Merck Serono points finger at UK oncologists for personalised meds lag
This article was originally published in Clinica
The UK is lagging far behind Europe in testing cancer patients for biomarkers, with oncologists who are too set in their ways to test for and prescribe innovative drugs the main problem, according to Merck Serono's director of oncology, Rob Drury-Dryden.
Merck's data from 2010 showed that across France, Germany, Italy and Spain (the EU4), an average of 66% of metastatic colorectal cancer (mCRC) patients were tested to see if they have the KRAS wild-type that makes them eligible for treatment with Merck's Erbitux (cetuximab), an epidermal growth factor receptor (EGFR) antibody. This compared to just 24% of UK mCRC patients.
A comparison of drug use in 2011 in the EU4 and the UK (see figure below) shows clearly that the UK is lagging when it comes to testing for and prescribing the most innovative medicines. These data were collected from a questionnaire responded to by 80-100 doctors from each country, who selected four mCRC patients each to the following criteria: two randomly selected mCRC patients, one patient in second line treatment plus chemotherapy, and one in third line treatment plus chemotherapy.
Across the EU4, an average of 22% of mCRC patients were treated with Erbitux, while 30% received Roche's Avastin (bevacizumab) and 3% Amgen's Vectibix (panitumumab). In the UK, these figures were just 15%, 11% and 0% respectively. However, this was an improvement on 2010 in the UK when just 9% received Erbitux and 3% Avastin. There was little movement in the EU4 figures from 2010 to 2011 (2010 numbers not shown). Merck Serono noted that it has seen month-on-month improvement in the numbers of patients being tested in the UK since September 2011.
A recent survey of UK oncologists sponsored by Merck Serono showed that doctors perceive barriers within the NHS, such as cost and access, which prevent them from administering tests and subsequently the targeted medicines that go with them (www.clinica.co.uk, 8 May 2012).
However, Dr Drury-Dryden asserts that with all the initiatives in the UK such as the Cancer Drugs Fund and Merck's own scheme which makes the KRAS biomarker test available to all NHS patients, "the funding issue is largely removed".
"Until we get to the point where we are completely saturated then we are in the fortunate position where funding is there for most of these drugs. I think the problem is a lack of appreciation of the best treatment pathways. I think it's the oncologists who are set up in a certain way. It's a change process. When you get innovation coming into a marketplace, it takes time to move from what you're used to doing."
Dr Drury-Dryden believes that companies and patient advocacy groups need to continue trying to raise awareness of the effectiveness of these drugs, while the NHS needs to be willing to test patients and implement the appropriate therapies. "There has to be joint working. We can have a lot of good initiatives but unless the NHS actually implements then we're failing. Without the pathologists buying, without the oncologists buying, then it won't happen. So we need to work together."
"My point of view is that it's a really obvious way to go ahead. The economic models show that this is clearly the way to go – you actually save money by getting much better outcomes by paying less. It's saving the NHS money, improving outcomes for patients, and it means that the pharmaceutical industry benefits as well."