Highway to health

Imagine cruising down a highway, with the hum of the engine and road beneath you, travelling towards your destination.

On the horizon lies a picturesque village that you want to visit. But there’s a catch – the exit ramp from the highway has yet to be built, so there’s no way to reach it.

This metaphor represents the challenge currently facing many innovative cancer treatments, but one in particular, radioligand therapy (RLT), has the potential to change our approach to cancer treatment.

RLT is a game-changing innovation that has already made a significant impact in treating gastroenteropancreatic neuroendocrine tumours (GEP-NETs) and metastatic prostate cancer.

However, despite a lot of excitement around the potential of RLT in cancer care, healthcare systems (HCSs) in Europe are not set up to be able to routinely offer it to patients.

As a result, it remains on the highway, with its potential unrealised.

Cancer care has made strides in many areas, yet it remains a leading cause of illness and death worldwide.

It accounted for around 20 million new cases and nearly 10 million deaths in 2022, with one in five people at risk of developing cancer in their lifetime.

Today, Europe represents a tenth of the world’s population, but accounts for almost a quarter of the world’s cancer cases.

Unless we take decisive action, lives lost to cancer in the EU are set to increase by more than 24% by 2035, potentially making it the leading cause of death in the EU5.

RLTs combine the power of radiation with precision medicine to redefine the standard of care for people living with various types of cancer.

With theranostic capabilities, RLTs can directly target cancer cells, which limits treatment exposure and, as a result, unwanted effects on nearby healthy cells.

Currently, RLT can be used for metastatic castration-resistant prostate cancer and certain types of neuroendocrine tumours, and there are opportunities in other advanced cancers that the industry is evaluating.

With the alarming increase in cancer incidence and the broadening scope of its applications, RLT’s significance is undeniable.

A consequence of the projected increase in cancer incidence is that the number of patients eligible for RLT is expected to grow exponentially in the coming years. The pharmaceutical industry is eager to meet this need with around 225 clinical trials currently ongoing in the RLT space to bring this innovation to patients.

While Europe has traditionally been a powerhouse in healthcare research and development, data from several countries highlights a lag in HCS readiness for RLT.

This is largely a side effect of the HCSs across the region being fragmented and decentralised, making coordination and implementation of decisions incredibly difficult.

There are specific challenges to the widespread HCS implementation of RLT, including variations in infrastructure and capacity, limited trained workforce and a lack of patient referral frameworks.

The decision to offer treatments like positron emission tomography (PET) scans, for example, which are required to determine a patient’s eligibility for RLT in prostate cancer, often depends on the individual physician’s background, leading to variations in treatment across regions and even within the same country.

Other challenges include the need to harmonise regulatory and legal frameworks and the lack of EU-wide protocols, which lead to varying practices among physicians.

There’s an urgent need to adapt policies that standardise the use of RLT and incorporate it as a routine part of cancer care.

This would help avoid similar challenges in the future, paving the way for RLTs to be made more broadly available for different types of cancer in the future.

As a leader in RLT, Novartis is bringing the first RLTs to market and investigating an extensive portfolio of RLTs in lung, breast, pancreatic and colon cancers.

As part of our role in developing and innovating in RLT, we also take on a responsibility to do what we can to bring this practice-changing modality to patients.

Novartis is partnering with stakeholders worldwide to ensure RLT access for every eligible patient.

These partnerships have included working with IQVIA on a capacity framework and policy recommendations for integration in European HCS, as well as developing referral pathways.

Our partnerships also extend to contributing to Europe’s RLT Academy for physician education, leading and participating in panel discussions at key medical meetings and supporting the European Association of Nuclear Medicine (EANM) ‘INSPIRE’ initiative for workforce recruitment in nuclear medicine.

We see many opportunities for the industry to drive the RLT access of the future.
Ensuring healthcare systems are ready for RLT relies on three things: identifying barriers to integration building coalitions to discuss how to address these barriers and then aligning on action and future goals.

This involves long-term political commitment, collaboration and support from a range of stakeholders to move it from rhetoric to reality.

Europe’s Beating Cancer Plan provides a roadmap for delivering higher standards in care and improving access to innovative treatments.

Successful integration of RLT could be a great example of this plan in action.

Examples of best practice are all around us. Both Germany and Spain have worked to develop an infrastructure needed for RLT, while the US has rapidly expanded its capacity driven by entrepreneurial initiatives.

Unfortunately, most other countries in Europe are currently unable to follow suit due to a lack of trained personnel or facilities that meet radio safety standards.

This has resulted in an implementation gap between European policy and its application at the national level.

It’s important we remember that investment in future scientific innovations is an investment in our future health and society.

Making these changes will not only support the delivery of RLT but will support patients having access to optimal treatment for their disease.

We’re making good progress but if we want to achieve our ambition – like getting to that village – we’ll need the road to get there. So, let’s start building!

Leonhard Schaetz is International Head Health System Readiness & Partnership Radioligand Therapy at Novartis. Go to novartis.co.uk