(UroToday.com) The 2024 Advanced Prostate Cancer Consensus Conference (APCCC) meeting featured a session on global access to advanced prostate cancer in low- and lower-middle-income countries, and a presentation by Dr. Fernando Maluf discussing the opportunities for big data mining and system remodeling in the Brazilian Unified Healthcare System.
From an epidemiological standpoint, there are challenges to cancer epidemiology in Latin America. This is secondary to significant epidemiologic differences, often inadequate data collection, under notification of cancer diagnosis and mortality, and different healthcare systems, access to drugs, hospitals, surgery, and radiation:
In Brazil, ~25% of patients are covered in the private sector, compared to 75% covered in the public sector. However, 60% of healthcare expenditures occur in the private sector, compared to 40% in the public sector. Dr. Maluf notes that 88% of new drugs launched are consumed in the US, Europe, or Japan. For example, to date, only ADT + docetaxel is approved in Brazil for advanced prostate cancer.
Brazil has a population of 203 million people, representing the 7th most important oncology market in the world, and the 9th most powerful economy globally. Moreover, Brazil and Latin America have great potential for clinical research. Among LACOG member institutions, there are 32,624 new cancer cases per month, including 2,623 new cases of prostate cancer.
One of the key ongoing projects in Brazil is transforming public hospitals in less favorable socio-economical areas in the country into research clinical units. There are several important reasons to do clinical research in Brazil:
- Improvement in patient healthcare – access to new drugs/technology from phase 3 clinical trials
- Cost containment
- Overcoming access limitations to medications in the public system
- Generation of new jobs
- Improvement in biodiversity by including Brazilian patients in multicenter international clinical trials
- Development/investment in the health chain with artificial intelligence for a big database of patient real-world information
This work has already begun, implementing six research unit centers across Brazil as part of the Love for Research Project:
The goal for this project is the implementation of 20 research centers by 2024 and up to 50 centers by 2026. This will boost clinical studies in the North, Northwest, and Central-West regions, strengthening the research program ecosystem and working alongside public health agencies.
A second ongoing project is promoting trials of innovative treatments for frequent tumors in developing countries and rare tumors in developed countries. Dr. Maluf is the PI on the LACOG 0218 HERCULES trial, which is a phase 2 single-arm clinical trial in penile squamous cell carcinoma (n = 33) assessing cisplatin + 5-FU + pembrolizumab followed by maintenance pembrolizumab in patients with metastatic disease:
A third ongoing project is promoting practice-changing trials of frequent tumors in developing/developed countries, but possible to be done due to Brazil’s public health system (SUS) characteristics. One such trial is the REDEMPTED trial for muscle-invasive bladder cancer:
A fourth project is promoting access to oral oncology medications. This is through the Sim Para Quimio Oral project, leveraging celebrity awareness to accelerate six times faster access to oral oncology medications for > 50,000 oncology patients/year. A fifth project is improving education and assembling consensus statements for developing countries:
Dr. Maluf concluded his presentation discussing the opportunities for big data mining and system remodeling in the Brazilian Unified Healthcare System with the following take-home messages:
- Clinical research has the potential to overcome the limitation access to optimal cancer therapies
- Healthcare policies that are able to harmonize the public budget in order to finance the most cost-effective treatments to be delivered to all patients are a reality and need to be done more often
- Physician and patient education are key to optimize patient care according to each region’s specific characteristics
Presented by: Fernando Maluf, MD, PhD, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Written by: Zachary Klaassen, MD, MSc - Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 Advanced Prostate Cancer Consensus Conference (APCCC) Meeting, Lugano, Switzerland, Thurs, Apr 25 - Sat, Apr 27, 2024.
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