Lung cancer outcomes have improved but there is still a long way to go. We, as leaders from different companies, are all engaged in researching and developing new treatment options in lung cancer. However, we are aware that the lung cancer challenge has many faces and cannot be tackled by a single stakeholder alone. Today’s Lung Cancer Day reminds us and the whole cancer community that we can’t rest until all patients have access to better prevention, screening, diagnosis and treatments.

A lung cancer diagnosis is devastating news for patients and their families. Survival rates are low and vary significantly. Even in developed countries, five-year survival rates for lung cancer average 15%[1]. In comparison, 50% of skin cancer patients can expect to be alive five years after diagnosis.

Lung cancer imposes a significant burden on Europe where mortality from lung cancer is the highest among all cancers, and almost equal to the mortality from breast, colon and prostate cancer combined[2]. In fact, lung cancer is the leading cause of cancer-related mortality worldwide, with an estimated 1.8 million deaths reported in 2018[3].

So, why are outcomes so poor? There are several reasons, including late diagnosis, poor access to treatment, along with stigma and the complexity of the disease. Lung cancer is a highly complex condition with numerous subtypes, where gene alterations can drive cancer cell growth and survival.

A recent report by Lung Cancer Europe reveals that 50% of experts view long wait-times in the lung cancer diagnostic pathway as a top challenge in their countries[4]. Despite the availability of better tools for screening and for diagnosing the disease, and an increasing number of treatment options, expectations for extending survival rates and improving quality of life remain stubbornly low.

Prevention, diagnosis, treatment

There is no single solution that delivers the striking improvement in survival that patients long for. Lung cancer is a challenge with many faces. First, prevention has a significant impact on the overall burden of the disease. Secondly, we must ensure that patients with a diagnosis have fast access to treatment. Even in Western countries, for example, large variations still exist, with up to 30 percent of diagnosed patients in late-stage lung cancer being untreated.[5] Many more lives could be saved if treatment guidelines were followed.

Thirdly, lung cancer is a very heterogeneous disease. Testing patients early for different biomarkers, using the right diagnostic tool, can help detect tumours and guide individual treatment choices.

Scientific research shows that implementation of lung cancer screening programmes can reduce the mortality rate associated with lung cancer. The NELSON trial concluded that low-dose CT screening reduces lung cancer deaths by 24%[6]. The focus should now be on assessing how best these findings can be implemented in practice.

Last but not least, scientific advances are making a real difference too, contributing to our understanding of cancer and how it develops. Due to the complexity of lung cancer and the different ways in which subtypes behave, different diagnostic and treatment approaches are needed to improve patient outcomes.

The number of available therapies has grown significantly over the past 25 years from four treatment options in 1996 to 25 in 2018[7]. 13,296 more lung cancer patients are alive for at least five years following a diagnosis in 2014, compared to those diagnosed in 2004[8]. The introduction of targeted treatments and immunotherapies – which have rapidly become standard of care – are also contributing to better outcomes.

The clinical benefits of a personalized medicine approach, which enables clinicians to choose the right drug for the right patient, can be significant. But access to comprehensive genomic profiling for cancer patients is just as vital as access to the latest therapies. Without genomic testing, there is no prospect of personalized treatments.

Patients cannot wait

Despite progress, there is no value from innovation if patients for whom it is intended cannot have access to it. It takes an average of 436 days for the European Medicines Agency to assess a new active substance. Compare this with 244 days in the United States, 323 in Japan, 348 in Canada and 363 in Australia[9].

This inevitably delays access to innovative treatments for European patients. It also positions Europe as a ‘follower’ rather than a leader in the fiercely competitive global environment to be at the vanguard of innovation. We must ensure that our regulatory system keeps pace with advances in science and technology to deliver more for patients.

Getting the green light from regulators does not guarantee patient access to innovative therapies. The Patient W.A.I.T indicator survey conducted by EFPIA underlines significant variance in access to new oncology medicines across Europe. The time period from a market authorisation being granted to patients getting access to that medicine can vary from 2.5 months to over 2.5 years[10].

Through the “Time to Patient Access” project, the EFPIA Oncology Platform has brought together diverse stakeholders to jointly identify factors which cause delays, and co-create practical solutions that could accelerate time to patient access.

For patients, every day counts.

A joint effort

Tackling the root causes of these delays is complex and requires close collaboration between regulators, governments, payers, industry and other stakeholders. We are keen to play our part.

World Lung Cancer Day (1 August) is an opportunity to revitalise our commitment to researching and developing new treatments to address the unmet need in lung cancer. It is a reminder of the scale of the challenge we face in improving lung cancer outcomes, and of the potential progress we can make if we work together.

With the EFPIA Oncology Platform, we have a platform that engages in dialogue and partnership with patient advocacy groups, healthcare professionals, academics, payers and policymakers to reduce the number of people dying from lung cancer. Together, we can raise standards for patients across Europe.   

This is a joint blog by:

Jörg Barth, Therapeutic Area Head Oncology, Boehringer Ingelheim
Françoise Bartoli, VP, Head of Europe Oncology, AstraZeneca
Masum Hossain, Regional President, Oncology, International Developed Markets (IDM), Pfizer
Deepak Khanna, Senior Vice President and Regional President for Europe, Middle East, Africa and Canada (EMEAC), MSD 
Robert LaCaze, Member of the Executive Committee of Bayer AG’s Pharmaceuticals Division and Head of the Oncology Strategic Business Unit
Gilles Marrache, Senior Vice President, Europe General Manager, Amgen
Dr William Pao, Head of Pharma Research & Early Development, Roche
Kees Roks, Head Region Europe Novartis Oncology
Avrum Spira, MD, MSc, Global Head, Lung Cancer Initiative, Johnson & Johnson

[1] Comparator Report on Cancer in Europe https://efpia.eu/media/413449/comparator-report-on-cancer-in-europe-2019.pdf

[2] https://www.ersnet.org/the-society/news/world-lung-cancer-day-2019--how-can-europe-tackle-lung-cancer-

[3] World Health Organization- International Agency for Research on Cancer. World Fact Sheet. Available at https://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf.

[4] https://www.lungcancereurope.eu/wp-content/uploads/2020/02/LuCE-POSITION-PAPER-English.pdf

[5] Carrato, A., Vergnenègre, A., Thomas, M., McBride, K., Medina, J., & Cruciani, G. (2014). Clinical management patterns and treatment outcomes i npatients with non-small cell lung cancer (NSCLC) across Europe: EPICLIN-Lung study. Current Medical Research and Opinion, 30(3), 447-461. doi:10.1185/03007995.2013.860372

[6] De Konig et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med 2020; 382:503-513. DOI: 10.1056/NEJMoa1911793 https://www.nejm.org/doi/full/10.1056/NEJMoa1911793

[7] Global Oncology Trends 2019, IQVIA https://www.iqvia.com/insights/the-iqvia-institute/reports/global-oncology-trends-2019

[8] https://efpia.eu/media/413442/infographic-comparator-report-on-cancer-in-europe.pdf

[9] CIRS, RD Briefing 70, New approvals in six regulatory authorities 2009-18, https://www.cirsci.org/wp-content/uploads/2020/02/CIRS-RD-Briefing-70-New-approvals-in-six-regulatory-authorities-2009-18.pdf 

[10] https://www.efpia.eu/media/554526/patients-wait-indicator-2019.pdf