Post on 12-Oct-2020
Josep Tabernero, MD PhD
Medical Oncology DepartmentVall d’Hebron University Hospital
Vall d’Hebron Insitute of Oncology (VHIO)Director R&D, Catalonian Cancers Centres Network
BarcelonaSpain
Coping with escalating healthcare costs in 2018
and beyond
DISCLOSURE SLIDE
Scientiic advisory role for Amgen, Bayer, Boehringer Ingelheim, Celgene, Chugai, Genentech, Inc., Lilly, MSD, Merck Serono, Novartis, Pizer, F. Hofmann-La Roche Ltd, Sanoi, Symphogen, Taiho and Takeda
The views expressed in this presentation are personal and do not have to coincide with the views of the European Society for Medical Oncology
ESMO 2020 VISIONSecuring the best possible outcomes for people with cancer
INTEGRATED CANCER CARE
1
SPECIALISEDEDUCATION
2
SUSTAINABLECANCER CARE
3
Bridging cancer prevention research, early-
diagnosis, and treatment to improve patient outcomes
Supporting oncologists in a fast-changing professional environment
Advocating for equal access to quality
treatment and for cancer prevention
SUSTAINABLE CANCER CARE
•Current cancer stats in 2015:
• Estimated 17.5 million
cancer cases globally, with
8.7 million deaths
• Cancer cases forecast to rise
by 75% over the next 20
years
• Skyrocketing costs of
oncotherapeutics and
supportive care drugs
The Economist
WHERE WE ARE TODAY
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
• Costs globally soared to $107
billion globally in 2015 – an
increase of 11.5% over 2014
• These costs are estimated to
reach $150 billion globally by
2020
• In the last 5 years:
• Costs of cancer medicines
increased by 72% over
2010 in the US
• By 50% in countries other
than the US
IMS Health, MIDAS, Dec 2015; Market Prognosis, Mar 2016;
IMS Institute for Healthcare Informatics, May 2016
Global Oncology Costs and Growth, 2010 – 2020
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
Data Courtesy of:Deined Health, Florham Park, NJ
Worldwide Sales by Therapeutic Area 2013-2020
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
Total spending on Cancer Therapeutics in 2016: 24bn €
Data Courtesy of:Murray Aitken, QuintilesIMS, MIDAS 2016,
QuintilesIMS Institute
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
Car-T Therapy Potentially curative
therapy Expected to be among
the most expensive of all time
Analysts estimation: $ 750,000 per patient
Financial Timeshttps://www.ft.com/content/7fce401e-8c47-11e7-a352-e46f43c5825d
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
Access to novel anti-cancer therapies:
• 49 new cancer medicines were launched between 2010 – 2014
• 17 of these are currently available in 10 or fewer countries
• Only 6 countries had access to at least half of the 49
• Lack of reimbursement under public insurance programs
• Of drugs approved 2014 – 2015 only US, Scotland and France have more than half on reimbursement lists (end 2015)
2015 Availability of Oncology Medicines Launched 2010-2014
Source IMS Health, MIDAS Q4 2015
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
Access to novel anti-cancer therapies:
• 49 new cancer medicines were launched between 2010 – 2014
• 17 of these are currently available in 10 or fewer countries
• Only 6 countries had access to at least half of the 49
• Lack of reimbursement under public insurance programs
• Of drugs approved 2014 – 2015 only US, Scotland and France have more than half on reimbursement lists (end 2015)
Reimbursement Status of Cancer Medicines Approved in 2014 and 2
Sources: National Institute for Health and Care Excellence (NICE) (England), Scottish Medicines Consortium (SMC)
(Scotland), The Dental and Pharmaceutical Benets Agency (TLV) (Sweden), Canadian Agency for Drugs and Technologies
in Health (Canada), Pharmaceutical Benets Scheme (PBS) (Australia), Federal Joint Committee (Germany), National
Comprehensive Cancer Network Guidelines (U.S.), IMS Institute for Healthcare Informatics, May 2016.
“Health is a human right and as a society we should favour actions to facilitate equal access to optimal cancer care to all patients worldwide”Fortunato Ciardiello, MD, PhD, ESMO President.
“Medicine doesn´t work if it doesn’t get to the patient” Daniel Hayes, MD, FACP, FASCO, Past President of ASCO.
