Personalised Cancer Care: a Global Perspective

Abstract

There has been much discussion in the cancer community around the so called personalised medicine. Controversy exists over its definition and about the likely impact personalised medicines will have in different settings and resources.We must also consider different views: from the patient -doctor to medical societies and public health perspectives. Each one of them has diverse considerations and deserves dissimilar evaluations. If we understand that personalised cancer care is similar to targeted therapies or molecular medicine, cancer can be seen from genetic, genomic, and proteomic information. The concept of “molecular diagnosis ”appears more and more frequently in the clinic and defines new ways for diagnostic procedures and more specific treatments. Today, an individual's odds of surviving cancer are strongly correlated with where that person lives. Whereas in the USA the five-year survival rate for patients with breast cancer is 84%, in The Gambia, breast cancer survival is just 12%.Interestingly, these gains in survival have not always been due to very expensive treatments. Sometimes increased survival has been achieved due to cancer treatments that are relatively low cost. Drugs are playing an increasingly important role in cancer management, however, many patients worldwide do not have access to the drugs they need. WHO has produced recommendations on the essential drugs required, but over the last decade several new anti-cancer drugs have been aggressively marketed, and most of these are costly and produce only limited benefits. Curable cancers and those cancers where the cost-benefit ratio clearly favours drug treatment can be managed appropriately with regimens based on only 17 drugs. All of these are available, at relatively low cost, as generic preparations and the wide availability of these drugs should be, from a public health global perspective, the first priority. In March 2010, the US Congress passed the much awaited legislation which would give the US FDA the authority to approve generic versions of an innovator biologic drug. Recently, regulators at the EMA worked to finalize draft recommendations for biosimilar versions of monoclonal antibodies.Worldwide access to the best possible cancer treatment, care and support is a top world priority and we all must be committed to participate in building collaboration and cooperation to address barriers in access to cancer drugs worldwide.