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Abstract

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

The Japan National Committee for the Union for International Cancer Control (UICC) and UICC-Asia Regional Office (ARO) organized an international session as part of the official program of the 71st Annual Meeting of the Japanese Cancer Association to discuss the topic “Healthcare Economics: The Significance of the UN Summit non-communicable diseases (NCDs) Political Declaration in Asia.” The presenters and participants discussed the growing cost of cancer in the Asian region and the challenges that are faced by the countries of Asia, all of which face budgetary and other systemic constraints in tackling and controlling cancer in the region. The session benefited from the participation of various stakeholders, including cancer researchers and representatives of the pharmaceutical industry. They discussed the significance of the UN Political Declaration on the prevention and control of NCDs (2011) as a means of boosting awareness of cancer in the Asian region and also addressed the ways in which stakeholders can cooperate to improve cancer control and treatment. Other issues that were covered included challenges relating to pharmaceutical trials in Asia and how to link knowledge and research outcomes. The session concluded with the recognition that with the onset of a super-aged society in most countries in Asia and an increasing focus on quality of life rather than quantity of life, it is more important than ever for all stakeholders to continue to share information and promote policy dialogue on cancer control and treatment.

The Union for International Cancer Control (UICC) is a membership organization that exists to help the global health community accelerate the fight against cancer. Founded in 1933 and based in Geneva, UICC's growing membership of over 760 organizations across 155 countries, features the world's major cancer societies, ministries of health, research institutes and patient groups. Together with its members, key partners, the World Health Organization (WHO), World Economic Forum and others, UICC is tackling the growing cancer crisis on a global scale.[1] As part of the official program of the 71st Annual Meeting of the Japanese Cancer Association the Japan National Committee for UICC[2] and UICC-Asia Regional Office (ARO)[3] organized an international session to discuss the topic “Healthcare Economics: The Significance of the UN Summit Non-communicable Diseases (NCDs) Political Declaration in Asia.”[4] The historic High-level Meeting of the United Nations General Assembly on the Prevention and Control of Non-communicable Diseases held in New York in September 2011, resulted in cancer being duly recognized as a global health agenda issue.[5] Despite this significant development, however, the issue of cancer, one of the most intractable of all non-communicable diseases, still faces a variety of challenges if it is to be addressed on the global level. The UICC International Session sought to address and discuss various issues in the light of the UN Political Declaration, based on the realities of cancer in Asia, which is a region that is experiencing a dramatic rise in the incidence of cancer. The session was co-chaired by Hideyuki Akaza, RCAST, The University of Tokyo and Jae Kyung Roh, Yonsei Cancer Center, Yonsei University Medical School.

The Purpose of the UICC International Session

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Hideyuki Akaza (RCAST) noted that in 2011 the United Nations (UN) identified the top killer diseases around the world, of which the majority of killers were NCDs. It is estimated that by 2030 the greatest cause of death in all countries, including developing countries, will be cancer.

With regard to the ratio of mortality to incidence in a specific year by cancer type and country income, the case fatality is much lower in high-income countries than in low-income countries for cancers that are treatable, such as childhood leukemia and testicular cancer; treatable if detected early, such as breast cancer; or preventable, such as cervical cancer.[6]

There is a cost to cancer. It has the most devastating economic impact of any cause of death in the world. The total economic impact of premature death and disability from cancer worldwide was 895 billion dollars in 2008. The WHO predicted that cancer would be the world's leading cause of death by 2010. There is also good news for cancer treatment; however, as cancer death rates are falling little by little. Every effort to develop anti-cancer agents is being made, and great advances have been made in the last decade, but costs are increasing dramatically.

The Asia Consensus Statement on Kidney Cancer of the NCCN Clinical Practice Guidelines in Oncology states the following: “Pivotal trials demonstrating the benefit of targeted therapies were done in the Western world. Most targeted therapies lack efficacy or toxicity data for patients of Asian origin; thus far … it is suggested that these targeted agents be investigated in the Asian population to develop an optimal dosage for Asian people.”[7]

Whether life extension for just a few months over its natural course can be justified in resource-lacking areas, is also an issue that remains to be debated. This is one of the reasons why discussion of the economics of cancer, particularly in emerging economies, is of such pressing importance.

