Breast cancer is not a verdict

"Breast cancer goes from fatal to chronic diseases or is cured forever"

Irina Reznik, Mednovosti

What is innovative antitumor therapy, how accessible it is to Russian patients and whether it is worth being afraid of generics, said Mikhail Lichinitser, Deputy Director for Research at the Blokhin Russian Cancer Research Center, Head of the Department of Chemotherapy and Combined Methods of Treatment of Malignant Tumors, Academician of the Russian Academy of Sciences.

Photo: RONC press service

– Mikhail Romanovich, there is a lot of talk today about "breakthroughs" in the therapeutic treatment of cancer.  What is it about?

– Of course, it is. Today there are encouraging achievements in practical oncology. New effective drugs give excellent chances for life, and many forms of cancer that were fatal ten years ago are being cured today. Significant progress has been achieved in the treatment of melanoma, breast cancer (breast cancer), ovaries, prostate, lung and kidney. And this list can be continued. Oncology has always been the engine of medical development. We have world-class specialists. Including chemotherapists who are engaged in drug therapy.

Modern science is moving from traditional chemotherapy to science-based. So-called targeted drugs have been created that are suitable for individual groups of patients. The characteristics of the tumor, which determine the rational treatment and the achievement of high results, have been established. Thanks to modern therapy, patients who had a poor prognosis 10 years ago now live for a long time and are often cured.

For example, breast cancer patients with genetic characteristics of HER2 overexpression used to have a poor prognosis. This form of the disease occurs in about 25% of all cases of breast cancer, progresses rapidly and gives metastases. 15-20 years ago, such patients died within six months, but, fortunately, the situation has changed. The first drug for the treatment of this disease appeared back in the 90s of the last century, marking the beginning of personalized medicine, thanks to which, subject to early detection of the disease, breast cancer began to be cured in 95% of cases. And the survival rate of women with the most aggressive forms has become even higher than with less aggressive ones.  Breast cancer today not only passes from the category of fatal diseases to chronic, but in a significant number of cases it is cured forever. People should know this, not be afraid of this disease and live with hope. 

The next breakthrough in the treatment of breast cancer is the appearance of new targeted drugs already for metastatic forms of cancer with the HER2+ mutation. Two such drugs have already been registered in Russia. These drugs open up new ways for Russian doctors to treat patients with the most aggressive forms of breast cancer. And the state should provide such treatment, if possible, to all patients. To make modern medical achievements available to all citizens, because this is happening all over the world.

– And how accessible is modern treatment in Russia?

– Our patients are provided with modern medicines, but, unfortunately, not all of them. And of course, this is a problem. No state in the world is able to provide expensive treatment for cancer patients on its own. Insurance companies, charitable foundations, large corporations are engaged in this. There is a real insurance medicine all over the world, and its best samples should be reproduced in Russia. We need to combine all efforts – people should receive effective medicines with which they associate hope for a cure.

On the other hand, the huge progress that is being observed today in oncology includes methods of rational therapy. So, there are not so many patients for whom expensive targeted therapy is effective. Those to whom it is shown, these drugs can save lives, but they must be used competently. Prescribe them to everyone in a row, overloading patients with useless treatment, it is impossible. And if earlier, with lung cancer, I would prescribe the same medicine to all 100 patients, today I will conduct a genetic analysis that will show that only five need it. And this targeting is another feature of targeted therapy.

– What other ways are there to solve the problem of expensive medicines?

– The main thing is the use of generic antitumor drugs. They are widely used both in our center and in other advanced clinics in Russia, and there are no serious claims to such drugs. There is no need to be afraid of this, generics are used all over the world. In America, 40% of all drugs are generics, in Europe, where special emphasis is placed on their own production – up to 60%. In Russia, 77% of anticancer drugs are reproduced.

Another thing is the quality of these drugs, that's where we have the weakest link. The generic should be evaluated according to criteria that allow to establish its compliance with the original drug. Laws should be effective, not convenient for pharmaceutical companies. I keep saying this to the leadership of the Ministry of Health. In countries with a high level of medical development, very strict control of non-original medicines has been established, there are strict standards for biosimilars and generics. And in Russia, the quality control of generics should not differ from the European one, and then patients will have no doubts whether to use them or not.

But there are medicines that have closed patents, and which do not yet have generics at all. Here they need to be purchased. Modern medicines that save patients' lives should be available with strict indications for their use, and should be paid for by the state.

– Is something being done in the country within the framework of import substitution? FSBI "N.N. Blokhin RSC" participates in the development of drugs of Russian companies?

– There is no question of import substitution yet. As for medicines, there is a problem with this in Russia, which we have inherited since Soviet times, when the pharmaceutical industry in the country did not develop. But our scientists, doctors, not only doctors, but also representatives of fundamental science, take part in the development of fundamentally new drugs. Such partnership participation in domestic and international projects, international cooperation, exchange of experience are very important for understanding the situation, for understanding the modern possibilities of medicine, which we all need to strive for. 

Portal "Eternal youth" http://vechnayamolodost.ru  02.03.2017