Akram Ashyani, Ph. D.（Life Science Platform）                 

European Mission on Cancer and Precision Medicine

TEUICP Column

Akram Ashyani, Ph. D.（Life science Platform） 

2022/07/27

According to the European Cancer Information System, new cancer cases will increase 21 percent in EU and EFTA countries by 2040 compared to 2020. They also state that it can result in a 23 percent increase in death rates in comparison with 2020. [1]

The Horizon Europe research and innovation programme suggested EU Missions as a novel approach to address some of the most challenges in EU such as the burden of cancer disease. They planned to invest on the topics close to the Missions from 2021 to 2027, which the Mission on Cancer is one of the priorities in the EU Missions. [2]

There are four objectives for the Mission on Cancer containing “understanding of cancer, prevention and early detection, diagnosis and treatment, quality of life for patients and their families”. A stronger insight for cancer will be provided by the collaboration among Mission on cancer and the “Europe’s Beating Cancer Plan”. It can help to understand cancer in a better way, diagnose it sooner and treat it earlier, and improve the life quality for cancer patients. The number of new patients with cancer in Europe will increase from 3.5 million up to 4.3 million by 2023 if nothing is done.  [3]

Cancer develops when cells grow without any control and in an abnormal way (See Figure 1). It can happen in any part of the body and spread to other organs, which is known as metastasize, and is the leading cause of death. In 2018, the second reason of death around the world was cancer as one among six deaths. The burden of cancer is enhancing world widely causing emotional, physical and financial burden for patients, their families and healthcare system. [4]

Figure 1. Cancer cells keep growing and form a tumor. CC BY-SA 4.0 [5]

Approximately one in every six death in 2020 was because of cancer in the world. As a result, it is the main reason of death globally. If cancer detected early and treated properly it has a high chance of being cured. The number of children who have diagnosed with cancer each year is 400,000. Common types of cancer are lung, breast, prostate, colon and rectum cancer. [6]

In the European Union 2.7 million persons had cancer and 1.3 of them dies in 2020. There were 2000 young people among them. They predict that until 2035 the number of cancer cases will boost by 24 percent, resulting in an increase in the number of deaths. [7]

Therefore, European Union considers allocating a special budget more than €3.5 billion for cancer research [3]. Under the Horizon Europe program, there are numerous funding opportunities for cancer researches to control and cure cancer. The following are some of the “Type of action: HORIZON-CSA HORIZON Coordination and Support Actions” with a deadline of 7 September 2022 17:00:00 Brussels time.

• “Improving and upscaling primary prevention of cancer through implementation research, TOPIC ID: HORIZON-MISS-2022-CANCER-01-01”. The investment for increasing or improving the prevention of cancer in the first stage is necessary. This call consider the economical, cultural, social and geographical conditions and digital tool and data sets to prevent cancer. [8]
• “Strengthening research capacities of Comprehensive Cancer Infrastructures, TOPIC ID: HORIZON-MISS-2022-CANCER-01-02”. The purpose of this call is to improve or develop existing Comprehensive Cancer Infrastructures in terms of digital and R&I capabilities in the Member States and Associated Countries. It is a collaboration with the EU network of comprehensive cancer centres CRANE, which has established as part of Europe’s Beating Cancer Plan. [9]
• “Pragmatic clinical trials to optimise treatments for patients with refractory cancers, TOPIC ID: HORIZON-MISS-2022-CANCER-01-03” This call supports practical clinical trials for healthcare system implementation in line with the specific needs, affordability and accessibility of the population in order to change clinical practice. The emphasis will be on refractory cancers in children, adolescents, young adults and adults. [10]
• “Towards the creation of a European Cancer Patient Digital Centre, TOPIC ID: HORIZON-MISS-2022-CANCER-01-04”. The scope of this call is to collect, organize, secure and reuse data networks for the patient controlled health data in order to reduce the heterogeneity of the data and facilitate the integration of existing health data networks. [11]
• “Establishing of national cancer mission hubs and creation of network to support the Mission on Cancer, TOPIC ID: HORIZON-MISS-2022-CANCER-01-05”, This call aims to build a national cancer mission hub by expanding current structure or constructing the new one as well as to facilitate the integration of activities in the Cancer Mission and Europe’s Beating Cancer Plan at the national level. [12]

