1
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Burkhardt B. What can we learn from cancer registries? Haematologica 2024; 109:716-717. [PMID: 37916385 PMCID: PMC10905063 DOI: 10.3324/haematol.2023.284104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023] Open
Affiliation(s)
- Birgit Burkhardt
- Paediatric Haematology, Oncology and HSCT, University Hospital Muenster, Germany; NHLBFM Study Center, University Hospital Muenster
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2
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Jakob U, Daumann F. The importance of the policy framework on orphan drug accessibility. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01899-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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3
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Vassal G, de Rojas T, Pearson ADJ. Impact of the EU Paediatric Medicine Regulation on new anti-cancer medicines for the treatment of children and adolescents. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:214-222. [PMID: 36682367 DOI: 10.1016/s2352-4642(22)00344-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 01/21/2023]
Abstract
The European Paediatric Medicine Regulation was launched in 2007, aiming to provide better medicines for children. However, its benefit for paediatric patients with cancer has been questioned and the European Paediatric and Orphan Regulations have been under review since November, 2020. To ascertain the effect of the European Paediatric Medicine Regulation, all paediatric anti-cancer medicines assessed by the European Medicines Agency from 1995 to 2022 were identified and reviewed using the agency's public assessment reports, and all Paediatric Investigation Plans granted since 2007 were analysed. 16 new molecular entities (NMEs; ie, a drug that contains an active moiety that had never been approved before) have been approved since the regulation was launched in 2007. The number of paediatric marketing authorisations increased from 2007 but represented the same 17% of all anti-cancer drug marketing authorisations before and after 2007. After 2007, nine (56%) of 16 NMEs were first authorised both in adults and children. For seven NMEs, a first paediatric indication was approved with a median lag time of 6·4 years (range 1·2-21·5 years) after the first authorisation in adults. Half of NMEs were authorised for the treatment of malignancies responsible for only 5·4% of all European childhood cancer deaths, including three medicines for melanoma and thyroid cancer-adult cancers occurring very rarely in children. The increased number of paediatric anti-cancer NMEs after 2007 is a result of the major increase in new medicines authorised for adult cancers since 2005 rather than a direct effect of the Paediatric Regulation. Paediatric development of these NMEs was driven by their adult market and did not address major unmet medical needs of children and adolescents with cancer. An improved, fit-for-purpose regulatory environment that incentivises paediatric drug development based on mechanism of action, better incentives, and a systematic multi-stakeholder engagement, with greater investment from industry, public funding, and non-governmental organisations, will increase the number of new medicines approved in the future to cure more children and adolescents with cancer.
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Affiliation(s)
- Gilles Vassal
- ACCELERATE, Brussels, Belgium; Department of Paediatric and Adolescent Oncology, Institut Gustave Roussy and Paris-Saclay University, Villejuif, France.
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4
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Voit K, Timmermann C, Orzechowski M, Steger F. Voluntariness or legal obligation? An ethical analysis of two instruments for fairer global access to COVID-19 vaccines. Front Public Health 2023; 11:995683. [PMID: 36778578 PMCID: PMC9909068 DOI: 10.3389/fpubh.2023.995683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction There is currently no binding, internationally accepted and successful approach to ensure global equitable access to healthcare during a pandemic. The aim of this ethical analysis is to bring into the discussion a legally regulated vaccine allocation as a possible strategy for equitable global access to vaccines. We focus our analysis on COVAX (COVID-19 Vaccines Global Access) and an existing EU regulation that, after adjustment, could promote global vaccine allocation. Methods The main documents discussing the two strategies are examined with a qualitative content analysis. The ethical values reasonableness, openness and transparency, inclusiveness, responsiveness and accountability serve as categories for our ethical analysis. Results We observed that the decision-making processes in a legal solution to expand access to vaccines would be more transparent than in COVAX initiative, would be more inclusive, especially of nation states, and the values responsiveness and accountability could be easily incorporated in the development of a new regulation. Discussion A legal strategy that offers incentives to the pharmaceutical industry in return for global distribution of vaccines according to the Fair Priority Model is an innovative way to achieve global and equitable access to vaccines. However, in the long term, achieving the Sustainable Development Goals will require from all nations to work in solidarity to find durable solutions for global vaccine research and development. Interim solutions, such as our proposed legal strategy for equitable access to vaccines, and efforts to find long-term solutions must be advanced in parallel.
