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Cancer Conclave 2024 Panel Discussion - Access to New Therapies and Advocacy Role

Cancer Conclave 2024 Panel Discussion – Access to New Therapies and Advocacy Role

Empowering Tomorrow: Cancer Conclave 2024 Panel Discussion – Access to New Therapies and Advocacy Role

I would like to invite Dr. Vijay Patil, a Medical oncologist with an overall 16 years of experience at Tata Memorial Hospital, who is currently working in Hinduja Hospital, Mumbai, and is also a director of Sunrise Oncology Center. He is considered to be the leading pioneer in the field of medical oncology who has revolutionized cancer treatments with his advanced research and studies. I would now request Dr. Vijay Patil to lead the panel. Let me invite Dr. Hasmukh Jain who is an Associate Professor at Tata Memorial Centre in Mumbai, Dr. Srinivas Chilukari who is a Professor and Senior Consultant at Apollo Proton Cancer Centre, Chennai, Dr. Ramana Rao who is an active Cancer patient, Dr. Saravana Rajamanickam – Surgical Oncologist in Namakkal, Dr. Venkat Radhakrishnan, Medial Oncologist in Adyar, and Ms. Urvashi Prasad – Director of Niti Ayog in Delhi, Dr. Alok Goel – Medical Oncologist in TMH Sangrur, Dr. Amit Agarwal – Medical Oncologist in AIIMS Raipur, and Dr. Vernkata Pradeep – Medical Oncologist in Assam Cancer Care Foundation.

Today, we’re here to Discuss Patient Advocacy and the Role it plays in access to neurotherapies.

Let me start by asking Dr. Alok Goel about – How important is targeted therapy, and immunotherapy in patients with cancer?

For treatment modalities of any disease we have to balance the efficacy and toxicity of those therapies. This is how research and development happens, we move from understanding the molecular pathology of the disease. We move on from therapy that is non-specific to a specific therapy. So when we are treating our patients our aim is not to just give an effective treatment but to also give a safer treatment. 

The role of targeted therapies and immunotherapies comes into place. These treatments are designed to specifically target and attack cancer cells while minimizing damage to healthy cells, unlike traditional chemotherapy which can affect both healthy and cancerous cells. Here’s a breakdown of their roles –

Targeted Therapy

Targeted therapies are drugs or other substances that interfere with specific molecules involved in the growth, progression, and spread of cancer. They work by targeting specific genetic mutations, proteins, or pathways that are essential for cancer cell survival and proliferation. By blocking these targets, targeted therapies can inhibit cancer growth and spread, leading to tumor shrinkage and improved outcomes for patients.

One of the key advantages of targeted therapies is their ability to selectively kill cancer cells while sparing normal cells, which reduces the risk of side effects commonly associated with traditional chemotherapy. Additionally, targeted therapies can be tailored to individual patients based on the specific molecular characteristics of their tumors, allowing for personalized treatment approaches.

Immunotherapy

Immunotherapy is a type of cancer treatment that harnesses the power of the body’s immune system to recognize and destroy cancer cells. Unlike traditional cancer treatments that directly target cancer cells, immunotherapies work by stimulating the immune system to mount an immune response against cancer.

There are several different types of immunotherapies, each with its own mechanism of action. One approach is to use checkpoint inhibitors, which block inhibitory signals that cancer cells use to evade detection by the immune system. By releasing these “brakes” on the immune system, checkpoint inhibitors can unleash an immune response against cancer cells, leading to tumor regression and prolonged survival in some patients.

Dr. Venkat Radhakrishnan – How important are immunotherapy and targeted therapy from a Pediatric oncology or hematology point of view?

I work in a charitable hospital and patients expect us to cover both immunotherapy and targeted therapy in terms of finances which sometimes becomes impossible to achieve. However, if access to finances is not an issue we can consider doing both therapeutical treatments to our patients. 

Dr. Saravana Rajamanickam – Robotic Surgery has improved dramatically, do you really think robotic surgery needs to be provided to patients?

Robotic surgery has indeed made significant advancements, offering numerous benefits such as enhanced precision, minimal invasiveness, and improved patient outcomes. However, whether robotic surgery needs to be provided to all patients depends on various factors, including the specific medical condition, patient preferences, and healthcare resources available.

