The new risk-sharing paradigm in rare cancers: Patient perspective

Advances in understanding the biology of rare cancers and in genomic technologies are reshaping drug development and are fostering patients' hopes because an increasing number of drugs are expected to be made available. However, timely patient access to innovative drugs in rare cancers continues to encounter methodological and regulatory hurdles in an environment more and more characterised by limited resources and health systems under pressure. Decisions on drug pricing and reimbursement often delay access to authorised drugs at national or even regional level. Regulatory and economic issues raise ethical problems. Rare cancer patients have a right to the same quality treatments as all other patients: the higher degree of uncertainty, due to the so-called “intrinsic lack of or defect in evidence” of these diseases, should be addressed by all the different stakeholders to prevent it from being the cause of discrimination against these patients. This challenging goal may be achieved by the adoption of the new ongoing paradigm able to take into consideration both the interdependence of all parties involved, their different drivers and their capability of risk-sharing, starting from the real “core driver,” which can be summarised in the words of a patient: “When you are faced with a rare cancer, you really can't wait.”