A question of demographics

Home to 60 per cent of the global population, Asia has enjoyed unprecedented economic growth over the last decade. But with the good things of life come the bad and the continent is now experiencing a major upsurge in health problems.

A recent Asian media briefing on oncology hosted by leading pharmaceutical company Novartis revealed that while cancer mortality rates are decreasing in western countries, they are increasing in developing parts of the world. Asia, in particular, is seeing a steep upward curve in cancer cases, with the recorded rate of 6.1 million cases in 2008 expected to rise to 10.6 million cases in 2030. The death rate is also going up with the 4.1 million deaths in 2008 projected to rise to 4.5 million deaths in 2030.

John Ketchum, senior vice president of Novartis Oncology’s Emerging Growth Markets division, says the company is attempting to meet the challenge by increasing its research efforts into cancers known to be prevalent in Asia and looking specifically at both the different genetic mutations and environmental effects.

This is particularly important as advances in research in recent years indicate quite large differences in the same disease between western and Asian countries.  

Margaret Dugan, senior vice president of Novartis Oncology and head of its global programme, notes that the advances in precision oncology represent a great leap forward in cancer treatment. In the past, cancer treatments were based on tumour type, body location and risk factors. 

Today, precision oncology uses screening to identify genetic changes in cell pathways that have caused the cancer to develop. Identifying these pathways means that medications can target these without harming surrounding areas.

Cancers that are more prevalent in Asia are gastric cancer, liver cancer and non-small cell lung cancer (a common type of lung cancer that can affect non-smokers and younger patients).

Xue Hong Ling, Medial Director, Solid Tumors, APSA, Novartis Onocology, adds that while breast cancer is the most prevalent form of the disease among women in both Asia and the West, the demographics are different. Half of the breast cancers diagnosed in Asia are premenopausal and include young women in their 20s meanwhile in the West, the prevalence is higher among postmenopausal women.

While no firm conclusions have been reached on why the age groups are so different, the influential factors are likely to include unhealthy lifestyle habits, worse pollution and stress induced by the rapid economic growth in the region.

Professor Cheng Ann-lii, director of the Department of Oncology at the National Taiwan University College of Medicine, says that liver cancer is particularly high in Taiwan due to prevalence of hepatitis B infection while in the west, the cause is more commonly linked to hepatitis C and alcohol problems.

He also points to the importance of taking into account the genetic differences between east and west when developing drugs.

Most drug development has traditionally focused on needs in the US and Europe. Even today, drug companies usually start their research and trials with Western patients and obtain approval first from the USFDA or the European Medicines Agency (EMA). Approval for use of the drug in Asia, which uses the same procedures as in the West, usually lags behind by two to three years.

The problem is that the drug for cancer treatment is the same for both regions. That could be about to change as all sides take note of causes and demographics in two very different parts of the world.

Novartis Oncology’s Thomas Weigold says the company is already taking a different approach to new drug approvals in Asia with the launch of a new partnership platform called StAR (Strategy in Asia Region).

The StAR platform is composed of a expert forum of doctors who regularly exchange clinical experiences across the region, thus leading to a better understanding of cancer subtypes. This in turn leads to local clinical trials of drugs designed specially for patients in Asian countries.

Some innovative drugs for the treatment of liver and gastric cancers are currently undergoing the processes of FDA approval in Asian countries and will thus allow patients early access to these new medications. 

 In 2016 and beyond, the focus will be expanded to other cancers prevalent cancers in Asia including pre-menopausal breast cancer and squamous oesophageal cancer.