While robotic surgery may be beneficial for many patients, it is not always necessary or suitable for every case. Some surgeries can be effectively performed using traditional techniques, and factors such as cost, availability of technology, and surgeon expertise also need to be considered. 

For certain complex procedures or cases where robotic surgery offers clear advantages, providing access to this technology can be highly beneficial. It can lead to better surgical outcomes, shorter hospital stays, and faster patient recovery times. 

Dr. Hasmukh Jain, you did the study for CAR T – Do you think CAR T shows excellent results in the second line and beyond setting?

Yes, CAR-T cell therapy has shown promising results in the second-line and beyond settings for certain types of cancer, particularly in patients with hematological malignancies such as relapsed or refractory B-cell acute lymphoblastic leukemia (ALL) and B-cell non-Hodgkin lymphoma (NHL).

CAR-T cell therapy involves genetically modifying a patient’s own T cells to express chimeric antigen receptors (CARs) that recognize and target specific proteins in cancer cells. These engineered T cells are then infused back into the patient, where they can recognize and destroy cancer cells bearing the target antigen.

In the second-line setting, CAR-T cell therapy has demonstrated impressive efficacy in patients who have relapsed or failed to respond to prior standard treatments such as chemotherapy or targeted therapy. Clinical trials have shown high rates of complete remission and durable responses in patients with relapsed or refractory ALL and NHL treated with CAR-T cell therapy as a second-line therapy.

One of the key advantages of CAR-T cell therapy in the second-line setting is its ability to provide a potentially curative treatment option for patients who have exhausted standard treatment options and have limited alternative therapies available. In some cases, CAR-T cell therapy has led to long-term remissions with dismal outcomes that have a median survival of fewer than 6 months even if you have a 30-40% chance of cure in patients who were previously considered incurable.

Dr. Srinivas Chilukari- What is your opinion on how important is proton beam therapy?

Proton beam therapy offers significant advantages for certain cancer patients, but but it’s important to note that it may not be suitable for all types of cancers or all patients. Factors such as tumor size, location, stage, and patient-specific factors such as overall health and treatment goals need to be considered when determining the most appropriate treatment approach. Overall, proton beam therapy represents an important advancement in cancer treatment, providing patients with a valuable option for achieving optimal outcomes while minimizing treatment-related side effects and complications.

How many percent of patients can afford proton beam therapy?

Less than 1% of childhood cancer patients can afford proton beam therapy or even consider going to the center to acquire these treatments. Overall around only 5% of cancer patients can afford this treatment. On the basis of cost perspective, out of 100, approximately only 5 people can afford it.

Is finance only the hindrance factor or are there other cost factors too?

While proton therapy and advanced radiation therapy offer numerous benefits for cancer patients, several hindrance factors may limit their accessibility and utilization –

  • Limited Access and Availability: Proton therapy facilities are not as widely available as conventional radiation therapy centers, which can limit access for patients who may benefit from this treatment. Proton therapy centers are typically located in major metropolitan areas or academic medical centers, making it difficult for patients in rural or remote areas to access this technology. 
  • Technical Complexity: Proton therapy and advanced radiation therapy techniques require specialized equipment and expertise to deliver accurately and effectively. This includes complex treatment planning software, advanced imaging technology, and highly trained radiation oncologists, medical physicists, and radiation therapists. The technical complexity of these treatments may limit their availability to healthcare providers without access to specialized training or resources.
  • Treatment Planning Challenges: While proton therapy and advanced radiation therapy techniques offer precise tumor targeting and sparing of healthy tissues, they also present unique challenges in treatment planning. Proton therapy treatment planning requires precise knowledge of the physical properties of proton beams and accurate modeling of dose distribution within the body. 
  • Clinical Evidence and Guidelines: Despite the potential benefits of proton therapy and advanced radiation therapy techniques, there may be limited clinical evidence or consensus guidelines supporting their use for certain types of cancer. This can create uncertainty among healthcare providers and patients regarding the appropriateness of these treatments and may influence treatment decisions.

Do Doctors sometimes don’t explain these options due to cost factors?

Yes, unfortunately, there are instances where doctors may not fully discuss expensive treatment options with cancer patients due to concerns about cost. This can be influenced by various factors, including financial constraints, insurance coverage limitations, and the desire to avoid causing undue stress or anxiety to patients and their families. But nowadays we do explain the treatment options but also mention that these are pretty expensive rest is up to them.