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Affiliation(s)
- Katja Voit
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany,*Correspondence: Katja Voit ✉
| | - Cristian Timmermann
- Ethics of Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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5
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Making Sure That Orphan Incentives Tip the Right Way in Europe. Healthcare (Basel) 2022; 10:healthcare10091600. [PMID: 36141212 PMCID: PMC9498781 DOI: 10.3390/healthcare10091600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 12/03/2022] Open
Abstract
The delicate balance of funding research and development of treatments for rare disease is only imperfectly achieved in Europe, and even the current provisional equilibrium is under a new threat from well-intentioned policy changes now in prospect that could—in addition to the intrinsic complexities of research—reduce the incentives on which commercial activity in this area is dependent. The European Union review of its pharmaceutical legislation, for which proposals are scheduled to appear before the end of 2022, envisages adjusting the decade-old incentives to meet objectives that are more precisely targeted. However, researchers, physicians, patients and industry have expressed concerns that ill-considered modifications could have unintended consequences in disrupting the current balance and could reduce rather than increase the flow of innovative treatments for rare diseases.
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6
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Outcomes and endpoints in clinical trials supporting the marketing authorisation of treatments in paediatric acute lymphoblastic leukaemia. Drug Discov Today 2022; 27:2440-2466. [PMID: 35597514 DOI: 10.1016/j.drudis.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/04/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
The improvement in acute lymphoblastic leukaemia (ALL) treatment has led research efforts to focus on the unmet medical needs of an increasingly smaller patient cohort with resistant leukaemia and to develop more-targeted agents. Survival and response rates remain the most-prevalent endpoints in paediatric ALL research, but other intermediate clinical endpoints and molecular biomarkers for efficacy and mid- and long-term safety endpoints are also being investigated. The success of current ALL treatment appears to be driving new paradigms to optimise clinical drug development, while at the same time, regulatory tools in place are supporting meaningful drug development in the area.
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7
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ACCELERATE – Five years accelerating cancer drug development for children and adolescents. Eur J Cancer 2022; 166:145-164. [DOI: 10.1016/j.ejca.2022.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023]
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8
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Casali PG, Trama A. Rationale of the rare cancer list: a consensus paper from the Joint Action on Rare Cancers (JARC) of the European Union (EU). ESMO Open 2021; 5:S2059-7029(20)30064-8. [PMID: 32220947 PMCID: PMC7174011 DOI: 10.1136/esmoopen-2019-000666] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/05/2022] Open
Abstract
Background The Surveillance of Rare Cancers in Europe (RARECARE) project proposed a definition and a list of rare cancers. The Joint Action on Rare Cancers (JARC), launched by the European Union and involving 18 member states and 34 partners, promoted a wide consensus effort to review the list. Patients and methods A group of experts was set up, including scientific societies, member state representatives of JARC, representatives of the European Reference Networks dedicated to rare cancers and rare cancer patient advocates. The definition and the list of rare clinical entities, based on the incidence data provided by two European projects (RARECARE and RARECAREnet), were rediscussed through a consensus meeting of the expert panel. Results By consensus, it was reiterated that the best criterion for a definition of rare cancers is incidence, rather than prevalence. By consensus, the experts slightly modified the composition of the tiers of rare cancers, according to the definition based on an incidence threshold <6/100 000/year, and grouped all rare cancers within 12 families of rare cancers. Even when defined conservatively this way, rare cancers are not rare collectively, since they correspond to 10%–20% of all cancer cases. Conclusions The list of rare cancers reviewed by JARC should be viewed as a tool in the fight against rare cancers and rare diseases. It may help to appreciate that rare cancers are cancers and rare diseases at the same time, combining issues and difficulties of both. We hope that refinements to the list and a wider understanding of its implications may contribute to increase awareness of problems posed by rare cancers and to improve quality of care in a large group of patients with cancer, who may be discriminated against just because of the low frequency of their diseases.