The Asia Consensus Statement on Prostate Cancer of the NCCN Clinical Practice Guidelines in Oncology[7] also states that biology and outcome of androgen depletion therapy (ADT) may be different between Asian and Western countries. There is a large unmet need for clinical trials in the Asian population to confirm their applicability in Asia.

These guidelines will begin to help the local oncology communities to optimize clinical management for their patients. They will also highlight areas where further research should be conducted to clarify existing practices.

To understand cost-effectiveness, it is essential to construct a single metric for costs and a single metric for risks/benefit to length and quality of life. It is very important to think about the right drug for the right patients at the right timing otherwise national health systems face bankruptcy.

As an example case study, the following was cited:

A 75 year old male who lives in China suffers from bladder cancer. His daughter who graduated from a university in Japan and is managing her office in Japan asked for a second opinion about her father's treatment. His doctor in China advised him to have a radical cystectomy. According to international guidelines, the first recommendation is endoscopic surgery and BCG intravesical instillation, preserving the bladder. Furthermore, radiation therapy, including proton-beam and IMRT is indicated for bladder preserving therapy. The daughter decided to bring her father to Japan, because BCG is not readily available in China.

This case is an example of a fortunate case, because the family could afford the cost of transfer and treatment in Japan. However, questions remain for people who cannot afford such costs. Key questions that need to be asked are: How to establish universal health coverage, both intra-nationally and internationally? How to invest appropriately in health in light of budget constraints?

Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Norie Kawahara (RCAST) spoke about activities to create a platform to promote cancer as a key theme on the global health agenda. There is a pressing need for such a platform because it would make further discussion possible on the social and economic challenges presented by cancer.

“Poverty is a carcinogen.” This is a well-known quote by Dr Samuel A. Broder in 1989.[8] As globalization advances, economic gaps around the world are actually growing bigger. What is more, the poverty rate is also increasing.

“Translating benefits of income increases and capital flow into health benefits cannot be taken for granted. NCD risk factors have very tight correlation with mediation factors of globalization.”[9] This statement was made by Dr David Woodward in a 2001 WHO report. However, his words of warning were lost in the move towards globalism. There was a failure to take notice at that time 11 years ago.

Human health is influenced by a variety of factors. These include income, education, employment, social status, gender and ethnicity. Recently the WHO has also been considering the various social determinants of health.[10]

The UN Summit on NCDs in September last year marked a historic turning point. It was also a result of various intensive actions that are being taken around the world. The UICC took a leading role in efforts that resulted in the UN political declaration last year.

Union for International Cancer Control President, Dr Eduardo Cazap, has summarized the major roles played by the UICC in three points.[11]

  1. To create the NCD Alliance and use it as an effective platform for global advocacy. The UICC played a central role in organizing the Alliance.
  2. Dr Cazap himself served as co-chair on an advisory committee to the Summit President and worked to promote UICC leadership on cancer issues. Health issues are rarely raised at the UN General Assembly. The UN Summit on NCDs was only the second time since the AIDS Summit in 2001.
  3. The UICC has a global membership. It has made active efforts to call on governments of all countries.

The UN Political Declaration referred to the social and economic loss, economic threat and inequality relating to cancer. It also called for strong leadership, a multisectoral approach, and primary prevention approaches. However, it should be noted that these concepts and ideas represent a summary of discussions that have been held in the past.

It has been pointed out that the political declaration did not include specific numeric targets for burden sharing among countries. This was because of concerns about financial pressures in industrialized countries. Also there was no reference to patents, due to inflexibility in WTO agreements.[12]

Most of the press coverage about the UN Summit outcomes was relatively cynical. However, Pulitzer Prize-winning journalist Sheri Fink, who has experience in observing UN negotiations, has noted that the situation surrounding global health and NCDs was one of the most complex issues facing the UN.[13] The global economy is still stagnating, so it may be difficult for NCDs to benefit from a support structure like the one that is in place for infectious diseases.