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
http://globocan.iarc.fr
Incidence (per 100.000)
Despite higher incidence rates in Western Europe,
the mortality rates are higher in Central Eastern Europe
Mortality (per 100.000)
Disparities in Cancer control in Europe
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
Inequalities in Access to Drugs: ESMO Anti-Neoplastic Medicines Survey 2014
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
Cherny N, et al. Ann Oncol 2016.
Western Europe
Eastern Europe
ESMO Survey 2014: NSCLC Targeted Agents
SUSTAINABLE CANCER CARE
WHERE WE ARE TODAY
Costs of cancer care per person in EU countries
EU countries spend ≈ 10% of GDP on health; but, the money spend per capita ranges from 7.000$ to as low as 500$
Cancer care costs account for only 4 % of total EU health care expenditure.
Drug costs ≈ 27% (15% to 61%) of all
costs.
Luengo-Fernandez R, et al. Lancet Oncol 2013; Vogler S, et al. Lancet Oncol 2016.
Drug prices in 15 European countries, Australia and New Zealand, 2013
Diferences between countries varied from 28% to 388%.
Slide kindly provided by Tanja Cufer
SUSTAINABLE CANCER CARE
DELIVERING ON ESMO´S MISSION OF FACILITATING EQUAL ACCESS TO OPTIMAL CANCER CARE TO ALL CANCER PATIENTS
ESMO in action:
• To tackle issues relating to equal access to both essential medicines and innovative cancer therapies ESMO´s Cancer Medicines Working Group (CMWG) launched in 2015
SUSTAINABLE CANCER CARE
DELIVERING ON ESMO´S MISSION OF FACILITATING EQUAL ACCESS TO OPTIMAL CANCER CARE TO ALL CANCER PATIENTS
ESMO in action:
• To tackle issues relating to equal access to both essential medicines and innovative cancer therapies ESMO´s Cancer Medicines Working Group (CMWG) launched in 2015
Essential Inexpensive Cancer Medicines:
• Inexpensive, essential medicines: address the shortages, growing disparities of access within Europe and beyond, global depletion of stocks and lack of incentives to produce these medicines
• Progress to-date includes:• Partnered with The Economist´s Intelligence
Unit to develop report on Cancer Medicines Shortages in Europe: Policy recommendations to prevent and manage shortages
• High proile launch of report at the European Parliament outcomes: recommendations disseminated to policymakers at EU & national
SUSTAINABLE CANCER CARE
ESMO in action:Expensive Innovative Cancer Medicines
• ESMO´s CMWG Task for Expensive, innovative medicines formally
addresses the issue of sustainability of healthcare systems
• The Task Force brings together experts from all over the world to
brainstorm and highlight challenges and work towards developing
solutions
• It aims to work on the potential development of an economic model
to tackle issues related to reimbursement of innovative, medicines
• Engaging and triggering the many must-have conversations among
stakeholders in oncology:
• WHO´s Fair Pricing Forum (May 2017)
• ASCO-ESMO Joint Symposium: Access to Cancer Medicines (June
2017)
• Biosimilars:
• ESMO Position Paper, published in ESMO Open (January
2017)
DELIVERING ON ESMO´S MISSION OF FACILITATING EQUAL ACCESS TO OPTIMAL CANCER CARE TO ALL CANCER PATIENTS
SUSTAINABLE CANCER CARE
• Oncology drugs in clinical
development has expanded by
63% over the last decade
• In 2015: 586 molecules in late
phase oncology pipeline
• Novel and expensive
immunotherapies represent a
rapidly emerging area in oncology
R&D: set to expand the pipeline in
2020
• Our collective eforts MUST center
on proven eicacy, equitable
access, and adjusted pricing or
adequate value-based
reimbursement
The QALY is just a well researched number.
The value of a life is far more complex question
Many people are cheering a new potential solution: paying for drugs according to how well they actually
work.