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Affiliation(s)
- Paolo G Casali
- Medical Oncology Unit 2, Fondazione IRCCS Istituto Nazionale Tumori & Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy
| | - Annalisa Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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9
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Horgan D, Moss B, Boccia S, Genuardi M, Gajewski M, Capurso G, Fenaux P, Gulbis B, Pellegrini M, Mañú Pereira MDM, Gutiérrez Valle V, Gutiérrez Ibarluzea I, Kent A, Cattaneo I, Jagielska B, Belina I, Tumiene B, Ward A, Papaluca M. Time for Change? The Why, What and How of Promoting Innovation to Tackle Rare Diseases - Is It Time to Update the EU's Orphan Regulation? And if so, What Should be Changed? Biomed Hub 2021; 5:1-11. [PMID: 33564657 DOI: 10.1159/000509272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022] Open
Abstract
Since developments are global in the healthcare arena, more should be done to align EU and other big markets' regulatory practices for rare disease patients. Notwithstanding efforts and cooperation between the US and EU aimed to harmonize their strategic plans in the field of orphan drugs, regulatory criteria and procedures to gain the designation, terms and classifications should be still harmonised. Aligning the criteria of prevalence and support to orphan medicines in the various jurisdictions internationally, would facilitate patient recruitment eventually at global level, so as to gain the data and the biological insights required to identify biomarkers and appropriate endpoints needed for progressing clinical development. A conducive regulatory environment can further support the development of medicines to treat rare diseases. Overall there is a need for joined-up regulatory process coordination. Better integration of regulatory pathways and better integration of regulatory systems, such as scientific tools and methods to generate evidence, would be helpful. There is a need to revise and agree the current frameworks to be improved which will take into account the considerations and challenges to diagnose and treat different rare diseases and improve quality of life. Deliberative processes with multi-stakeholders' involvement for reimbursement should be considered. This paper explores the successes and limitation of both the regulation and its implementation mechanisms in the current regulatory context, and suggests some improvements that could maximise its benefits and boost rare disease research even further.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
| | - Barbara Moss
- Europacolon (UK), London, United Kingdom.,Bowel Cancer UK, London, United Kingdom
| | - Stefania Boccia
- Sezione di Igiene, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Genuardi
- European Society of Human Genetics, Vienna, Austria.,Complex Operational Unit, Medical Genetics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Gabriele Capurso
- PancreatoBiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Pierre Fenaux
- Service d'hématologie seniors, Hôpital St Louis / Université Paris 7, Paris, France.,ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France
| | - Beatrice Gulbis
- ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France.,Ht. ERASME-CUB, Brussels, LHUB-ULB, Brussels, Belgium
| | - Mariangela Pellegrini
- ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Maria Del Mar Mañú Pereira
- ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France.,University Hospital Vall d'Hebron - Vall d'Hebron Research Institute, Barcelona, Spain
| | - Victoria Gutiérrez Valle
- ERN-EuroBloodNet, the European Reference Network on Rare Hematological Disease, Paris, France.,University Hospital Vall d'Hebron - Vall d'Hebron Research Institute, Barcelona, Spain
| | - Iñaki Gutiérrez Ibarluzea
- EuroScan International Network, Cologne, Germany.,BIOEF, Basque Foundation for Health Innovation and Research, Barakaldo, Basque Country, Spain
| | - Alastair Kent
- Independent Patient Advocate, London, United Kingdom
| | | | - Beata Jagielska
- Clinic of Oncological Diagnosis and Cardio-oncology, Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland
| | - Ivica Belina
- Coalition of Healthcare Association, Zagreb, Croatia
| | - Birute Tumiene
- Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Adrian Ward
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
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10
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Benezech S, Saintigny P, Attignon V, Pissaloux D, Paindavoine S, Faure-Conter C, Corradini N, Marec-Berard P, Bergeron C, Cassier P, Eberst L, Dufresne A, Wang Q, Agrapart V, De La Fouchardière A, Perol D, Garin G, Corset V, Ben Abdesselem L, Chabaud S, Tredan O, Blay JY, Frappaz D. Tumor Molecular Profiling: Pediatric Results of the ProfiLER Study. JCO Precis Oncol 2020; 4:785-795. [PMID: 35050753 DOI: 10.1200/po.20.