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Good morning health colleagues, and welcome to the European Alliance for Personalised Medicine (EAPM) update. Naturally, there is much focus in these troubled times on the coronavirus pandemic that is sweeping the world, but EAPM is still very much also focused on the pandemic of cancer, particularly ahead of the formal launch of the Europe Beating Cancer Plan on 3 February. Read on for more information, writes EAPM Executive Director Dr. Denis Horgan.
EAPM round table
Registration is open for the European Alliance for Personalised Medicine (EAPM) ‘virtual’ event, held online next week, on 3 February, 9h30 – 11h CET. The round table is entitled ‘Recruiting serology to the long fight ahead against pandemics‘. Please find the link to register here and the agenda is here.
Screening is key to beating lung cancer
Europe’s Beating Cancer Plan (BCP) holds out the prospect of many improvements in tackling cancer, and its vision embraces admirable principles – including the merits of screening, technology and enlightened guidance. It foresees “putting the most modern technologies at the service of cancer care to ensure early cancer detection”. But as long as it hesitates over endorsing screening for lung cancer, a major opportunity will remain neglected.
Drafts of the BCP acknowledge that lives are saved by early detection of cancer through screening. They speak approvingly of population-based screening programmes for breast, cervical and colorectal cancer in national cancer control plans, and of ensuring that 90% of the qualifying citizens will have access by 2025. For screening of these three cancers, they even envisage reviewing the Council Recommendation, and issuing new or updated Guidelines and Quality Assurance schemes.
But lung cancer screening enjoys no such priority in current drafts of the BCP, which are limited to allusions, to a “possible extension” of screening to new cancers, and to a consideration of “whether the evidence justifies an extension of targeted cancer screening.”
As Europe enters the third decade of the century, significant evidence has already justified action to implement LC screening. It is not the time to be debating whether the evidence is sufficient. The evidence is in. “There is evidence of a benefit of low-dose CT screening compared to no screening,” says one of the recent studies.
The NLST study demonstrated a relative reduction in lung cancer mortality of 20% and a 6.7% reduction in all-cause mortality in the LDCT arm. 5-year survival in patients diagnosed early (stage I-II) can be as high as 75%, especially in patients who have a surgical resection. Earlier diagnosis moves the focus from palliative treatment of incurable disease to radical potentially curative treatment with a resultant transformation of long-term survival. LuCE claims that five-year survival rates for NSCLC could be 50% higher with earlier diagnosis.
Historic objections to LC screening – in terms of risks of radiation, overdiagnosis, and unnecessary interventions, or uncertainties over risk models and cost effectiveness – have been largely answered by recent research. And given the commitment of the BCP to put research, innovation and new technologies at the service of cancer care (“the use of technology in healthcare can be a lifesaver”, says the latest draft), it might well provide for further studies to refine and clarify the areas where LC screening can be even further improved, and the necessary infrastructure and training be consolidated.
Maximizing opportunities for diagnosis
By providing more precise information on tumours, lung cancer screening has opened the way to more personalized treatment for lung cancer and provides fertile ground for further innovations in technology, image analytics and statistical techniques, and future image interpretation will be increasingly assisted by computer-aided diagnostics. The EU’s parallel Mission on Cancer is expected to generate new evidence on the optimisation of existing population-based cancer screening programmes, develop novel approaches for screening and early detection, and provide options to extend cancer screening to new cancers. It will also contribute to providing new biomarkers and less invasive technologies for diagnostics. The new ‘European Cancer Imaging Initiative’ will facilitate the development of new, enhanced diagnostic methods to improve quality and speed of screening programmes using Artificial Intelligence, and promote innovative solutions for cancer diagnostics. A leading to the development of new screenings, diagnostic pathways and treatments.
These are encouraging concepts, and could – if implemented – assist the refinement of early detection and diagnosis. But it would be even more promising if the recognition of improved access to biomarker testing on diagnosis and progression extended to treatment, and to advancing the emergence of personalised medicine. The BCP could be the context for a more systematic development of biomarker testing. Perhaps data on variations in testing rates could be included in the envisaged cancer inequalities registry.
