Cost key to new cancer treatment

A revolutionary cancer treatment that teaches the body to attack tumours is beginning to save and extend the lives of UAE patients, but the expense is putting it beyond the reach of many sufferers and healthcare budgets.

Delegates and visitors to the European Society for Medical Oncology annual congress in Copenhagen. Courtesy Esmo
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COPENHAGEN // A revolutionary cancer treatment that teaches the body to attack tumours is beginning to save and extend the lives of UAE patients, but the expense is putting it beyond the reach of many sufferers and healthcare budgets.

Experts speaking on the sidelines of the European Society for Medical Oncology Congress in Copenhagen, Denmark, hailed immunotherapy as a treatment that was “changing the landscape” of oncology, radically improving prospects for people with metastatic melanoma – skin cancer’s most deadly form – non-small cell lung cancers, and other cancers affecting the kidney, bladder, head and neck.

“Immunotherapy has now become the star in every oncology conference,” said Falah Al Khatib, a consultant clinical oncologist at City Hospital, Dubai. “The responses are incredible and the cure rate is unbelievable.”

But the Iraqi, an oncologist specialist in the UAE for 30 years, said immunotherapy could be five times more expensive than chemotherapy – meaning most UAE cancer patients will be unable to afford the new drugs. Doctors attending the congress said ways of making it more affordable must be found.

Immunotherapy trials have shown it has eradicated tumours in patients whose life expectancy was several months, but who are now leading normal lives.

It trains the immune system to attack cancerous cells and penetrate the protective shields that tumours can develop. Some new drugs have proved so effective that survival rates are being measured in years rather than months.

“With metastatic melanoma, for example, no patient was living for more than a year,” said Dr Al Khatib. “With immunotherapy, about 30 per cent of patients are living for three years without any evidence of disease.

“We have used these trials to treat our patients and have seen melanoma dissolve after the first shot of immunotherapy.”

Such treatments have been available in the UAE for about two years, and Dr Al Khatib has treated about seven patients with it. However, he said costs and red tape were preventing wider access, a particular problem in the Emirates as medical costs are being examined in an attempt to stem rising health premiums.

“Immunotherapy has been approved as a first-line drug for very few cancers,” he said. “Not many patients can afford it. It costs Dh35,000 a session, which is much more expensive than chemotherapy.

“And with cancer therapy, sometimes you need chemotherapy, radiotherapy, surgery, a stay in ICU. So there are a lot of costs.”

Immunotherapy can be needed weekly, while combination immunotherapy treatment – working in conjunction with other treatment – can cost up to US$1 million (Dh3.67 million) a year, said Dr Al Khatib, who added: “A lot of people only get access to immunotherapy for entering clinical trials.”

Despite these obstacles, he believes immunotherapy drugs represent the best hope for people with currently untreatable forms of cancer, but said: “We need to see the price come down.”

Dr Nouri Bennini, a consultant in oncology at Tawam Hospital in Al Ain, says immunotherapy trials are the first to show “a positive effect on the progression of survival” when compared with standard cancer treatment, while having fewer side effects.

He cited cases where the lives of some patients with metastatic melanoma have been extended by five years or more. And while this applied in only a handful of cases a year in the UAE, he said immunotherapy could help more people if the cost was addressed.

“It is a question not only for the UAE, but the world,” the Algerian said. “The impact of these drugs on health payers is very important, as is finding a way to deal with the cost.

“We are trying to find a way of using these new drugs in the best way. In the coming years, when more immunotherapy drugs are available on the market, it will be cheaper.”

Dr Bennini believes data from the UAE’s cancer registry will allow doctors to better determine which patients should receive particular treatments, and compile financial forecasts.

“These drugs should be used very wisely, with specific requirements and criteria,” he said. “It is all about personalised care, giving the best result for the patient while not impacting on the health system.”

According to Dr Ridwaan Jhetam, Middle East medical director for global healthcare leader MSD, the scepticism about immunotherapy that existed several years ago has dissipated amid recognition that it allows a patient’s own immune system to fight cancer.

“We are transforming patients’ lives, and getting better results that last longer,” he said.

Thousands of international experts met this weekend in Copenhagen for the annual ESMO congress to discuss the latest drug trials and future cancer care. The four-day conference addressed ongoing challenges and progressions in treating different cancers, with a major emphasis on public health challenges in patient access to therapies, as doctors grapple with the implications of using a new generation of medicines that cost far more than conventional chemotherapy without straining healthcare budgets.