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Program to Establish the Genetic and Immunologic Profile of Patient's Tumor for All Types of Advanced Cancer study (ClinicalTrials.gov identifier: NCT01774409) analyzed the genome of refractory cancers to identify a potential molecular-based recommended therapy (MBRT). The objectives of the pediatric substudy were to describe the incidence of genomic mutations, the MBRT, and the treatments undertaken with a molecular-targeted agent in a pediatric cohort. METHODS The tumor genome was analyzed within a 69-gene next-generation sequencing panel and an array comparative genomic hybridization assay. The results were evaluated by a multidisciplinary molecular board, and the targeted therapies were provided in the setting of a clinical trial or through compassionate use programs, when indicated. RESULTS Between November 2013 and June 2017, 50 patients younger than 19 years who were treated for a high-risk or relapsing tumor were included. Sarcomas (n = 24; 47%), CNS tumors (n = 14; 29%), and neuroblastomas (n = 5; 10%) were the most frequent tumor subtypes. Seven patients (14%) were excluded because no DNA could be recovered. Among the 43 remaining patients, 10 exhibited at least one targetable genomic alteration. Ultimately, four patients (8%) were treated with the recommended targeted therapy. CONCLUSION The results of this study confirm treatment with a targeted therapy for pediatric patients with cancer is still limited at present, as also is reported for adults.
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Affiliation(s)
- Sarah Benezech
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Pierre Saintigny
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France.,Department of Medical Oncology, Centre Léon Bérard, France
| | - Valery Attignon
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Daniel Pissaloux
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - Cécile Faure-Conter
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Nadège Corradini
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Perrine Marec-Berard
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Christophe Bergeron
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | | | | | | | - Qing Wang
- Department of Translational Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Vincent Agrapart
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | | | - David Perol
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Gwenaëlle Garin
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Véronique Corset
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Leila Ben Abdesselem
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Olivier Tredan
- Department of Medical Oncology, Centre Léon Bérard, France.,University Claude Bernard Lyon 1, CNRS 5286, INSERM U1052, Cancer Research Center of Lyon, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, France.,University Claude Bernard Lyon 1, CNRS 5286, INSERM U1052, Cancer Research Center of Lyon, France
| | - Didier Frappaz
- Institut d'Hématologie et Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
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11
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Health technology assessment and reimbursement policy for oncology orphan drugs in Central and Eastern Europe. Orphanet J Rare Dis 2020; 15:277. [PMID: 33032634 PMCID: PMC7545889 DOI: 10.1186/s13023-020-01556-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/23/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The reimbursement of orphan drugs (OD) is an increasingly important for country policymakers, and still insufficiently understood, especially in Central and Eastern Europe. The aim of this research was to provide a comprehensive description of country-specific health technology assessment (HTA) policies as well as evaluate the percentage of HTA recommendations and reimbursement decisions for oncology OD. In addition, the study was designed to elucidate the impact of reimbursement of these drugs on the public budget and the agreement between HTA recommendations and reimbursement decisions in the analysed countries. A questionnaire survey was used to collect data on the reimbursement status, HTA recommendation, marketing authorisation, and public expenses on reimbursement in 2014, 2015, and 2016 for all oncology drugs with an orphan designation by the European Medicine Agency in 2017 in Bulgaria, Croatia, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, and Slovakia. The agreement between the HTA recommendation and reimbursement status was assessed using the kappa coefficient. The Pearson's correlation was used to analyse the relationship between gross domestic product (GDP) and GDP per capita and reimbursement expenses. RESULTS A total of 36 drugs were analysed (25% conditionally approved; 5.56% approved under exceptional circumstances). The share of reimbursed drugs ranged from 11.11% in Latvia to 41.67% in Poland. The highest share of positive recommendations was observed for Bulgaria and Estonia (36.11%), and the lowest, for Latvia (11.11%). The agreement varied from 0.4 for Poland to 1 for Latvia, Hungary, and Slovakia. Expenses were correlated with GDP (0.95 [0.81-0.99]), and not with GDP per capita (0.54 [- 0.136 to 0.873]). Expenses per capita were not correlated with GDP per capita (0.52 [- 0.15 to 0.87]). CONCLUSIONS In Hungary, Latvia, and Slovakia, a positive recommendation was associated with a reimbursement, and a negative one, with the lack of reimbursement. The reimbursement of oncology OD is associated with a growing burden for public budget, and the expenses are correlated with the total GDP. The highest share of drugs with any recommendation was observed in Poland, and the lowest, in Latvia and Romania. The share of reimbursed drugs was the lowest in Latvia and the highest in Poland.