Cancer research has tended to become very specialized in recent years. Researchers can easily lose sight of the big picture. By taking a global health perspective, it is imperative to expand the horizons of the cancer research community and bring the big picture into focus.

One more thing that is also becoming clear is that the problems surrounding cancer treatment are shifting to become international foreign policy issues, framed under the global health agenda. The issue of NCDs and cancer cannot be discussed in simple terms as an aid issue. That was possible for infectious diseases, but it is no longer a realistic option. It is first necessary to list up the current challenges being faced, so that all stakeholders can take part in the discussions from now.

Within the challenge of how best to allocate medical resources, there lies the ultimate question about what kind of a world and society we want to live in. With limited medical resources, it is essential to be open to various options and consider the burden of cancer treatment in a super-aged society. Discussion must also take into account issues of social justice and fair allocation of resources. It is essential for us to pool our knowledge. We must bring each strand of wisdom to the table to tackle the global threat of cancer.

Discussion

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

A Chinese participant referred to the case study cited by Hideyuki Akaza and noted that due to the fact that Chinese medical insurance cover is generally very low, some people choose to die rather than receive treatment. The reason for this is because the cost of cancer treatment for one person, which may result in life being extended for a period of months, could be otherwise used for other treatments for up to 10 people.

Jae Kyung Roh (Yonsei University Medical School) responded to the participant's comment, noting that in Korea the national health system was established approximately 40 years ago by President Park Chung-Hee. Now in Korea, 99% of people are covered by the national health insurance. The challenge for the system is to cover all illnesses that may occur from pregnancy through to end-of-life treatment. There are times when the national insurance system cannot cover certain newly emerging novel drugs. Issues of cost effectiveness are thus appearing and the situation is likely to be similar in Japan. It is likely that China will soon have universal coverage, but will face the dilemma of cost effectiveness and how to use limited resources, like Korea and Japan.

Tomoyuki Kitagawa (Japanese Foundation for Cancer Research), noted that equality of treatment is one goal in Japan, but it also presents problems. To have equal access to very advanced and sophisticated treatment requires large amounts of funding, which is creating a tremendous burden for health systems. As Japan is already experiencing this problem, China and other emerging economies are likely to experience it in the near future. One controversial solution could be to make a social understanding in which extremely aged people agree not to use very sophisticated treatment, in order to lessen the burden on national health systems.

The Economic Burden of Cancer in Korea

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Park Eun-Cheol (Yonsei University College of Medicine), noted that incidence and mortality of cancer in Korea is relatively high compared to global averages, particularly in view of the fact that Korea accounts for only 0.73% of the global population. Over a 10-year period the per 100 000 age-adjusted incidence increased from 219.9 to 299.4. Cancer is a leading cause of death in Korea, although the 5-year survival rates have grown from 41.2% to 62% from 1993–1995 to 2005–2009. This improvement in the survival rate has been attributed to better prognosis. Increasing numbers of people are falling victim to cancer in Korea and as a consequence the country will face a growing economic burden related to cancer.

The study implemented by the Department of Preventive Medicine was to measure the economic burden of cancer from 2001 to 2010. The study considered the economic burden in two ways: the direct and indirect costs. Direct costs include hospitalization, prescription drugs, transportation, caregiver's costs, etc. Indirect costs include costs of productivity losses due to morbidity and productivity losses due to mortality.