How can we rationalize this proton beam, robotic, targeted therapy, immunotherapy, CAR T therapies? So who deserves it gets it without financial discrimination?

Rationalizing access to proton beam therapy, robotic surgery, targeted therapy, immunotherapy, and CAR T-cell therapy without financial discrimination involves –

  • Establishing evidence-based guidelines for treatment eligibility.
  • Implementing decision support tools for shared decision-making.
  • Conducting health technology assessments to inform coverage decisions.
  • Adopting value-based pricing and payment models.
  • Ensuring comprehensive insurance coverage and patient assistance programs.
  • Investing in research and innovation to improve affordability and accessibility.
  • Addressing social determinants of health to reduce disparities in access.

What is the role of research in increase access of these drugs?

Cancer research increases access to drugs like targeted therapy, immunotherapy, and CAR T-cell therapy by –

  • Developing new treatments.
  • Improving treatment effectiveness and safety.
  • Identifying biomarkers for personalized treatment.
  • Reducing treatment toxicity.
  • Expanding access through clinical trials.

Why don’t policymakers listen to doctors, and can patient advocates help us?

Patient advocates can play a crucial role in advocating for cancer therapies by –

  • Raising Awareness: Patient advocates can raise awareness about the importance of access to cancer therapies and the impact of policies on patient care. 
  • Providing Expertise: Patient advocates often have firsthand experience with cancer diagnosis, treatment, and survivorship. 
  • Advocating for Policy Changes: Patient advocates can work with policymakers to advocate for policy changes that improve access to cancer therapies, such as increasing funding for cancer research, expanding insurance coverage for innovative treatments, and reducing barriers to clinical trial participation.
  • Promoting Equity and Access: Patient advocates can advocate for policies that promote equity and access to cancer therapies for all patients, regardless of their socioeconomic status, geographic location, or other factors.

How should we make an advocacy group for neuro therapies access?

To create an advocacy group for access to neurotherapies for cancer patients –

  • Define mission and goals.
  • Build a diverse team.
  • Research and educate on cancer care issues.
  • Raise awareness through campaigns.
  • Advocate for policy changes.
  • Collaborate with stakeholders.
  • Provide support and resources.
  • Monitor progress and evaluate impact.
  • Sustain momentum through regular activities.
  • Stay informed, adaptable, and focused on the mission.

How can advanced treatment like targeted therapies be included in public and private reimbursement schemes?

To include targeted therapies in public and private reimbursement schemes –

  • Generate robust evidence on efficacy and cost-effectiveness.
  • Incorporate into treatment guidelines.
  • Negotiate reimbursement rates with payers.
  • Consider value-based pricing models.
  • Implement managed entry agreements.
  • Offer patient access programs.
  • Provide education and training.
  • Advocate for policy changes.
  • Increase public awareness.
  • Ensure equitable access for patients.

What can shareholders contribute to improve Oncology Packages and access to advanced treatments?

Shareholders can contribute to improving oncology packages and access to advanced treatments by –

  • Investing in research and development.
  • Advocating for accessible pricing.
  • Collaborating with stakeholders.
  • Supporting education and awareness.
  • Investing in healthcare infrastructure.
  • Advocating for policy changes.
  • Supporting patient assistance programs.
  • Promoting equity and diversity.
  • Monitoring and evaluating impact.
  • Supporting clinical trials and innovation.

Which patient advocacy groups are required for therapies that cannot be covered in Ayushman Bharat?

Advocacy groups should not be focussed only on the central level but also on the state level which would make a bigger difference in accessibility. By engaging with these patient advocacy groups and organizations we should make it accessible at the state level too so individuals affected by diseases not covered by Ayushman Bharat can also access localized support, advocacy efforts, and resources tailored to their specific needs and circumstances, ultimately improving their ability to access the treatments they need at the state level too. 

Overall, we can say that neurotherapies play a critical role in advancing medical care, improving patient outcomes, and addressing unmet medical needs across a wide range of diseases and conditions. As our understanding of disease mechanisms continues to evolve and technology advances, we need to think of a cohesive platform for the development and adoption of neurotherapies to remain a cornerstone in modern medicine.

Thank you to all my panelists for joining us today and Thank you so much, Vivek…


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