The majority of medical treatments are designed based on “average patients”, meaning that they can be successful for some of them but not all. Precision medicine or “personalized medicine” is a new approach considering differences among gene, lifestyle and environment of patients. The goal of this kind of medicines is to find the best cure based on the patient’s specifics. The FDA approved some form of treatments based on different characteristics of patients such as the “genetic profile of an individual’s tumor”. Molecular testing is used as a part of the patient care to assist doctors in selecting the best treatment with the highest chance of survival and the least amount of side effects [13]

Precision health can aid to have a better prediction, prevention and treatment for the disease in a variety of ways including using the history of diseases in a family to inform people about the possibility of developing a specific disease in the future. For instance, for a person with having one of the family members by a history of cancer, is more likely to develop it in the future than others. Hence, a doctor may also recommend regular testing for the disease. Some people have inherited conditions that will cause them to have a special disease in the future. In the precision medicine approach, a doctor can regularly check the person and screen them frequently or give medicine or suggest surgery to prevent this from happening. A woman with a “BRCA1 or BRCA2 gene mutation”, for example, has a higher risk of having ovarian or breast cancer. [14]

Biomarker testing, which is done in tumor genetic testing, can assist doctors in selecting the best treatment because two people may require different treatment for the same cancer. Personal devices can also be used in precision medicine to monitor subject’s health status and improve their disease through diet or other activities, as well as to remind them of their regular checkups and cancer screenings. [14]

The European Commission has also issued a call for “Personalised oncology: innovative people centred, multi-modal therapies against cancer, TOPIC ID: HORIZON-JU-IHI-2022-01-03” with a deadline of September 20^th, 2022, 17 Brussel time. The goal of this call is to develop “biomarker-guided multi-modal precision oncology” [15].

However, there are some challenges in applying precision medicine to cancer treatment. People involved in the precision medicine process including public hospitals, health authorities, and private companies have various aims that should be coordinated and connected. Public hospitals want to give patients the approved medicine, health authorities introduce new treatments with adequate funding, and private companies produce new medicine. To connect these goals, a public-private consortium called CONNECT was formed in Norway. The Oslo Cancer Cluster collaborate with them. The IMPRESS as an off-label study on advanced cancer with support of Regional Health Authorities also coordinate with CONNECT. Their concept is that cancer patients with no other treatment options can receive precision medicine through InPreD, a national infrastructure. The CONNECT, IMPRESS and InPreD will lead the development of a comprehensive ecosystem for the implementation of precision medicine for cancer in Norway and can be as an insight for other countries looking to implement precision medicine. [16]

