Dr. Larry Shulman, WHO Expert Committee Meeting 2015, Remarks
Channel: Claire M Wagner
Date: 2015-04-21

Statement by the Union for International Cancer Control (UICC)
20th WHO Expert Committee on the Selection and Use of Essential Medicines


Chair, Expert Committee Members, WHO Secretariat, ladies and gentlemen,

Thank you for the opportunity to deliver this statement on behalf of the Union for International Cancer Control (UICC) – which aims to help the global health community accelerate the fight against cancer through its global membership of over 800 organizations across 155 countries:

Today, the world suffers from severe inequality in access to cancer medicines. In an effort to improve availability, Member States (MSs) approved the WHO Global Action Plan on Prevention and Control of Non- communicable Diseases (NCD) in 2013 which specified an access target by 2020 of 80% availability of essential medicines and technologies. In line with this effort, UICC responded to a WHO invitation in 2013 to conduct a formal review of anti-cancer medicines on the WHO Model List of Essential Medicines (EML) which resulted in the current proposal for consideration of 22 additions to the EML.

The original EML published in 1977 included 6 cancer medicines. New medicines were added after reviews in 1984, 1995, and 1999. In the most recent list, 30 “Cytotoxic and Adjuvant Medicines” are specified. A full review of Section 8.2 of the WHO EML has not been undertaken for 15 years.

Treating cancer is a complex, toxic, and often costly endeavour. There are numerous solid tumours and hematologic malignancies. All require discrete, often multidrug, treatment protocols and all have separate branches for disease stage, patient circumstances and treatment availability. Systemic therapies are critical to the care pathway, which also includes surgery, radiation therapy, or palliative care. Many resource-limited countries have insufficient access to all of these services.

Given this context, UICC convened a team of cancer experts to chart a course forward – proposing a new methodology for selection of systemic therapies. The methodology, developed by a core team, began with the identification of cancer types which would most benefit from systemic treatment and/or cause the largest burden on the population. Thus, diseases were chosen that are highly responsive to treatment but rare (chronic myeloid leukemia); are highly responsive to treatment and common (breast cancer); and have a lower response to treatment but are highly burdensome (non-small cell lung cancer).

After holding a series of open meetings led by the UICC and the Dana-Farber Cancer Institute, in partnership with ASCO, ESMO and SIOP, 29 diseases were identified for inclusion in the Review. Experts in each cancer type from around the world were solicited to write disease-based briefings with sections on epidemiology; diagnosis, testing, and monitoring; standard and alternative regimens; a review of the benefits and harms (including systematic reviews) and recommendations for addition to Section 8.2 of the WHO EML. Additional sections on pricing and cost scenarios, regulatory information, patent status and a separate briefing on granulocyte-colony stimulating factor were authored centrally. The central committee synthesized all reviews into coherent disease-based documents.

The 29 briefings were each peer-reviewed by at least 2 additional experts. Over the course of this process, nearly 100 oncology experts were engaged over hundreds of volunteer hours (neither authors nor peer reviewers were remunerated).

From these 29 disease-based briefings, a list of medicines were derived and linked to diseases when they were included in recommended treatment regimens. For example, dacarbazine links only to Hodgkin Lymphoma, but cyclophosphamide has 11 different diseases listed. In this way, MSs can readily select medicines for national formularies and determine procurement volumes based on the associated disease- based briefings in the UICC application.

The utility of this proposed methodology and list, we believe, is in providing valuable information to policy- makers as they strengthen cancer control programs. This effort is a first iteration of an envisaged continuous update, with regular reviews as new data come online. As our global community endeavours to respond swiftly and effectively to the WHO NCD target, it is vital that we offer accurate, useful, and up-to-date guidance to MSs that may otherwise not have access to such information.

We encourage adoption of this package and the addition of the 22 medicines which have been proposed for their ability to save lives and relieve suffering. The UICC offers WHO our continued support in this process.

Dr. Julie Torode, Deputy CEO, UICC