DrugEfectivenessStatistically signiicantClinically relevantCost-EfectiveValue ≠ CostQALYs
Value =
BeneitCost + Toxicity
RegimenCost of Nivolum
ab
Cost of Ipilimum
ab
Cost of Regime
n
Nivo+lpi for 11.5m
$144,408
$151,158
$295,566
Nivo for 6.9m $103,220 $0 $103,2
20
Ipilimumab for 2.9m $0 $158,25
2$158,2
52
DELIVERING ON ESMO´S MISSION OF FACILITATING EQUAL ACCESS TO OPTIMAL CANCER CARE TO ALL CANCER PATIENTS
SUSTAINABLE CANCER CARE
ESMO in action:Expensive Innovative Cancer Medicines
Outline of the model: Reimbursement based on local-referenced value
Value of “X” drug(tumor type/setting)
HE parametersMCBSFrequency of the disease
Adapt to the country/region level
Country/Region parameters:GDP% of GDP in health expendituresFrequency of the disease (registries, extrapolation)
Planned Outcome:•Models and Tools (template) •No speciic discussions on speciic drugs/regions
Geographically-adapted value-based reimbursement
DELIVERING ON ESMO´S MISSION OF FACILITATING EQUAL ACCESS TO OPTIMAL CANCER CARE TO ALL CANCER PATIENTS
SUSTAINABLE CANCER CARE
CHALLENGES & OPPORTUNITIES (I):MAJOR VALUE-BASED FRAMEWORKS - UPHOLDING PROVEN AS OPPOSED TO PROMISING
Major Value-Based Frameworks
• ESMO-Magnitude of Clinical Beneit Scale1-3
• ASCO Value Framework4
• Sloan Kettering Drug Abacus5
• NCCN Value Blocks6
1.- Cherny et al. Ann Oncol 2015; 2.- Tabernero J. Ann Oncol 2015; 3.- Cherny et al. Ann Oncol 2017, 4.- Schnipper et al. J Clin Oncol 2015; 5.- Bach P. http://www.drugabacus.org; 6.- http://www.nccn.org/about/news/newsinfo.aspx?NewsID=545
SUSTAINABLE CANCER CARESUSTAINABLE CANCER CARE
Major Value-Based Frameworks
• ESMO-Magnitude of Clinical Beneit Scale1-3
• ASCO Value Framework4
• Sloan Kettering Drug Abacus5
• NCCN Value Blocks6
1.- Cherny et al. Ann Oncol 2015; 2.- Tabernero J. Ann Oncol 2015; 3.- Cherny et al. Ann Oncol 2017, 4.- Schnipper et al. J Clin Oncol 2015; 5.- Bach P. http://www.drugabacus.org; 6.- http://www.nccn.org/about/news/newsinfo.aspx?NewsID=545
CHALLENGES & OPPORTUNITIES (I):MAJOR VALUE-BASED FRAMEWORKS - UPHOLDING PROVEN AS OPPOSED TO PROMISING
Magnitude of Clinically Beneit
Magnitude of Clinically Beneit
Overall survival,
Progression free
survival
Overall survival,
Progression free
survival
ToxicityToxicity
CostsCosts
Prognosis of the
condition
Prognosis of the
condition
Quality of Life
Quality of Life
HR, Long term survival,
RR
Not analyzed in view of signiicant “Heterogeneity”across Europe
SUSTAINABLE CANCER CARE
ESMO – MCBS FACTORS TAKEN INTO ACCOUNT
Curative setting A & B or non-curative setting 5 & 4
Curative Non-curative
ESMO – MCBS SUBSTANTIAL IMPROVEMENTS
5
4
3
2
1
A
B
C
SUSTAINABLE CANCER CARE
ESMO-MCBS – inclusion of scores in Guidelines
Metastatic NSCLC
aEMA approvals in 2016 to end August 2016. bESMO-MCBS version 1.0 [181], cEMA approval, October 2015
dCo-primary end points (overall survival and progression-free survival both in the total population and in patients with PD-L1 expression on at least 50% of tumour cells)
Therapy Disease setting
Trial Control Absolute survival gain
HR(95% CI)
QoL/toxicity
MCBS scoreb
Nivolumab Advanced Nivolumab versus docetaxel in advanced squamous-cell NSCLC [98] Phase III NCT01642004
Docetaxel in patients with advanced SCC who have disease progression during or after 1st-line chemotherapy. Control OS 6 months
OS gain: 3.2 months. 2-year survival gain 15%
OS: HR for death 0.59 (0.44-0.79)
Improved toxicity proile
5(Form 2a)c
