseases with more than 200 different types, and a most formidable foe: it can use the human body to resist treatment, and continues to be a leading cause of death worldwide.  Ongoing innovation and clinical development are critical to continue to extend and improve the lives of those impacted by cancer. A pro-inno­vation environment for the industry to continue the development of innovative medicines is good for patients and society and helps put healthcare systems on a more sustainable path.

The “Taking Action Together: Improving Care for Cancer Patients in ASEAN countries” session at the WCC facilitated an exchange among relevant stakeholders (policy-makers, patients, doctors, medical societies, and the healthcare industry) on ways to improve access to innovative medicines in ASEAN countries and aimed to drive stronger partnership amongst stakeholders towards the enhancement of treatment outcomes and access to innovative oncology medicines in ASEAN, ultimately benefitting patients and  society.