Practice changing in common advances in common cancers


Prof Paul Ruff, Chief Specialist, Professor and Head of the Division of Medical Oncology at Wits & Dr Georgia Demetriou, Senior Consultant in the Division of Medical Oncology and Head Medical Teaching Unit at Wits and Charlotte Maxeke Johannesburg Academic Hospital.

With ever evolving technology, it’s only natural for the medical industry to improve in how they deal with sicknesses and find new ways on how to combat illness. New innovations involve lots of research, which was presented at the Wits University pre-media briefing of the Practice changing advances in common cancers.

Presenting on this gripping topic was Professor Paul Ruff, chief specialist in the Medical Oncology department at Wits and Medical Oncologist Dr Georgia Demetriou. Starting off the roundtable briefing Professor Ruff was asked to comment on the latest investigation by the competition commission. The question posed to him was, is this investigation going to upset the negotiation between the department of health and Roche on the decrease in the price of their cancer drug?

“The competition commission is doing this on the basis of complaints from the public sector, including a number of NGOs. The problem is that they’ve got all their facts wrong and as a result of that if they are going to pursue this they’re going to mess the entire thing up and its going to backfire because, if you are going to do something you need to do your homework on what you talking about before you raise issues. If you look at what was written in that document from them they got many things wrong, whereas I completely agree that there are issues with pricing but this process is completely erroneous,” said Professor Ruff. Further on “First of all look at the Pfizer thing, they’re complaining about medicine that’s not even available in this country, the only way to try and get it is internationally. So to say that the company involved with it here is fixing prices is completely absurd because it’s actually got nothing to do with us, so it’s completely farcical,” added Professor Ruff.

“The thing with Aspen, the medicine that they’re complaining about has had issues in Spain and Italy which have got nothing to do with South Africa. Those medicines all date back to the 1960s, there are generally no generics of them because nobody has bothered to make them. They’re relatively cheap medicines and they have roles that have become less and less significant. If you look at what the Competition Commission wrote in their document as to what it’s used for, it’s all rubbish. Those indications are 30, 40, 50 years old. So I mean the whole thing is flawed with inaccuracies” said Professor Ruff.

He said the big one is the Roche issue. He said that they don’t know the difference between a generic and a biosimilar, which is the big problem. This then makes their whole thought process wrong. So the whole thing is flawed with inaccuracies.

Practice changing in common advances in common cancers

With all that being said about the cancer drug price investigation the focus turned on the main topic of the briefing which was the practice changing in common advances in common cancers. Professor Ruff was asked to address first the metastatic colorectal cancer. He said he would speak from a scientific point of view rather than healthcare because that is a different topic.

A long time ago when oncology started, what was offered to patients who had metastatic cologne cancer was very limited. The research back then in the 1950s to 1980s wasn’t as advanced as we see today, in actual fact, it was very poor. Statistics weren’t done properly the numbers were small as compared to today the standard of research has improved dramatically. Although it’s more difficult, laborious and more costly,things are done more efficiently. If there was a patient with metastatic cologne cancer there wasn’t much that could be done with that patient.

Then in the 1990s, there were two chemotherapy drugs that were invented. The first being oxaliplatin and the second Peginterferon. These are standard chemo drugs. A study was done and has shown that when you add these drugs to the older ones it can improve survival rate with about one more year. Those were studies conducted in the 90s.

The major thrust of oncology research in the past 10 to 15 years until recently was looking at two specific areas:

Angiogenesis (ways on how to block it)

  • Bevacizumab – survival benefit of extra 5 months
  • Ramucirumab
  • Aflibercept

Epidermal growth factor

The epidermal growth factor receptor (EGFR) belongs to the ErbB family of receptor tyrosine kinases (RTK). These trans-membrane proteins are activated following binding with peptide growth factors of the EGF-family of proteins.

Scientific research

The big scientific breakthrough was the discovery that one of the proteins in the pathway to the nucleus called RAS, if that is mutated the blocking upstream of one of these antibodies doesn’t work. So it will only work on patients that are non-mutant.

The big issue today is the realisation that the outlook on cologne cancer depends on where the tumour is. Patients who have tumours on the left side of the cologne do far better than patients who have tumours on the right side of the cologne. There is still a lot of research being done as to why this so and there is no definite answer at this point in time, but one of the reasons might be because of mutations. Cancer is primarily a molecular disease due to the mutations that occur in the cells.

Another possible reason can be that the left and the right-hand sides of the cologne are different and they have different growth patterns. This is still a question that is not yet fully answered.

Dr Georgia Demetriou stated that the topic of her talk is her2 positive breast cancer

Her2 positive breast cancer

Dr Demetriou mentioned that breast cancer is the most common cancer in South Africa. Even globally it’s the most common cancer among woman. Her2 positive disease makes about 15-20% of breast cancers. These patients have a more aggressive type of breast cancer, whether it’s picked up early or late.

From the 1980s we’ve moved a long way when it comes to identifying and testing for Her2 to the development of trastuzumab which was the first Her2 blocker which was available to us.

These were the topics that were touched on at the pre-media briefing. The full presentation will be on Tuesday, 20 June at the School of Public Health Auditorium, York Road, Parktown.


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