In 2010 the economic burden of cancer was calculated to be 26 billion dollars (2.21% of GDP). The largest portion of the burden was productivity loss due to morbidity and mortality. The figure of 2.21% of GDP is larger than the global average (1.5%) and larger than Japan's burden of cancer (2%). The total medical costs relating to cancer amount to approximately 5.4% of total health expenditure. The economic burden of cancer has markedly increased over the last 10 years, rising from 1.8% in 2001 to 2.21% in 2010. Medical costs accruing to cancer stood at 3.32 billion dollars, and have risen to 5.37 billion dollars. In terms of out-of-pocket money, the burden has risen from 1.5 billion dollars in 2001 to 3.31 billion dollars in 2010.[14] The government of Korea has attempted to decrease the cost burden of the national health service from 20% to 10%, and then from 10% to 5%, but still the individual burden for cancer sufferers has continued to grow over the last 10 years.

The total economic burden has increased from 11.7 billion dollars (2001) to 26 billion dollars (2010), marking an annual increase of 2.7% over the 10-year period. The percentage of total health expenditure has also increased, obliging the government to budget more funds for the health system and for cancer in particular.

Discussion

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

A Korean participant from the floor asked about the proportion of loss in productivity due to morbidity and asked if levels in Korea are similar to other countries. Park Eun-Cheol responded that he was unaware of figures for other countries, but noted that the loss from morbidity is generally high in Korea. The participant asked about the precision of “loss in productivity due to morbidity,” noting that this was a much more difficult calculation compared to mortality, given that some people continue to work while receiving treatment for cancer, whereas others retreat entirely from the workplace. Park Eun-Cheol responded that the study used various set parameters to calculate the figures in general terms, attempting to take into account the different working situations of cancer patients. It was noted that culture in Asia could contribute to more people being encouraged to refrain from returning to work while receiving cancer treatment than in other regions, due to the conservative practices at healthcare centers and other factors.

Tomoyuki Kitagawa (Japanese Foundation for Cancer Research), asked whether the indirect costs were less for aged people. Park Eun-Cheol responded that the people over 70 years of age were not included in the study. Tomoyuki Kitagawa suggested that it would be interesting to study the burden on the young and the old to compare generations.

A participant from the floor asked about the measures the Korean government is taking to keep costs down and ensure they do not increase more. Park Eun-Cheol responded that the government is engaged in cost-effectiveness measures, including the testing of new technologies.

A participant asked about the measures the Korean government is taking to keep costs down and ensure they do not increase more. Park Eun-Cheol responded that the government is engaged in cost-effectiveness measures, including the testing of new technologies and whether they would prove cost-effective. New technologies present two issues: cost versus quality of life. The government's response has been to make decisions on whether new technologies are covered under the national health insurance system or not. Some patients, therefore, take out personal health insurance that will cover treatment using new technologies. Unfortunately, the economic problems presented by cancer are affecting Korea more strongly than other countries and the issue is one that is difficult to solve.

Hideyuki Akaza also stressed the importance of cost-effectiveness and seeking ways to perfect a fair, equitable and efficient medical system. He noted that the general health insurance system in Japan is also over-burdened and cost-effectiveness will have to be given serious consideration in the near future.

Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Masafumi Nogimori (Astellas Pharma), discussed the role of pharmaceutical companies in addressing non-communicable diseases, including cancer. Global health refers to issues that require a global response. The Millennium Development Goals (MDGs) were set in 2000 to be achieved by 2015. Three of the MDGs relate to medical issues, particularly for low-income countries: MDG4 (reducing child mortality), MDG5 (improving maternal health), MDG6 (combating HIV/AIDS, malaria and other diseases). Non-communicable diseases are becoming an increasing concern for both high-income and low-income diseases alike. Non-communicable diseases are defined as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes.

The UN Political Declaration on the prevention and control of NCDs (2011) recognized that NCDs can be prevented and their impacts can be significantly reduced. Heads of state committed to five areas of action:

  1. Reduce risk factors and create health promoting environments.
  2. Strengthen national policies and health systems.
  3. International cooperation.
  4. Research and development.
  5. Monitoring and evaluation.

According to the WHO, more than 60% of all deaths in 2008 were attributable to NCDs,[15] and this proportion is expected to rise to 76% by 2030. In addition, the proportion of NCD-related deaths in people before the age of 60 years old in low- and middle-income countries is more than twice the size of the number of deaths in high-income countries.[16] This is very much related to poverty in low-income countries.

