Despite the advances in innovative targeted therapies and immunotherapies that largely increase melanoma survival rates, nearly one-third of metastatic melanoma patients in Europe are denied access to those new medicines.
The findings were presented at the European Society for Medical Oncology (ESMO) 2016 Congress, held Oct. 7-11, in Copenhagen, Denmark, and highlight the difficulties that European patients and physicians, particularly in Eastern Europe, face in accessing new, potentially life-saving drugs.
“Before 2011 there were no effective treatment options for metastatic melanoma patients, but that has changed tremendously in the last 5 years. We now have medicines which can prolong overall survival of these patients to more than 18 months and, in some patients, durable responses lasting up to 10 years have been reported,” Lidija Kandolf-Sekulovic, MD, a dermatologist and associate professor at the Military Medical Academy in Bulgaria, said in a press release.
“However, access to these medicines is limited and patients and physicians are facing increasing difficulties to obtain them. This is especially the case for Eastern and Southeastern European countries, where a majority of patients are still treated with palliative chemotherapy that does not prolong overall survival,” she said.
Metastatic melanoma is an aggressive skin cancer associated with poor outcomes. In recent years, new immunotherapies and targeted therapies that can improve patients’ survival rates have been developed, but their costs are high. This led Kandolf-Sekulovic to conduct a survey examining whether European patients had access to the new drugs.
The survey estimated that approximately 19,250 patients with metastatic melanoma are treated each year in Europe, 7,450 (39.7%) of whom live in Eastern and Southeastern Europe.
But, according to the survey, 5,180 of those patients do not have access to first-line therapy according to European guidelines. That means that nearly one-third of all patients treated with metastatic melanoma in Europe are not getting the recommended treatment.
The percentage of patients being treated with appropriate therapies varied widely depending on their geographical location. While 70% of patients in Western Europe received the latest treatment recommended by the European Guidelines, less than 10% of patients living in Eastern Europe received those innovative therapies.
Focusing particularly on the combination of BRAF plus MEK inhibitors, one of the first-line treatments for BRAF-mutated metastatic melanoma, the study found that the treatment combo was registered in 75% of countries in Western Europe, and fully reimbursed in 58%. In Eastern Europe, however, only 42% of the countries had the combination registered, and less than half of those reimbursed the treatment. Also, even when treatment was reimbursed in Eastern European countries, time-consuming administrative work was required to obtain the therapies.
“Our study raises ethical questions on the inequalities that affect survival based on the country of residence in Europe,” Kandolf-Sekulovic said. “It is not new that disparities in healthcare can lead to disparities in overall survival of patients, but these disparities are becoming even sharper for patients with chemotherapy-resistant metastatic melanoma in whom durable responses lasting for years can be seen in up to 20% of patients if treated with innovative medicines. In European healthcare systems that declare universal access to healthcare, these inequalities must be overcome,” she said.
“Despite the encouraging rate of new medicine development, there are still unacceptable inequalities in the availability and accessibility of new and effective cancer medications across Europe,” said Alexander Eniu, MD, PhD, chair of the ESMO Global Policy Committee. He added that those disparities are not unique to melanoma patients and hold true for other types of cancers.
“It is important to continue to provide health authorities with data, and to carry on calling attention to the difficulties patients with incurable diseases are facing, in the hope that equal access will soon be a reality, at least in Europe,” said Eniu.