Nivolumab Advanced Nivolumab versus docetaxel in advanced non-squamous NSCLC [104] Phase III NCT01673867
Docetaxel in patients with NSCC who progressed during or after platinum-based doublet chemotherapy. Control OS 9.4 months
OS gain: 2.8 months. 2-year survival gain 16%
OS: HR for death 0.73 (0.59-0.89)
Improved toxicity proile
5 (Form 2a)
Ramucirumab
Advanced Ramucirumab plus docetaxel vs placebo + docetaxel for 2nd-line treatment of stage IV NSCLC after disease progression on platinum-based therapy (REVEL): a multicentre, double-blind, randomised phase 3 trial [94] Phase III NCT01168973
Placebo + docetaxel in patients with SCC or NSCC who progressed during or after a 1st-line platinum-based chemotherapy regimen. Control OS 9.1 months
OS gain: 1.4 months OS: HR for death 0.86 (0.75-0.98)
Deteriorated toxicity proile
1 (Form 2a)
Pembrolizumab
Advanced Pembrolizumab vs docetaxel for previously treated, PD-L1-positive, advanced NSCLC (KEYNOTE-010): a randomised controlled trial [96] Phase III NCT01905657
Docetaxel in patients with previously treated,PD-L1-positive, advanced NSCLC. Control OS 8.5 months
In PD-L1 >1%:d OS gain: 1.9 months In PD- L1 >50%:d OS gain: 6.7 months
In PD-L1 >1%:d OS: HR for death 0.71 (0.58–0.88) In PD-L1 >50%:d OS: HR for death 0.54 (0.38–0.77)
Improved toxicity proile
In PD-L1 >1%: 3(Form 2a) In PD-L1 >50%: 5(Form 2a)
SUSTAINABLE CANCER CARE
ESMO – MCBS SUBSTANTIAL IMPROVEMENTS
SUSTAINABLE CANCER CARE
Distribution ESMO-MCBS grades EMA approved solid tumor drugs since 2016
ESMO – MCBS SUBSTANTIAL IMPROVEMENTS
SUSTAINABLE CANCER CARE
Vivot et al, Ann Oncol 2017
No relation between price and clinical beneit of 38 FDA approved anticancer drugs 2000-2015
CHALLENGES & OPPORTUNITIES (I):MAJOR VALUE-BASED FRAMEWORKS - UPHOLDING PROVEN AS OPPOSED TO PROMISING
SUSTAINABLE CANCER CARE
CHALLENGES & OPPORTUNITIES (II): SAFEGUARDING ACADEMIC CLINICAL CANCER RESEARCH OF EXCELLENCE
• Academia-based researchers have driven many therapeutic breakthroughs and standards of treatments by validating complex therapeutic strategies
• 65% of all clinical trials, globally, are supported by health systems, government funds, universities and other research organisations1
• Countless patients across the globe have beneited from practice-changing discoveries made by basic and clinical cancer researchers over decades
• In the era of precision medicine academic research is crucial to prioritizing treatments independently, based on sound evidence
*Workman P et al. Cell. 2017 Feb 9;168(4):579-581. https://clinicaltrials.gov/ Last accessed 28 April 2016
* Figure: The Academic Drug Discovery and Development Continuum and Its Relationships with Stakeholders
SUSTAINABLE CANCER CARESUSTAINABLE CANCER CARE
What is non-commercial or academic clinical research in the EU?
WHOThe party responsible for carrying out an independent, non-commercial clinical trial in the EU, i.e., the trial sponsor, can be a university or hospital or any other non-proit organisation or researcher recognised as a non-commercial sponsor.
WHATThe trial sponsor is responsible for the design, conduct, access to data and biological material, recording and reporting of the clinical trial and owns all data and indings resulting from the trial.
WITH WHOMProvided these principal conditions for independence are met, the sponsor can also enter into agreements with third parties, including commercial partners, to secure trial funding or delegate some responsibilities, such as drug manufacturing, supply or monitoring.