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) is an international federation of research-based pharmaceutical corporations that engages in activities against NCDs. In concert with the UN Declaration, the IFPMA confirmed its intent to work with the UN and to identify the obstacles regarding NCDs (2011–). This study has found that effective first-line NCD medicines adherence are now available as generic drugs but are still failing to reach many people living in the developing world. Points to consider for the research-based pharmaceutical industry include: innovative ways to improve NCD medicines, enhancing supply chain activity and integrity.

Cancer is already a serious issue in developing countries, where lung and breast cancers are particularly common.[17] On the other hand, liver, stomach and cervical cancer show higher incidence in lesser developed countries, partially due to inadequacies in diagnosis. In terms of the stages of cancer diagnosis in China, for example, cancer tends to be diagnosed at a later stage than in countries such as Japan and the United States.[18] Due to high costs and under-development of facilities, CT is seldom used as a means of diagnosing lung cancer. Cytotoxic therapy is still dominant in China, but targeted therapy is growing as a treatment option, although there is still a large gap between China and other developed countries.[18]

In terms of the contributions of the pharmaceutical industry, the industry currently has 1500 new drug candidates in the development pipeline to treat NCDs.[19] Current medicines in development include 887 in cancer, more than for any other disease.

New medicines have the real ability to contribute to “life.” From 1987 to 2000 life expectancy has increased by approximately 2 years, which is a testament to the input by new medicines.[20]

In cooperation with governments and the WHO, the research-based pharmaceutical industry should continue research and development of new medicine and continue to improve modalities and treatment.

Discussion

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Jae Kyung Roh asked a question concerning the development of new drugs by pharmaceutical companies, noting that low-income countries are generally unable to afford new drugs. Masafumi Nogimori noted that for pharmaceutical companies in order to continue in business and to discover new drugs it is essential to recoup development costs. As cancer research is becoming a more and more molecular targeted base, the patient spectrum is becoming ever narrower and per capita the price is becoming higher and higher. On the other hand, it is essential to consider what an affordable cost is for the patient. This is why pharmaceuticals are conducting donations of their drugs and implementing differential pricing in developing countries. The issue of cost-effectiveness versus development and availability of drugs is a matter that concerns companies and governments alike. It is not an easy issue and it is imperative for all stakeholders to address the issue together.

Hideyuki Akaza asked about efforts or policies to improve access to drugs. Masafumi Nogimori responded that while efforts are made to increase access, individual pharmaceutical companies generally seek to maintain their patents as a means of funding future development, but concentrate efforts on working together with international organizations, such as the WHO.

A participant from the floor noted that Japanese pharmaceuticals are generally in good financial condition and much of their income is coming from the national and local health insurance systems through taxation. He asked therefore whether there are moves to reinvest in Japan, in academia or other areas, as well as other countries around the world, given that it is the taxpayers who fund the profits for pharmaceuticals. He suggested that the financial system for funding would need to be changed in order to make the system sustainable, given the massive annual increases in government funding for drugs, which in Japan is increasing in annual increments amounting to trillions of yen.

Masafumi Nogimori noted that this is an issue that is being considered very seriously by the pharmaceutical industry. Pharmaceutical companies are paying a reasonable amount of money to universities, etc., for basic research and are seeking to establish good working relationships. Although there is a perception that pharmaceutical companies have deep pockets, it should be understood that companies need to recoup their investments. He noted that it is therefore essential for pharmaceutical companies to achieve high profitability in order to recoup large development costs and maintain high-level research investment for future new drugs and treatments.

