The biosimilar symposium yesterday was focussed on communication and information. First of all, here we are at ESMO, the EMA for Europe has launched a brochure what physicians should know about biosimilars so that they can transport this information later on to the patient without confusing them. Because patients, of course, are in a life-threatening situation, they want to be informed and they want to be without risk. So telling them that you get a cheaper medication that is the same as their originator product might promote some criticism or some complaints to be put on something cheaper. Reassuring them about the fact that this is the same product, the same efficacy, the same side effects with the same immunogenicity is important.

ESMO also released a press release yesterday saying that communication also with nurses is very important. That’s why we had this EONS session of the European Oncology Nurses Society educating nurses about what are biosimilars so that everybody talks about the same thing and with the same attitude – the physician, the nurse and later on, of course, the patient as well.

So by educating the educators that information?

Exactly - educating the educator or the one who has to transfer the information to the patient. That increases compliance and adherence to medication because biosimilars, of course, one aspect is oncology but the other aspects would be rheumatoid arthritis, Crohn’s disease, where we get all the information of switching as well.

When it comes to understanding the apprehension that some doctors or nurses may have, what are the common fears and how do you feel it’s best to address them?

The fears are, of course, ‘I am very sick,’ especially if we address breast cancer patients in metastatic disease. These patients have in HER2 positive disease a long survival time, they are on treatment for five, six or longer years. They have had at least the experience that they survive with this medication. So if you have to change chemotherapy and then suggest a switch from the originator product to a biosimilar that produces fear. ‘I am ill, I am probably dying in a reasonable time and now they want to save money on me,’ that’s a logical consequence, that’s what everybody would think. Then to reassure that that also gives more money in the system that can be used for further science and also medication in individual patients, that’s a cognitive process and this must be installed slowly with time and also with the reassurance that if they absolutely do not want then they will be kept on the originator product.

There is that choice then?

Yes, if it’s their choice then we must accept that some of them, although that’s the minority, will want to remain on the originator product while 90% will be informed and will consent to the switch.

Then those benefits for patients also come with benefits for local and global economy?

This is a benefit for local and global economy and yesterday it was calculated, or figures were presented, that probably within Europe €10 billion per year can be saved all over Europe by the introduction of all biosimilar agents, we’re not only talking of oncology but of all biosimilar agents.

By way of conclusion how would you encourage clinicians, nurses, doctors, patients to engage with biosimilars as a treatment choice?

I would say first of all there is no data to be afraid of the use of biosimilars because everything is safe. Second, you must tell the patient what a biosimilar agent is because they cannot distinguish from an antibody from a chemotherapy, how should they do that? They have never been educated like this, especially if it comes to extrapolation. How should a gastric cancer patient understand that he gets the same drug as a breast cancer patient? It’s totally different diseases. Because they have the same driver, the biologic driver of the disease is the same. So you have to explain to them that there’s one feature in the disease that is the same with breast cancer and if you have positive results with breast cancer you can translate them and extrapolate them also for gastric cancer. So it’s all about communication and reassurance. Once the patients understand that most of them do agree because every reasonable patient will understand that it makes sense to save money if the result is the same and use the money for something else that is needed.