Who is footing the bill for cancer?

Breakthroughs in cancer pose the ‘Who pays?’ question, says Dr Neil Murray, Redx Pharma

The molecular revolution over the last decade has done much to help turn cancer into an illness that can be managed, as opposed to as disease that prematurely ends lives.

Cancer immunotherapy is at the frontier of this change, challenging tumour cells’ ability to hide from the body’s immune system. By provoking the immune system into attacking tumour cells, immunotherapy has achieved a meaningful step-change in terms of saving lives. In those patients where it’s effective, it’s a smart alternative to the highly invasive approach of surgery, radiation or chemotherapy. And yet, immunotherapy, in common with other breakthroughs in cancer, is not without its own issues — in particular, the cost of treatment.  

As a result of these advances in therapy, the best chance of surviving any form of cancer today may well involve a cocktail of different drugs. The associated costs of using these treatments, however, present a profound financial challenge to all public health systems.

The question of who pays is only ever going to become more acute — ironically because of the good news that we are all living longer. Across the board, advances in modern medicine have made a big impact on life expectancy. As cancer is predominantly a disease of older people, these improvements mean our society faces an ever-burgeoning bill for combating cancer.

A BUPA study recently estimated that costs will soar by 65% by 2021. It found that the total cost of cancer diagnosis and treatment in the UK, incorporating the NHS, the private sector and the voluntary sector, was in the region of £9.4 billion in 2010, the equivalent of an average of £30,000 per person diagnosed with cancer. It estimates that the UK’s ageing population is likely to see the number of new cancer cases rise by 20% from a level of 318,000 cases per year in 2010 to 383,000 cases per year in 2021.

It follows that rising incidence levels will increase demand for cancer diagnosis and treatment. This increase, combined with advances in technologies and treatments mean that the total cost to the NHS, the private sector and the voluntary sector for treating cancer is projected to be almost £15.3 billion in 2021, an average of £40,000 per person diagnosed with cancer.

As a country it’s abundantly clear to everyone in healthcare that we need to invest more in cancer services and to work harder as a society to educate people about healthier lifestyles. At the same time, given the soaring costs there’s an obvious imperative to get the right treatment to the right patient.

This is where the era of ‘personalised medicine’ using new diagnostics offers hope, improving the cost effectiveness of our care. Increased efficiency by better use of expensive equipment, targeting expensive drugs to those that will really get benefit and keeping patients out of hospital has to be part of the plan.

Cancer immunotherapy research is one of the areas of expertise at our Redx Oncology subsidiary — one of the best bets modern medicine has when it comes to delivering what in simple terms might be described as maximum cost-benefit. Following on from recent successes in the nomination of development candidates for blood cancers and autoimmune diseases (Btk programme) and basal cell carcinoma (SMO programme), Redx Oncology has two programmes that directly look to stop tumours using evasive mechanisms to escape the body’s natural immune defences.

The first of these programmes targets a type of white blood cell called a macrophage; the name comes from the Greek meaning ‘big eater’. These macrophages are present in the tumour microenvironment. They can exist as both anti-inflammatory ‘M1’ macrophages, which will help clear the cancer cells from the body and inhibit tumour growth, or as pro-inflammatory ‘M2’ macrophages, which can actually promote growth of the cancer.

Inhibition of the cFMS receptor ensures healthy balance between the macrophage types and hence prevents accumulation of undesired M2-like macrophages in the tumour microenvironment. This provides the rationale for the use of cFMS inhibitors in cancers such as glioblastoma and pancreatic cancer as a combination with other cancer killing therapies.

The second Redx programme focusses on inhibiting an enzyme called IDO. Tumours have evolved mechanisms that weaken the immune system or render them invisible to it. By blocking IDO, we can release the breaks on the immune system and allow it to find and destroy growing tumours.  

The combination of IDO with targeted chemotherapies and other immune-promoting therapies has been shown pre-clinically to have a synergistic effect. It can mean better efficacy than existing treatments. A race is now on within the scientific community to identify an IDO inhibitor that can demonstrate this in the clinic.

As a society we understand that drug discovery and development is key to achieving improvements in cancer diagnosis and treatment. And whilst new resources will need to be directed towards meeting the future cost of fighting cancer, we also need to find ways to use the resources we have more efficiently. Immunotherapy provides the very real hope of putting a brake on cancer.