Oncology in Asian Countries: Clinical Development Challenges and Opportunities

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Kunihiko Takeyama (Oncology Business Unit, Sanofi K.K.), noted that oncology is a strategic priority for Sanofi, due to the huge impact of cancer on society. Cancer is the first cause of death in Japan (and also in Korea and soon to be in China). Regionally common cancers and Asia-specific cancers are gastric cancers. However, breast cancers are more prevalent in Europe and the US than in Asian countries.[21]

Asian patient specificity is a reality in some cancer treatments. Gefitinib is extremely responsive to lung cancer (adenocarcinoma in female non-smokers).[22] Another drug that has just been approved is crizotinib in ALK-positive non-small cell lung cancer, the PK was different in Asian or non-Asian populations, and serum concentration was higher even 112 days after administration in Asian subjects.[23]

Oncology is a key area for the pharmaceutical industry. Demand for cancer-fighting drugs is increasing. The global market is expected to reach 101 billion dollars in 2018, up 60% from 2011.[24] Oncology is expected to be the largest pharmaceutical market by 2016. Japan is the second largest market worldwide, after the US and Europe.

Oncology is also a key research focus in the pharmaceutical industries[25] although development in oncology is very risky. Cancer drugs have the worst phase III track record.[26] A study by BIO and Bio MedTracker shows that oncology had the lowest phase III success rate among seven therapeutic areas, with only 34% of candidates succeeding at this stage over a 7-year period. Cancer also had the second lowest phase II success rate (29%).

Asia is taking a larger part in global clinical development activities. There has been a change in the percentage of industry-sponsored phase II/III trial sites in the US trial registry. Japan is still the country with the most phase III trials in progress, but oncology is a major area of clinical research in Asia as a whole.[27]

One of the challenging issues is the diversity of the regulatory environment in Asian countries. There is a need to validate dose and PK (Phase I) and generate efficacy and safety data in Japanese patients. The regulations in Korea are slightly easier, making it easier for Korea to participate in international trials, while the situation in China is complicated, due to various government requirements for participation in international trials.

One of the biggest issues for patients and patients' families is the reduction of the “drug lag,” which is a priority for Japanese and Asian health authorities. Efforts are being made to expedite review times, by increasing the number of Pharmaceutical and Medical Devices Agency (PMDA) review staff in Japan and speeding up priority reviews.[28] Participation in international clinical trials is also being promoted.

Clinical development strategies in Asia can be divided into “traditional” and “new models.” The traditional strategy engages in sequential development, with phases I to III being conducted in Western countries and clinical development starting in Asia only once a product is launched or registered in the US/EU. The new model is parallel (or simultaneous) development, where the validation of the dose/regimen is being used early on for Asian patients. Parallel development is now set to become the new standard for the pharmaceutical industries.

Cancer is a major health issue worldwide, in Asia and in Japan. The pharmaceutical industries are investing significantly to develop new solutions, so that Asia is increasingly included in global development plans for new products.

Discussion

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Jae Kyung Roh noted that in Korea the Korean Food and Drug Administration (FDA) required that all materials be translated into Korean in order to be considered for approval and asked about the situation in Japan. Kunihiko Takeyama responded that as the Korean FDA follows the US FDA, it is generally a less complicated system than in Japan. With regard to translation volume for a new drug application, each submission requires 2000–3000 pages of translation, which takes a considerable amount of time, usually about 3 months. The PMDA is still using Japanese as its main language and requires that information be provided in Japanese for purposes of transparency.

A participant from Japan BCG Laboratory noted that the regulations of the United States FDA are easier to understand than those of the PMDA in Japan. In general European companies cooperate with many universities, and this is something that does not happen frequently in Japan. Joint collaborations should be further promoted in Japan.

Our Dream, Our Burden, and Our Future

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Tohru Masui (National Institute of Biomedical Innovation), provided a wrap-up of the presentations, under the theme of “Our dream, our burden, and our future.” He noted that “our dream” includes the following hopes and expectations:

  1. Quality of life in both material and spiritual terms, without hunger, thirst and with good hygiene;
  2. Happiness and prosperity; and
  3. Long life, although as Norie Kawahara had pointed out “poverty is a carcinogen” that threatens long life, and longevity itself could be perceived as being carcinogenic.

