EADO Congress 2015

Disruptive technologies in cancer

Prof Grant McArthur - Peter MacCallum Cancer Centre, Melbourne, Australia

Grant, disruptive technology is not a word you normally associate with medicine, the calm situation of doctors being in control of the technology normally. What is happening down in Melbourne, Australia? Some quite unusual things are taking place.

Yes, it’s interesting to think about the term disruptive technology. We’ve had it in medicine if one thinks about joint replacement surgery and what that meant to the life of an orthopaedic surgeon and delivery of those sorts of care of our patients. But what’s happening not just in Melbourne but really worldwide is that we are at the start of a very disruptive technology in cancer and that is the combination approaches of immune based therapies giving very durable, long-lasting responses, clinical cure for some patients plus substantial improvements in overall survival from the targeted therapies in melanoma. So, for us, this is a disruptive technology. We are having workforce issues, having enough staff to look after our patients in clinic because they’re living longer. Patients are staying in clinic for a long time, receiving treatments that are keeping them alive, giving them major improvements in their overall survival, so this is a disruptive technology and our medical oncology workforce has to respond to this.

We’ve seen technological changes, for instance in HIV/AIDS drugs were developed through a huge international effort, they were extraordinarily expensive then they became available. What can happen in the world of melanoma medicine, do you think?

I think now that we have remarkable improvements in clinical outcomes based on both immune treatments and targeted treatments, we’re using them sequentially, there are trials under way to combine these, one would anticipate that we’re going to really improve significantly the overall survival of patients with advanced melanoma, we’re going to bring that back to the adjuvant setting as well, there may be positive trials there. Then when you just think about melanoma as a tip of an iceberg, lung cancer we also have seen great clinical activity of the immune checkpoint inhibitors, so I think the new technology is coming through now, these new immunotherapies for cancer is an example of a disruptive technology in oncology. It’s going to change the way we practice medicine for cancer patients.

But, of course, only for a small proportion of the population, with some of the first generation drugs costing over $100,000 a year to treat one patient. So how can this medicine practically be brought to the world, not only in melanoma but then over to lung cancer which is enormously common? What can doctors do to help the process of introducing drugs at a reasonable price?

It is a responsibility of the oncology profession to work with governments to try to bring down the cost of these medicines to make them more affordable. Pleasingly, with technology advances, even making something as complex as a biologic like a monoclonal antibody to PD1, the technology for that is advanced so once those particular agents go generic the cost will come down very, very substantially worldwide, even the developing world will have access to these. But of course it behoves us to try to accelerate that reduction in cost in the meantime because patent life is long.

But there is a case to be made out for increasing the profits of drug companies by mass producing a product which can then be used by a hundred or a thousand times as many patients worldwide.

Economies of scale, once the new immune based treatments roll out to more cancers. So, very interestingly, I just saw some data, the latest phase II data for anti-PD1 agent pembrolizumab, seventeen different cancers now have clinically significant response rates with that agent. So this is going to influence on a large scale oncology and hopefully those economies of scale we can think about bringing prices down to make these medicines more available throughout the world. That’s very important – throughout the world, not just in rich countries.

Meanwhile, in Melbourne, Australia, how are you coping with this disruptive technology right now?

Faced with the disruptive technology in the disease of melanoma where our patient survival is going up, we have a great need for an increased number of infusions in our day oncology unit so we’re looking at delivering infusions at home and looking at extending the operating hours of our day oncology unit, which actually is favourable for patients. Patients don’t necessarily want to have their infusions 9 – 5, they quite like having infusions after hours, for example. So one is having to accommodate this rapid change in demand which is only going to accelerate as these new technologies roll out to more cancers than just melanoma and lung cancer.

All in all, it’s nice to have a success story.

I’ve been saying to my staff faced with this challenge of staffing our clinics what a great place to be in. Our patients are surviving so well it’s creating a workforce shortage for us – a great place to be in.