We actually don’t have a primary care system in Hong Kong so unlike, say, in I would think maybe the UK you would tend to collaborate with the GP in your patient care but for most of our patients with cancer they only really are seen by the surgeons or the radiation oncologists or the medical oncologists. So for those sorts of collaborations we usually have joint clinics so much like a multidisciplinary meeting where we sometimes see the patients together when they need joint decisions.
What have been the highlights of this meeting?
For this meeting I learnt a lot about the newest immunotherapy developments. In Hong Kong a lot of our drugs are self-financed so people think Hong Kong is a really rich country and maybe that our patients would get treatments for free but actually most of our cancer treatments, at least the on patent ones, are self-financed. So our experience to exposure is often limited by how much patients can pay or how many clinical trials we can take in our unit. So that’s why I need all the blogs and all the experience from oncologists working overseas to inform me about what side effects these new treatments might have and what sort of efficacy we’re looking at. Now with these new treatments coming out very, very fast it’s almost not possible to just read about it all in the journal and sometimes you miss certain perspectives just from reading a study. It’s very useful to read opinion pieces from experts in the field and see what they think about it. This is what this meeting has done.
Where do you access information on new clinical trial data?
Mostly from when I’m doing, say, my own research and I have to do literature reviews or through journal club updates, in our own institution, conferences like these, sometimes from drug reps as well, that would be the main sources.
Do you think that immunotherapy is a breakthrough?
Immunotherapy is definitely now a breakthrough; I would be very cautious about saying that it’s a cure. As with a lot of cancer treatments, cancer is a very heterogeneous disease biologically and it’s very hard to sort of one size fits all. So I think immunotherapy will prove to be a very good treatment for a small number of cancer patients but definitely it won’t answer all our patients’ problems.
How would you aim to solve the problem of price and affordability?
That’s a great question and that’s why I love one of the blog writers on ecancer, Vishal, because he always loves to speak from the perspective of a developing country. Hong Kong, we have the highest Gini coefficient in the world so we have a lot of income inequality and actually most of our drugs are not affordable. How we’re going to make it available, it really is going to be a long-term debate with pharmaceutical companies and also NGOs to see how they will fill in the gap. Even in Europe they’ve already proven that a lot of these drugs are not going to be sustainable in the long run for the government to finance. To design more clinical trials and to ask the question of, say for example, immunotherapy whether we need these high doses of drugs and whether we need to continue them forever as most of these new trials are seemingly designed to, cap us give these drugs forever and I don’t believe that that’s necessary in some cases.
