Our knowledge about cancer is continuously increasing. We know by now that cancer is caused by changes (mutations) in your DNA. These changes are different in each tumor, so that in effect each tumor is unique. We don’t know enough yet about how all those unique tumors respond to the different treatments. This means that patients sometimes get medication which is not sufficiently effective for his or her type of cancer. At present the medication you get as a patient is still determined by the type of (organ) cancer you have. On average the medication you get only works for 30%. How can we increase that percentage.
In order to improve the care for cancer patients and to be able to offer personalised treatment, we need data: the genetic and clinical information of as many as possible cancer patients. This means Hartwig Medical Foundation gathers tumor specific characteristics of patients, (clinical) treatment data and its results.
Hartwig Medical Foundation analyses blood and tumor tissue of patients and maps the complete DNA of patients with metastatic tumors. This is done in a so-called predictive DNA test (Whole Genome Sequencing).
In a patient report all identified cancer-related DNA defects are fed back to the treating physician and to the patient. As a result the patient sometimes qualifies for participation in a trial or other treatment. All genetic and clinical data are stored in a DNA database. Researchers use these data to offer future patients even better care.
The gathering of tumor specific characteristics and (clinical) data of patients is done jointly by 44 Dutch hospitals, as part of the CPCT-02 study. Doctors ask their patients suffering from metastatic cancer to give a biopsy and blood. The blood and the biopsy are sent to Hartwig Medical Foundation for analysis.
Hartwig Medical Foundation visualizes the patients DNA-mutations and other tumor specific characteristics using Whole Genome Sequencing techniques and bio informatic analyses. The treating specialist subsequently receives a patient report, as part of a clincial study, containing a complete overview of the specific DNA defects of the tumor and all its characteristics. The reports gives all possible treatment options, for example off label use medicine or clinical trials (experimental studies) in which a patient could participate.
All genetic and clinical data (including treatment results) of thousands of patients suffering from metastatic cancer in The Netherlands, are being filed in a national DNA-database. The database is constantly growing with patient data each month. It offers unique chances for research into new biomarkers and for the ability to better distinguish patient groups for treatment. Biomarkers give information on the characteristics of the tumor an can provide information on how the cancer develops, the choice for an effect of a treatment. Many researchers already use these data for their research. In doing so they has to contribute to a continuous improvement of cancer treatment.
Each year about 110,000 people contract cancer in The Netherlands, 40,000 of whom suffer from metastatic cancer. The number of cancer patients is still increasing, as is the number of expensive cancer treatments. The ten most expensive medications in cancer care for patients with metastatic cancer cost one billion euros in 2020, of which only 30 per cent was effective.
This means that per year 700 million euros is spent on ineffective medication and that patients suffer the burden of overtreatment (source: ZiNL). If we can improve predictions by 10% we can save 70 million euros per year in The Netherlands on overtreatment costs based on the ten most expensive cancer medications only.
Since 2012 the Ministry of Health, Welfare and Sport has been funding the Good Use of Medication programme (Dutch) of ZonMw (the Dutch Organisation for Health Research and Development). In communications from the Minister of Health, Welfare and Sport to Parliament, the Minister states that accessibility of new medication at acceptable prices to the patient is a key policy objective (Dutch) of the Ministry. The Ministry further states that apart from various efforts to establish lasting change in the pharmaceutical sector and tackling extremely high prices, in the coming years the emphasis should also be on the appropriate (good) use of medication.
Hartwig Medical Foundation is committed to contribute to the various efforts from the (healthcare) sector which will eventually lead to the appropriate use of medication and thus to better care for the patient. To this effect the Ministry applies the following 6 points: 1) research, 2) the role of appropriate use with regard to the reimbursement of medication, 3) appropriate use of available alternatives – biosimilars, 4) registers, 5) information for patients and finally, 6) further consultation on initiatives to promote appropriate use.
With the predictive DNA test performed by Hartwig Medical Foundation, it can in some cases be predicted (to a certain extent) for which patients certain cancer medication is going to be effective or not. Apart from the prevention of all side effects for the patient, it may also result in a substantial reduction of the treatment costs. The costs of a DNA analysis are negligible compared to the costs of treatment. The centralised effort of Hartwig Medical Foundation guarantees uniform and high quality genetic data for all cancer patients in The Netherlands and optimises the use of relatively expensive equipment and staff. This means that for our collective healthcare system the introduction of new promising technology and medication remains affordable.
Various Dutch healthcare insurers are enthusiastic about the approach and objectives of Hartwig Medical Foundation and encourage further developments.
The national database of Hartwig Medical Foundation can give clarity about all current medication provided by the pharmaceutical industry. This includes the large quantities of targeted drugs, often only intended for certain specific types of cancer.
Besides, in the future aided by the analysis techniques and pseudonymised parts of the database provided by Hartwig Medical Foundation the pharmaceutical industry may develop even better targeted experimental medication. Also, future promising treatments involving for instance immunotherapy may benefit from this. This way, new medication may be available to the right patient faster.