By Paul Ruff, MD, University of Witwatersrand, Johannesburg, South Africa. Since the turn of the century, we have seen a paradigm shift in the way we treat cancer, with the advent of targeted therapies, especially monoclonal antibodies and small molecule kinase inhibitors. Indeed the development of imatinib in CML and rituximab in B-cell lymphomas have been considered amongst the greatest breakthroughs in cancer care in the last 50 years.

Unfortunately, these and many other therapies that have significantly improved outcomes in cancer patients are not available to everyone who needs them. The cost of new anticancer medicines is increasing all the time, with the average monthly cost of some of the newly released molecules being over US$10,000 per month for oral kinase inhibitors, and US$120,000 for a course of monoclonal antibodies. These costs have long been out of the range of most low- and middle-income countries, and are now becoming excessive for European and North American patients.

There are no easy solutions as pharmaceutical companies need to make profits to be able to develop new medicines, knowing that not all medicines undergoing study come to market, and that biological medicines are costly to produce. There are, however, limits to the acceptable profits that are made. An annual turnover of over US$20 billion for the three most widely used monoclonal antibodies in oncology, rituximab, trastuzumab and bevacizumab, is frightening.

The current model of oncology drug development, distribution and marketing needs to change before it is too late. There needs to be collaboration between individual pharmaceutical companies, as well as with regulatory authorities, to avoid the situation in renal cancer, where we now have ten agents on the market from multiple pharmaceutical companies. Collaboration with regulatory authorities can also reduce research and development costs by streamlining the regulatory burden on clinical research. Development of medicines with limited benefits should be halted as early as possible. “Evergreening” must also be prevented – extended patents are detrimental to underfunded patients in both developing and developed countries. International collaboration in the development of good quality generics and biosimilars will also help make these molecules available more rapidly to patients around the world. The recent reduction in marketing spend by pharmaceutical companies should also help reduce drug prices.

Unless we all work together to find a solution, leading-edge cancer care will only be available to the very wealthy. Indeed we are seeing the development of more and more exciting medicines for less and less people!

Paul Ruff, MD, serves as Chief Specialist, Professor and Head of the Division of Medical Oncology of the Department of Medicine at the University of Witwatersrand Faculty of Health Sciences and Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, South Africa. He is actively involved in both clinical and laboratory research in colorectal cancer with a number of publications and presentations in the field. He also serves on a number of national committees involved in the regulation and access of medicines.