Ketil Widerberg, General Manager of Oslo Cancer Cluster, describes the complexities of implementing precision cancer medicine in Norway and suggests a way forward
Every year, almost 10 million people die from cancer globally. Developments in precision cancer medicine offer new treatments that can give people longer lives, better lives and even save lives.
However, the wave of new medicines is putting pressure on European welfare states and raises the question: How can we afford this cancer revolution?
A recent survey by Kantar of the Norwegian population’s stance on health policy showed a majority want more modern cancer treatments with less side effects at public hospitals. It is now up to politicians, health officials, clinicians, and the pharmaceutical industry to work together to make this happen.
Taming the three-headed dog
When talking about giving patients access to new treatments, the key players generally fit into three categories:
• The public hospitals, where clinicians wish to give their patients the best possible treatment but are restricted to the medicines that have been approved.
• The health authorities, who are tasked with introducing new treatments, while also ensuring there is enough funding to support the entire public healthcare service.
• The private companies that produce new diagnostics and treatments, who have spent years of research and development. They need return on investment to be able to continue to attract private capital.
Much like the three-headed dog Cerberus guarding the gate to the underworld in Greek mythology, each head serves different purposes and the three need to work together to grant access to new medicines.
The public-private consortium CONNECT was set up to tackle this challenge. The aim is to drive the implementation of precision cancer medicine in Norway. Oslo Cancer Cluster coordinates the consortium and acts as a neutral facilitator between the various stakeholders.
The CONNECT consortium includes all six university hospitals, the Norwegian Medicine Agency, the Norwegian Health Directorate, the Norwegian Institute of Public Health, the Norwegian Cancer Society, the Norwegian Pharmaceutical Industry Association (LMI), 16 pharmaceutical companies and two tech companies. Together they work to address key obstacles and pilot novel solutions to transform the current practice.
Contributing cancer drugs
One of the successes of CONNECT is getting pharmaceutical companies onboard to contribute drugs to the nation-wide clinical study IMPRESS. IMPRESS is an off-label study on advanced cancer and an opportunity for cancer patients to get personalised
medicine. It has been supported by the Regional Health Authorities with NOK 60 million.
If a patient has an effect of the treatment contributed by the pharma companies after 16 weeks, the Regional Health Authorities have agreed to pay for further treatment. This is an example of a future pay-for- performance model in precision cancer medicine in Norway.
The idea is simple. Cancer patients with no other treatment options can receive precision diagnostics through a national infrastructure called InPreD within the specialist health service. This is currently being set up at all Norwegian hospitals with financial support from the Regional Health Authorities.
The patient’s results are then discussed in a weekly national molecular tumour board, which refers the patient either to IMPRESS, other biomarker-defined trials, early-access programmes or back to ordinary treatment.
This is an example of what can be accomplished when “the three heads” work together and how the monstrous watchdog can be turned into a trustworthy companion. The areas of research and treatment are elegantly brought together so that new medicines faster can reach patients who need them the most, while the various needs of the stakeholders are cared for.
These interconnected precision medicine initiatives have already gained widespread international attention, including in a Letter to the Editor published in Nature Medicine, presentations at Nordic Precision Medicine Forum 2022 and an abstract at ASCO 2022.
InPreD, IMPRESS and CONNECT spearhead the development of a complete ecosystem for the introduction of precision cancer medicine in Norway. Our hope is that this can inspire other European countries and partners to continue their public-private collaboration efforts and initiate new partnerships within Europe. Then novel cancer research can become not just a distant dream but everyday practice for cancer patients.