PRNewsfoto/ESMO
• ESMO-EORTC-EACR decided to address this crucial topic through the Clinical Academic Cancer Research Forum (CAREFOR) that was created in 2014
• CAREFOR intends to:1. Raise awareness about the importance of non-
commercially sponsored clinical trials2. Provide a space for key actors in this area to discuss
advances and solve challenges3. Engage with the EU institutions to come up with
ways to safeguard & foster independent academic trials
4. Ensure appropriate implementation of the EU Clinical Trials & Data Protection Regulations
• CAREFOR’s paper, Safeguarding the future of independent, academic clinical cancer research in Europe for the beneit of patients, published in ESMO Open (2017)
Integrating Science into Oncology for a Better Patient Outcome can and will only happen when all partners, all stakeholders in oncology, better understand and embrace the importance of economic returns in improved health outcomes and major impact on public health driven by academic research
CHALLENGES & OPPORTUNITIES (II): SAFEGUARDING ACADEMIC CLINICAL CANCER RESEARCH OF EXCELLENCE
SUSTAINABLE CANCER CARE
• A study* showed that out of 124 oncology agents in the pipelines of the 9 companies examined, 74% had an overlapping mechanism of action
• There are too many ´me too´ drugs – contributing to the current health budget burden
• The ´me too´ approach to drug development hampers other areas of essential research
We must be collectively better organized to avoid costly duplication which is no longer sustainable.
*Fojo T et al. JAMA Otolaryngol Head Neck Surg. 2014 Dec;140(12):1225-36.
Comparison of Cancer Therapies in the Pipelines of PharmaceCompanies According to Their Putative Mechanisms of Action
CHALLENGES & OPPORTUNITIES (III): ‘ME TOO’ – TOO MANY
SUSTAINABLE CANCER CARE
CHALLENGES & OPPORTUNITIES (IV):THE ADVENT OF BIOSIMILARS
A recent ESMO position paper* reported on the potential promise of biosimilar medicinal products in obtaining sustainability:
• Positively impact on the purse strings of national healthcare budgets
• Spur competition and lead to reduced prices of respective reference products
• Represent a timely and necessary opportunity for physicians and patients
• The EU has pioneered the approval of 23 biosimilars up to 2016
• With several monoclonal antibodies coming of patent by 2020 there will be many more biosimilars that will also impact on current innovative treatment strategies
• Biosimilars are here to stay and represent essential, more accessible anti-cancer weaponry - now and in the future*Tabernero J et al. ESMO Open. Jan 2017, 1 (6) e000142
SUSTAINABLE CANCER CARE
A recent ESMO position paper* reported on the potential promise of biosimilar medicinal products in obtaining sustainability:
• Positively impact on the purse strings of national healthcare budgets
• Spur competition and lead to reduced prices of respective reference products
• Represent a timely and necessary opportunity for physicians and patients
• The EU has pioneered the approval of 23 biosimilars up to 2016
• With several monoclonal antibodies coming of patent by 2020 there will be many more biosimilars that will also impact on current innovative treatment strategies
• Biosimilars are here to stay and represent essential, more accessible anti-cancer weaponry - now and in the future*Tabernero J et al. ESMO Open. Jan 2017, 1 (6) e000142
CHALLENGES & OPPORTUNITIES (IV):THE ADVENT OF BIOSIMILARS
SUSTAINABLE CANCER CARE
The physician and patient´s joint and fully
informed decision to switch requires:
• Knowledge when a product is being switched
• Deep understanding of the product
• Factual information to fully brief the patient
• Close and multidisciplinary monitoring of the patient
to track adverse events
• Automatic switching is not an option
CHALLENGES & OPPORTUNITIES (IV):THE ADVENT OF BIOSIMILARS
SUSTAINABLE CANCER CARE
• European Commission Stakeholder Event on Biosimilar Medicinal Products, Josep Tabernero, ESMO President-elect, chaired a session “Collaborative Approach in the Use of Biosimilar Medicines” in May 2017.
• 15th Biosimilar Medicines Conference organised by Medicines for Europe in March 2017: ESMO was represented by Rosa Giuliani, ESMO PPSC member, who participated in a panel discussion.
• ESMO special session during ESMO 2017 in Madrid: “The incoming wave of biosimilars in oncology”.
• ESMO survey on awareness of biosimilars launched during ESMO 2017 in Madrid. Results to be presented in ESMO Asia 2017.