References

[1] J. R. Centre, “European Cancer Information System: 21% increase in new cancer cases by 2040,” EU Science Hub, 16 04 2022. [Online]. Available: https://joint-research-centre.ec.europa.eu/jrc-news/european-cancer-information-system-21-increase-new-cancer-cases-2040-2022-03-16_en#:~:text=Joint%20Research%20Centre-,European%20Cancer%20Information%20System%3A%2021%25%20increase%20in%20new%20cancer%20. [Accessed 12 08 2022].
[2] “EU Missions in Horizon Europe,” European Commission, [Online]. Available: https://research-and-innovation.ec.europa.eu/funding/funding-opportunities/funding-programmes-and-open-calls/horizon-europe/eu-missions-horizon-europe_en. [Accessed 11 08 2022].
[3] “EU Mission: Cancer,” European Commission, [Online]. Available: https://research-and-innovation.ec.europa.eu/funding/funding-opportunities/funding-programmes-and-open-calls/horizon-europe/eu-missions-horizon-europe/cancer_en. [Accessed 11 08 2022].
[4] “Cancer,” World Health Organization, [Online]. Available: https://www.who.int/health-topics/cancer#tab=tab_1. [Accessed 11 08 2022].
[5] C. R. UK, “File:Diagram showing how cancer cells keep on reproducing to form a tumour CRUK 127.svg,” Wikimedia Commons, 30 07 2014. [Online]. Available: https://commons.wikimedia.org/wiki/File:Diagram_showing_how_cancer_cells_keep_on_reproducing_to_form_a_tumour_CRUK_127.svg. [Accessed 12 08 2022].
[6] “Cancer,” World Health Organization, 03 02 2022. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/cancer. [Accessed 11 08 2022].
[7] “A cancer plan for Europe,” European Commission, [Online]. Available: https://ec.europa.eu/info/strategy/priorities-2019-2024/promoting-our-european-way-life/european-health-union/cancer-plan-europe_en. [Accessed 11 08 2022].
[8] “Improving and upscaling primary prevention of cancer through implementation research,” European Commission, 2022. [Online]. Available: https://ec.europa.eu/info/funding-tenders/opportunities/portal/screen/opportunities/topic-details/horizon-miss-2022-cancer-01-01;callCode=null;freeTextSearchKeyword=cancer;matchWholeText=true;typeCodes=0,1,2,8;statusCodes=31094501,31094502;programmePeriod. [Accessed 11 08 2022].
[9] “Strengthening research capacities of Comprehensive Cancer Infrastructures,” European Commission, 2022. [Online]. Available: https://ec.europa.eu/info/funding-tenders/opportunities/portal/screen/opportunities/topic-details/horizon-miss-2022-cancer-01-02;callCode=null;freeTextSearchKeyword=cancer;matchWholeText=true;typeCodes=0,1,2,8;statusCodes=31094501,31094502;programmePeriod. [Accessed 11 08 2022].
[10] “Pragmatic clinical trials to optimise treatments for patients with refractory cancers,” European Commission, 2022. [Online]. Available: https://ec.europa.eu/info/funding-tenders/opportunities/portal/screen/opportunities/topic-details/horizon-miss-2022-cancer-01-03;callCode=null;freeTextSearchKeyword=cancer;matchWholeText=true;typeCodes=0,1,2,8;statusCodes=31094501,31094502;programmePeriod. [Accessed 11 08 2022].
[11] “Towards the creation of a European Cancer Patient Digital Centre,” Commission, European, 2022. [Online]. Available: https://ec.europa.eu/info/funding-tenders/opportunities/portal/screen/opportunities/topic-details/horizon-miss-2022-cancer-01-04;callCode=null;freeTextSearchKeyword=big%20data;matchWholeText=true;typeCodes=0,1,2,8;statusCodes=31094501,31094502;programmePe. [Accessed 11 08 2022].
[12] “Establishing of national cancer mission hubs and creation of network to support the Mission on Cancer,” European Commission, 2022. [Online]. Available: https://ec.europa.eu/info/funding-tenders/opportunities/portal/screen/opportunities/topic-details/horizon-miss-2022-cancer-01-05;callCode=null;freeTextSearchKeyword=cancer;matchWholeText=true;typeCodes=0,1,2,8;statusCodes=31094501,31094502;programmePeriod. [Accessed 11 08 2022].
[13] “Precision Medicine,” U.S. Food & Drug administration (FDA), 27 09 2018. [Online]. Available: https://www.fda.gov/medical-devices/in-vitro-diagnostics/precision-medicine. [Accessed 12 08 2022].
[14] “Precision health: Improving health for each of us and all of us,” Center of Disease Control and Prevention, 17 05 2022. [Online]. Available: https://www.cdc.gov/genomics/about/precision_med.htm. [Accessed 16 08 2022].
[15] “Personalised oncology: innovative people centred, multi-modal therapies against cancer,” European Commission, 2022. [Online]. Available: https://ec.europa.eu/info/funding-tenders/opportunities/portal/screen/opportunities/topic-details/horizon-ju-ihi-2022-01-03;callCode=null;freeTextSearchKeyword=cancer;matchWholeText=true;typeCodes=0,1,2,8;statusCodes=31094501,31094502;programmePeriod=null. [Accessed 11 08 2022].
[16] “Who will pay for the precision cancer medicine revolution?,” Open Access Government, 22 06 2022. [Online]. Available: https://www.openaccessgovernment.org/who-will-pay-for-the-precision-cancer-medicine-revolution-treatments/138190/. [Accessed 16 08 2022].