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12
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Challenges of Clinical Management of Adolescent and Young Adults With Bone and Soft Tissue Sarcoma. ACTA ACUST UNITED AC 2019; 24:301-306. [PMID: 30480574 DOI: 10.1097/ppo.0000000000000337] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Clinical management of adolescents and young adults with bone and soft tissue sarcomas is quite challenging, mainly because of different chemotherapy approaches adopted by pediatric and adult oncologists and tumor-associated factors related to this peculiar age group. Overcoming these barriers is essential for adolescent and young adult patients, whose survival and long-term physical effects are worse than their pediatric counterparts. Nowadays, constant efforts from international collaborations between pediatric and adult oncologists of sarcoma groups have optioned in converging toward a common therapeutic strategy, while improving quality of treatment, as well as research advances dedicated to this at-risk age group of patients with sarcomas.
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13
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Baldi GG, Orbach D, Bertulli R, Magni C, Sironi G, Casanova M, Ferrari A. Standard treatment and emerging drugs for managing synovial sarcoma: adult's and pediatric oncologist perspective. Expert Opin Emerg Drugs 2019; 24:43-53. [PMID: 30841761 DOI: 10.1080/14728214.2019.1591367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION in this review we discuss the standard of care for both pediatric and adult synovial sarcoma (SS), the prognostic differences between them, and the treatments available for localized and advanced diseases. We also overview the biology and the recent drugs under consideration in clinical trials on SS. Areas covered: we focus on new targeted therapies being investigated for advanced SS, especially anti-angiogenic drugs, and immunotherapy. We review all the published data and ongoing trials dedicated to SS or to soft tissue sarcoma in general, paying particular attention to the results obtained in SS patients. Expert opinion: we expect new treatment strategies to become available for SS in the near future. The ongoing and published trials on targeted therapies and immunotherapy mainly concern adult patients, but the somatic biology of pediatric SS has some similarities as in adult disease. A stronger cooperation between adult and pediatric oncologists in recent years has led to a more shared effort to find new treatment strategies for advanced SS patients, regardless of their age.
