Precision cancer medicine is challenging politicians, health authorities, industry and patient organisations to think new about current methods for assessing and approving treatments.
“We live in a unique time period, where we have the opportunity to improve and save lives, but there are uncertainties about how effective and safe the treatments are, and how they will affect our total resources in the health sector.”
The newly appointed State Secretary Usman A. Mushtaq (the Norwegian Labour Party) gave his perspective on how precision cancer medicines will change the health sector in a recent meeting during Arendalsuka 2024.
The Norwegian Ministry of Health and Care Services is developing a White Paper on Prioritisation ("Prioriteringsmeldingen") to be published during Easter in 2025. They have gathered input from four expert groups and the question on everyone’s minds is: have they taken personalised medicines into account?
“The challenge with personalised medicine is that by its nature it challenges how we think in the health sector. We in the Green Party call for the white paper to include the overall perspective and the socioeconomic perspective so that patients don’t fall outside the system,” commented Kristoffer Robin Haug, The Green Party (Norway) in the debate with Mushtaq.
A cultural revolution
Haug also called for a “cultural revolution” in how politicians think about precision medicine and said it might be time to talk about new models for temporary introductions of treatments.
Mushtaq added: “In a meeting with the health authorities before the summer, the Minister of Health asked them to look at personalised medicine specifically and how to establish an access scheme. So several things are happening in parallel. Private-public partnerships like CONNECT will play a massive role. Our ambition is to strengthen these partnerships because they are important to maintain trust.”
Industry, patients, clinicians and authorities agree
A panel conversation among the key stakeholders showed consensus on tweaking the current system to accelerate access to new treatments.
“We need to find ways to handle uncertainty and ensure quicker access to personalised cancer medicines. We need to implement new methods to solve the challenges we are facing in the health sector. This means putting precision cancer medicines into use more effectively than today,” said Thomas Axelsen, Head of the socio-political section in the Norwegian Cancer Society.
Åslaug Helland, Head of Research at Oslo University Hospital, mentioned lung cancer patients with progressive disease as one example:
“There are new medicines for small patient groups, where we don’t have overall survival data from a large randomized study, so we need to use phase II data from smaller studies. There are efficient and good medications for certain patients with metastatic lung cancer. It is difficult to tell the patient that the medicine targeting the genetic mutation they have isn’t covered by the public healthcare system. I am happy we are now discussing alternative approval methods.”
Kristin Krogsrud, Head of Public Affairs and Communications at Roche Norway, represented the pharmaceutical industry at the meeting.
“The challenge is that things are coming on the market with more uncertain data, and we need to find ways to address this. We must to a much larger extent use alternative price models to decrease the time used to approve new treatments, which is a major challenge in Norway, especially in oncology,” Krogsrud commented.
Jan Frich, director of Diakonhjemmet Hospital and impending director of The Norwegian Central Regional Health Authority (Helse-Midt), agreed personalised medicine is forcing everyone to think differently:
“We need to become aware of the changes coming with personalised medicine. Everyone dreams about the randomised study with data from large populations, but we must think of alternatives when we don’t have that.”
Expert elicitation in evaluations
Eline Aas, professor at the University of Oslo, presented a pilot project completed as part of CONNECT together with Oslo Economics. It investigated how expert elicitation can be used to implement precision cancer medicine.
“Small patient populations mean there is little documentation and large uncertainties. When you do a randomised study without a control arm, it is challenging to estimate the effect of the new treatment in comparison to the standard treatment today,” commented Aas.
The project looked at how to involve clinicians to look at phase II data and assess the effect of a given treatment compared to standard treatment. The results showed there was a big overlap and similar results between phase II and phase III data. The clinicians agreed and were consistent on progression-free survival and overall survival between one another.
“In CONNECT, we can discuss solutions, test new pilots, exchange mutual learning, develop new models for decision-making, develop guidelines and discuss how we can handle uncertainty,” Aas commented.
Elisabeth Kirkeng Andersen moderated the meeting. You can watch a recording in Norwegian here:
For upcoming meetings in CONNECT, please check information on our website and LinkedIn channel.
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