• ESMO meeting with the Biosimilar Medicinal Products Working Party (BMWP) – EMA in London, 21st September
• ESMO Colloquium on biosimilars during
ESMO special session during ESMO 2017 in Madrid: “The incoming wave of biosimilars in oncology700 participants
CHALLENGES & OPPORTUNITIES (IV):THE ADVENT OF BIOSIMILARS
SUSTAINABLE CANCER CARE
CHALLENGES & OPPORTUNITIES (V):POLICY POINTS
• Major societies including ESMO share the will and the
responsibility to lead public policy debate on
equitable access and afordable pricing and value-
based reimbursement of anti-cancer therapies across
borders
• Reliable value frameworks including ESMO-MCBS
provide policymakers with expanded data on eicacy
and value of oncology treatments
• We must collectively engage and consider the views
of all stakeholders towards regional-based priority
setting factoring in ´local´ socioeconomics and
reimbursement models
SUSTAINABLE CANCER CARE
Framing of oncopolicy must embrace all assessment methodologies and include other specialists from in and out of oncology to also successfully tackle the pricing/reimbursement and performance of cancer medicines, the current state of research, drug development and treasury.
CHALLENGES & OPPORTUNITIES (V):POLICY POINTS
ENSURING SUSTAINABLE CANCER CARE
Looking to the future for issues afecting all Oncology Professionals
Cancer Medicines CommitteeExpensive, innovative
cancer medicines
It aims to develop an economic
model to tackle issues related to
reimbursement of innovative medicines
Cancer Medicines CommitteeExpensive, innovative
cancer medicines
It aims to develop an economic
model to tackle issues related to
reimbursement of innovative medicines
Cancer Medicines
Committee Inexpensive,
essential cancer medicines
Report on Cancer Medicines
Shortages in Europe developed
with The Economist
Intelligence Unit.
Recommendations made to policy
makers on how to prevent and
manage shortages
Cancer Medicines
Committee Inexpensive,
essential cancer medicines
Report on Cancer Medicines
Shortages in Europe developed
with The Economist
Intelligence Unit.
Recommendations made to policy
makers on how to prevent and
manage shortages
ESMO MCBS
Designed to assess the therapeutic
beneit of drugs registered for the
treatment of cancer
ESMO MCBS
Designed to assess the therapeutic
beneit of drugs registered for the
treatment of cancer
Biosimilars
Tailored educational material for
oncologists & patients
ESMO Colloquia on biosimilars during
ESMO 2018 & ESMO Asia 2018
European Commission 2018 Stakeholder Event
on Biosimilar Medicinal Products
Biosimilars
Tailored educational material for
oncologists & patients
ESMO Colloquia on biosimilars during
ESMO 2018 & ESMO Asia 2018
European Commission 2018 Stakeholder Event
on Biosimilar Medicinal Products
SUSTAINABLE CANCER CARE
SUSTAINABLE CANCER CARE
COPING WITH ESCALATING HEALTHCARE COSTS IN 2017 AND BEYOND:THE ´WHERE TO´ NEXT
“I don´t think limits” - Usain Bolt,
retired Jamaican Sprinter
Neither should we.
SUSTAINABLE CANCER CARE
SUSTAINABLE CANCER CARE
Members of Public Policy
Steering Committee
Members of Magnitude of
Clinical Beneit Committee
Invitees to Cancer Medicines Committee
TF on Expensive Medicines
TF on Inexpensive Medicines
Name Name Name Name
Paolo CasaliElisabeth G. E. de Vries
Elisabeth G. E. de Vries
Elisabeth G. E. de Vries
Alexandru Eniu Jan Bogaerts Fatima Cardoso Paolo CasaliJosep Tabernero Nathan I. Cherny Paolo Casali Alex Eniu
Rosa Giuliani Urania DafniFortunato Ciardiello Fatima Cardoso
Fatima CardosoGeorge Pentheroudakis Alexandru Eniu
Jean-Yves Douillard
Martine J. Piccart Rosa GiulianiFortunato Ciardiello
Josep Tabernero Elisabeth de Vries Elisabeth de Vries
Christoph ZielinskiJean-Yves Douillard Rosa Giuliani
Ana Clopes Vlad Voiculescu Bill Evans Klaus Meier Maarten IJzerman Annete Freidank
Gilberto LopesBernhard Wörmann
Bengt Jonsson Franco Cavalli Francesco PerronePetar Stefanovski Jose Maria Borras Timur Ceric Rosanna TarriconeSmruti Koppikar
Leadership: Fortunato Ciardiello, Solange Peters, Jean-Yves Douillard, Keith McGregor, Rolf StahelESMO Staf: Malvika Vyas, Gracemarie Bricali, Nicola Latino, Monica Gheorghe
ACKNOWLEDGEMENTS
Other Stakeholders: WHO, EMA, EU, EORTC, ASCO, EUnetHTA, …VHIO: Amanda Wren
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