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Affiliation(s)
- Giacomo G Baldi
- a "Sandro Pitigliani" Medical Oncology Department , Hospital of Prato , Prato , Italy
| | - Daniel Orbach
- b SIREDO Oncology Center , PSL University, Institut Curie , Paris , France
| | - Rossella Bertulli
- c Medical Oncology Unit 2, Medical Oncology Department , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Chiara Magni
- d Pediatric Oncology Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Giovanna Sironi
- d Pediatric Oncology Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Michela Casanova
- d Pediatric Oncology Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Andrea Ferrari
- d Pediatric Oncology Unit , Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
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14
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From Rare to Neglected Diseases: A Sustainable and Inclusive Healthcare Perspective for Reframing the Orphan Drugs Issue. SUSTAINABILITY 2019. [DOI: 10.3390/su11051289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This work is about how healthcare issues can be reframed from a sustainable and inclusive development perspective. Focusing on the case of orphan drugs and rare diseases, first, a country-based review of the main regulatory approaches to orphan drugs is conducted; then, the main contributions of the literature are reviewed to identify dominant views and the way the problem is more commonly framed. The main findings reveal that the dominant regulatory approaches and theoretical interpretations of the problem are mainly based on economic considerations. However, this does not seem to have led to very satisfactory results. Reflecting upon what the sustainability perspective can highlight with reference to healthcare, substantial connections between the orphan drugs issue and that of neglected diseases are highlighted. These connections suggest reframing the orphan drugs issue as a social equality and inclusiveness problem, hence the need to adopt a sustainable and inclusive development perspective. As a key sustainable development goal (SGD) to be shared by all nations, healthcare should always be approached by putting the principles of sustainable and inclusive development at the core of policy makers’ regulatory choices. Accordingly, we think that the orphan drugs issue, like that of neglected diseases, could be better faced by adopting a social equality and inclusiveness perspective.
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15
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Saif M, Ager EI, Field P, Lilischkis KJ. The role of cancer stem cells and the therapeutic potential of TRX-E-002-1 in ovarian cancer. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1508339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Muhammad Saif
- GI Oncology & Exp. Therapeutics, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - E. I. Ager
- Kazia Therapeutics, Three International Towers Level 24, Sydney, Australia
| | | | - K. J. Lilischkis
- Kazia Therapeutics, Three International Towers Level 24, Sydney, Australia
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16
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Morandi F, Amoroso L, Dondero A, Castriconi R, Parodi S, Luksch R, Casale F, Castellano A, Garaventa A, Moretta A, Bottino C, Ponzoni M, Corrias MV. Updated clinical and biological information from the two-stage phase II study of imatinib mesylate in subjects with relapsed/refractory neuroblastoma. Oncoimmunology 2018; 7:e1468953. [PMID: 30357053 DOI: 10.1080/2162402x.2018.1468953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/12/2022] Open
Abstract
Several studies support the notion that the kinase inhibitor Imatinib mesylate exerts off-target effects on cells of the immune system. After our first report of continuous daily oral administration in subjects with relapsed/refractory neuroblastoma (NB, EudraCT: 2005-005778-63), here we update the clinical information and report additional information on potential surrogate markers for prediction of efficacy. Peripheral blood (PB) samples collected at study entry and after the first and second cycle of Imatinib mesylate treatment were tested for IFN-γ, TNF-α, TGF-β, IL-10, CXCL12 and soluble (s) B7-H6 plasma levels. In addition, paired PB and bone marrow (BM) samples collected at study entry and after the second Imatinib cycle were evaluated for CXCL12, CXCR4 and NKp30 isoform mRNA levels. Correlation between each parameter level and response/outcome was then evaluated. Out of the six subjects still alive at the time of the first report, thee died after additional therapy, two for NB progression and one for a second malignancy. Three are presently alive and cured from NB at 10 years after the first Imatinib cycle. Of these, one achieved complete response (CR) during Imatinib treatment and never relapsed, one had a local relapse removed by surgery and the third received TVD as rescue therapy. Response and outcome were associated with low Imatinib exposure, whereas none of the tested immunological and molecular parameters was predictive of response/outcome. However, after Imatinib treatment NKp30 isoform mRNA levels significantly increase in BM samples, indicating that Imatinib mesylate exerted an off-target effect on NK cells in vivo. Imatinib mesylate efficacy in relapsed/refractory NB has been confirmed at a longer follow-up, supporting its inclusion in new Phase II trials for these subjects, that should envisage collection of samples to evaluate the predictive power of other potential surrogate markers of efficacy.
