Monthly Archives: May 2015

Uganda’s state-of-the-art cancer centre: great if you can get there in time

esther

Guest blogger – Esther Nakkazi, freelance science journalist

On Thursday 21st May 2015, I was in Kampala to witness the opening of a US $10 million comprehensive regional cancer center – a product of almost 10 years of partnership between the Fred Hutchinson Cancer Research Center and the Uganda Cancer Institute (UCI). As a health journalist in a country where cancer tends to come a poor second to infectious diseases, this seemed like real progress, and a true north to south collaboration.

It was a colorful ceremony and the President of Uganda, Yoweri Museveni, and many gurus from the Fred Hutch in Seattle were present to open the 25,000-square-foot state-of-the-art-facility that can treat up to 20,000 patients a year. It has adult and pediatric outpatient clinics, a research clinic, laboratories, specimen repository, training center, conference rooms and a pharmacy.

Uganda has a substantial cancer burden, and six out of 10 of the most common cancers found here are caused by infectious diseases, also fuelled by HIV infection.

This UCI/Hutchinson Center Cancer Alliance will provide American and Ugandan physician–scientists with in-depth training in the treatment of infection-related malignancies.

Three hundred Ugandans and Americans have already been trained by Fred Hutch’s extensive medical training program in the treatment of infection-related cancers, including physicians, nurses, laboratory technicians, pharmacists, data specialists, and experts in regulatory affairs and fiscal management. The number of practicing oncologists in Uganda has increased twelvefold over recent years.

Jackson Orem, the director at the UCI, was filled with joy on this day ‒ we all were. For a facility that had him as the only oncologist in 2008, treating more than 10,000 patients a year, this is really good.

"The Ugandan Cancer Institute looked like this ever since it was established in 1973 (Photo by Andrea Stultiens)

“The Ugandan Cancer Institute looked like this ever since it was established in 1973 (Photo by Andrea Stultiens)

The New UCI-Fred Hutch Cancer Center, which opened on May 21st, 2015 (Photo by Esther Nakkazi)

The New UCI-Fred Hutch Cancer Center, which opened on May 21st, 2015 (Photo by Esther Nakkazi)

 

 

 

 

 

 

 

 

 

But hopefully, Ugandans do not think that, with this new facility, everything is now fine. To maximise impact, I think Uganda needs to use the strategy that made it a success in treating such cancers in the early 70s.

At the time, Prof. Charles Olweny was the director, the first at UCI, appointed in 1973. When I interviewed him three years ago for a special edition of The Health Digest on “Uganda’s Walk with Cancer” (http://www.hejnu.ug/sites/default/files/public/magazines/Cancer.pdf) he narrated how the team worked.

There were no mobile phones then, he said, but nevertheless the institute traced every patient within a month of not showing up.

Some staff knew every patient by name, where they came from, their treatment regimens, when they last came in and more. The nurses were thoroughly trained to mix the medicines because at the time treatment was done by a mixture of drugs. That freed up a lot of time for the doctors, and medical students were always available to step in.

Even if Uganda now has this modern facility, it may not be enough if patient families are not supported to come in, and awareness is not created. Cancer will still be defined as affecting the poor and the rich differently, yet it is the same disease and can be treated the same way.

In reality, the only difference between how the disease affects rich and poor is that for the poor it often is diagnosed either too late or not at all. With poor roads, limited follow up and poverty, many will still not be able to raise the cost of transport to the capital to the UCI. And then the state-of-the-art-centre may not make much difference.

In praise of academic cancer treatment studies

roger Wilson

Guest blogger – Roger Wilson, Honorary President of Sarcoma Patients Euronet

 

 

 

 

 

 

 

 

 

As a patient working in cancer research for over ten years now, one thing has slowly become more and more apparent.

 

The greatest patient benefit accrues from studies which are academically led. A

bold statement which needs a bit of unpicking.

 

Pharmaceutically led studies dominate our attention because of the scale of

investment and the power of the public relations team. They may well be led by

talented academic clinicians but the protocol has been driven by commercial

requirements even if it is an early phase study. The reality is that larger and

larger amounts of money are being committed to studies which benefit fewer

and fewer patients.

 

I am not decrying all that effort. My personal view is that if a new drug can

benefit just one patient let us have that drug. However I don’t have deep

pockets, any more than any healthcare system does, so that principle has some

weaknesses – as does the current pharmaceutical business model.

 

Beyond numeric significance

Academically led studies, which draw funding from government, charities or

philanthropic sources, may have a component from pharma providing free

access to drugs. These studies can also draw on treatments more widely

available in the market such as generic versions of previously patented drugs.

 

Academic studies will be seeking to find better ways of treating patients using

more clinically relevant outcomes and taking fuller account of the whole patient.

They are not seeking solely to identify the numeric significance of a treatment.

This sets academic studies apart from highly publicised drug studies with

registration objectives.

 

The EORTC (a charity) is an important provider of academic studies. The

European Commission is funding studies through its R&D programme.

Governments support studies, often providing funding to a university hospital.

An important source for such studies is the UK, where local funding from Cancer

Research UK is a critical component. Occasionally one trial will stand out.

 

Two extra years from an off-patent drug

STAMPEDE is a ‘basket’ study looking at a range of drugs in treating advanced

prostate cancer. It is a 7,000 patient multi-arm study. It could not be run by

pharma. Its first results published at ASCO 2015 looked at docetaxel, which is

now off patent. The drug was given earlier than it is in current practice. An OS

(overall survival) improvement of 24% and ‘failure free’ survival of 38%

translates into significant clinical benefit, improving patient longevity by a

median of just under two years.

 

The Chief Investigator, Professor Nick James from University of Warwick, said

“Our headline conclusion would be that docetaxel should be considered as

routine practice in men with newly diagnosed metastatic disease. With non-

metastatic disease, there remains uncertainty as to whether there’s a survival

benefit or not but it certainly improves failure-free survival by a substantial

amount.”

 

Pharma company researchers would give their right arms for results like that in

a cohort of patients as large as this. It will change clinical practice without

truckloads of expensive documentation being required by EMA.

 

So let’s pay more attention to academic studies. They can change things in big

ways and have the potential to provide patient benefit far beyond the seemingly

eternal procession of pharma company registration studies targeting smaller and

smaller cohorts of patients.

Roger Wilson blogs at http://rogerwilson.me.uk/