“Our burden” can be denoted by the following:

  1. Heavy physical and mental burden of cancer; and
  2. Worry, hardship and distress.

“Our future” incorporates the following items under the overall concept of “hope”:

  1. Development of medical treatment;
  2. New drugs for cure and treatment; and
  3. Easy access of medical treatment.

He concluded by quoting the following: “We do not inherit the earth from our ancestors, we borrow it from our children” – If we focus only on ourselves during illness it is easy to become lost, but if we consider ourselves as part of a larger process it would be possible to be useful to future generations.[29]

Discussion

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Kazuo Tajima (UICC-Asia Regional Office), noted that there are two issues to consider in terms of cancer treatment, and which the UICC has discussed over a long period of time: (i) cancer is becoming an increasing challenge in developing countries, but costs are prohibitive, meaning it will be important to consider generic drugs; and (ii) the need for pharmaceutical companies to invest large sums for drug development and clinical trials.

He also noted that the UICC World Cancer Leaders' Summit of 2006 was an important high-level policy meeting concentrating on cancer control and care and NCDs. It brought key decision-makers from around the world. The World Cancer Leaders' Summit will continue to announce new initiatives to help achieve the WHO goal of reducing cancer and NCD-related deaths by 25% around the world. It is also imperative to raise awareness among leading decision makers and provide a forum to exchange information and innovate ideas. It is essential to create initiatives that will stimulate politicians and create political will.

The World Cancer Leaders' Summit 2012 in Montreal, Canada concluded that in the face of the growing global impact of cancer, partnership is essential. The Summit engaged in debate among key stakeholders and UN officials on cancer prevention, treatment and advocacy. Such partnership is very important for addressing global issues and should incorporate all stakeholders, civil society, international development agencies, charitable foundations, the media and the private sector. The UICC International Session at the 71st Annual Meeting of the Japanese Cancer Association has played an important role in promoting discussion and sharing information.

Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Jae Kyung Roh summarized by noting that cancer is increasing in low-income countries, and funding is tight. However, even low-income countries have access to the internet and patients in those countries are aware of the latest treatments that are available, even though such treatments may not be readily available or affordable in their countries.

Cancer care now means quality of life rather than quantity of life and the modern techniques that are required to enhance quality of life are currently generally only available in Japan, Korea and limited parts of China.

It is essential to continue to support developing countries that face increasing incidence of cancer, and the aim for Asian countries should be to take care of Asia, including multi-national, cost-effective measures with efficient and accurate shared diagnostic methods.

Disclosure Statement

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References

Dr Nogimori serves as Representative Director and Chairman of Astellas Pharma; Dr Takeyama serves as an employee of Sanofi K. K.; Dr Nogimori has stock ownership of Astellas Pharma; Professor Akaza received honoraria from Janssen Pharmaceutical K.K., Astellas Pharma, Pfizer Japan, Shionogi & Co., Taiho Pharmaceutical Co., AstraZeneca K.K., Nippon Kayaku Co., Takeda Pharmaceutical Company. and Japan BCG Laboratory; Professor Akaza received fees for promotional materials from ASCA; Professor Akaza received Research funding from AstraZeneca K.K., Astellas Pharma, Sanofi K.K., Daiichi Sankyo Company, Japan BCG Laboratory and Astellas Pharma.

References

  1. Top of page
  2. Abstract
  3. The Purpose of the UICC International Session
  4. Promoting Perceptions of Cancer as an Integral Part of the Global Health Agenda
  5. Discussion
  6. The Economic Burden of Cancer in Korea
  7. Discussion
  8. Pharmaceutical Industry's Contribution to the Prevention and Control of NCDs in Accordance with the UN Political Declaration
  9. Discussion
  10. Oncology in Asian Countries: Clinical Development Challenges and Opportunities
  11. Discussion
  12. Our Dream, Our Burden, and Our Future
  13. Discussion
  14. Closing Remarks: Healthcare Economics: The Significance of the UN Summit NCDs Political Declaration in Asia
  15. Disclosure Statement
  16. References