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Affiliation(s)
- Fabio Morandi
- Experimental Therapy in Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Loredana Amoroso
- Pediatric Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandra Dondero
- Dipartimento di Medicina Sperimentale, Università degli Studi di Genova, Genoa, Italy
| | - Roberta Castriconi
- Dipartimento di Medicina Sperimentale, Università degli Studi di Genova, Genoa, Italy.,Centre of Excellence for Biomedical Research, Università degli Studi di Genova, Genoa, Italy
| | - Stefano Parodi
- Epidemiology and Biostatistics Section, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Aurora Castellano
- Department of Hematology-Oncology, IRCCS Ospedale Bambino Gesù, Rome, Italy
| | | | - Alessandro Moretta
- Dipartimento di Medicina Sperimentale, Università degli Studi di Genova, Genoa, Italy.,Centre of Excellence for Biomedical Research, Università degli Studi di Genova, Genoa, Italy
| | - Cristina Bottino
- Dipartimento di Medicina Sperimentale, Università degli Studi di Genova, Genoa, Italy.,Laboratory of Clinical and Experimental Immunology, Istituto Giannina Gaslini, Genoa, Italy
| | - Mirco Ponzoni
- Experimental Therapy in Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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17
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Karres D, O’Connor D, Norga K, Siapkara A. Drug development in pediatric oncology – challenges and opportunities – reflections from European regulators. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1491304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Dominik Karres
- Medicines and Healthcare Products Regulatory Agency, Licensing Division, London United Kingdom of Great Britain and Northern Ireland
| | - Daniel O’Connor
- Medicines and Healthcare Products Regulatory Agency, Licensing Division, London United Kingdom of Great Britain and Northern Ireland
| | - Koen Norga
- Department of Pediatric Hematology or Oncology Unit, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
- Federaal Agentschap voor Geneesmiddelen en Gezondheidsproducten, Brussel, Belgium
| | - Angeliki Siapkara
- Medicines and Healthcare Products Regulatory Agency, Licensing Division, London United Kingdom of Great Britain and Northern Ireland
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18
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Ferrari A, Bleyer A, Patel S, Chiaravalli S, Gasparini P, Casanova M. The challenge of the management of adolescents and young adults with soft tissue sarcomas. Pediatr Blood Cancer 2018; 65:e27013. [PMID: 29493075 DOI: 10.1002/pbc.27013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 01/14/2023]
Abstract
Soft tissue sarcomas are relatively frequent in adolescents and young adults and their clinical management may be complex, partly due to tumor associated factors, but also because different approaches have been adopted by pediatric and adult medical oncologists dealing with the same disease. However, times are changing and in the last few years, management has tended to converge towards a common strategy. Continued and increased international collaboration between pediatric and adult sarcoma groups is of critical importance to improve the quality of treatment as well as research programs dedicated to young patients with soft tissue sarcomas.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Patrizia Gasparini
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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19
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Pearson AD, Heenen D, Kearns PR, Goeres A, Marshall LV, Blanc P, Vassal G. 10-year report on the European Paediatric Regulation and its impact on new drugs for children's cancers. Lancet Oncol 2018; 19:285-287. [PMID: 29508745 DOI: 10.1016/s1470-2045(18)30105-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Dj Pearson
- Paediatric and Adolescent Oncology Drug Development, The Royal Marsden NHS Foundation Trust, Sutton, SM2 5PT, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK; Innovative Therapy for Children with Cancer, Europe.
| | | | - Pamela R Kearns
- Innovative Therapy for Children with Cancer, Europe; Cancer Research UK Clinical Trials Unit Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; SIOPE Brussels, Belgium
| | - Anne Goeres
- Unite 2 Cure, Europe; Fondatioun Kriibskrank Kanner, Strassen, Luxembourg
| | - Lynley V Marshall
- Paediatric and Adolescent Oncology Drug Development, The Royal Marsden NHS Foundation Trust, Sutton, SM2 5PT, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | | | - Gilles Vassal
- Innovative Therapy for Children with Cancer, Europe; SIOPE Brussels, Belgium; Department of Clinical Research, Gustave Roussy, Paris-Saclay University, Villejuif, France
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