EPP to provide rapporteur for Pharma Strategy report
The European People’s Party Group has been chosen to put forward a rapporteur to draft the Parliament’s response to the Commission’s pharmaceutical strategy. He or she will be from the center-right political grouping. They will be in charge of writing an “own initiative” report in response to the Commission’s plans to re-write rules for the bloc’s pharmaceutical industry.
Vaccine certificates
EU countries have now adopted Commission recommendations to have an EU-wide vaccination certificate.
Greek Prime Minister Kyriakos Mitsotakis first suggested creating vaccine certificates to allow travel across the bloc and save the 2021 summer for tourism. The EU will roll out a common approach so that a certificate issued in one member states is recognized in another. But it is not decided yet if they will be used for travelling, less alone be mandatory. Especially since people could still infect others despite being vaccinated. Workplaces might decide to give incentives for employees to get vaccinated, but it is unlikely that it would be obligatory.
“Future versions should take into account people for whom vaccination is not possible, so that these groups would not be discriminated against in cases when vaccination certificates are requested from the public,” the guidelines state.
The Commission will also continue to work with the World Health Organization on the use of these certificates globally.
Dombrovskis: EU vaccine control ‘primarily’ about transparency
EU trade and economy chief Valdis Dombrovskis has sought to calm fears that the EU could soon restrict exports of coronavirus vaccines, stressing that a newly proposed control mechanism is about “transparency” rather than an outright ban.
Health Commissioner Stella Kyriakides has announced a new scheme to require companies to register any exports of coronavirus vaccines in response to fears that manufacturers will not live up to their commitments.
“All companies producing vaccines against COVID-19 in the EU, will have to provide early notification whenever they want to export vaccines to third countries … the European Union will take any action required to protect its citizens and rights,” Kyriakides said on Monday (25 January).
‘Long COVID’ still puzzles doctors but treatment is possible
Medical professionals are working to understand more about a condition they are calling “long Covid,” among patients who experience lingering symptoms months after recovering from coronavirus.”Persons with long Covid often present reporting persistent, severe fatigue, headaches and brain fog, which is defined as mild subjective cognitive impairment, approximately four weeks after acute illness,” Dr. Alfonso Hernandez-Romieu, a member of the Centers for Disease Control and Prevention’s (CDC) Covid-19 response team, said during a CDC briefing on Thursday (28 January). A study recently published in the journal The Lancet found that of 1,733 coronavirus patients treated in the Chinese city of Wuhan, 76% were still experiencing at least one symptom six months after their symptoms began. Doctors have reported that the severity of COVID-19 illness may have little impact on whether patients experience long COVID symptoms, Hernandez-Romieu added.
Charles Michel: ‘Urgent measures’ may be needed to combat vaccine shortfall
European Council President Charles Michel on Thursday said the EU could adopt “urgent measures” in response to a shortfall in coronavirus vaccine, by invoking an emergency provision in the EU treaties.
Michel raised the possibility of emergency steps in a letter to the chancellor of Austria and the prime ministers of the Czech Republic, Denmark and Greece, following up on a leaders’ tele-summit last week that focused on the response to the pandemic.
During that meeting, which came before news broke about a major shortfall in vaccine production by AstraZeneca, the EU heads of state and government had demanded that pharmaceutical companies live up to their contractual commitments. At that point, concern was raised by a smaller production drop related to the Pfizer/BioNTech vaccine.
“You are indeed right that vaccines will prove the real game-changers in our fight against COVID,” Michel wrote to the four leaders. “We must therefore spare no effort, at our end, to ensure the timely vaccination of our citizens. Our discussions on 21 January revealed our clear common position that vaccinations need to be accelerated as a matter of the utmost urgency.”
Commission proposes update to coordinated approach on free movement restrictions
The Commission has proposed an update to the Council Recommendation of last October co-ordinating measures affecting free movement in the European Union. This is part of the Commission’s ongoing efforts to ensure better coordination and communication of travel-related measures at EU level. In light of new coronavirus variants and high numbers of new infections across many member states, it is necessary to strongly discourage non-essential travel, while avoiding border closures or blanket travel bans and ensuring that the functioning of the Single Market and supply chains remain uninterrupted. Therefore further targeted action to ensure a coordinated approach on measures restricting free movement within the EU is necessary.
And that is all for this week, have an excellent weekend, stay safe and well, don’t forget to register for EAPM’s round table on 3 February, find the link to register here and the agenda is here, and see you next week.
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