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. 2022 Sep 30;29(10):7257-7271.
doi: 10.3390/curroncol29100572.

Precision Oncology in Canada: Converting Vision to Reality with Lessons from International Programs

Geoffrey Liu  1   2 , Winson Y Cheung  3   4 , Harriet Feilotter  5   6 , Jackie Manthorne  7 , Tracy Stockley  8   9 , ManTek Yeung  10 , Daniel J Renouf  11   12
Affiliations

Precision Oncology in Canada: Converting Vision to Reality with Lessons from International Programs

Geoffrey Liu et al. Curr Oncol. .

Abstract

Canada's healthcare system, like others worldwide, is immersed in a process of evolution, attempting to adapt conventional frameworks of health technology assessment (HTA) and funding models to a new landscape of precision medicine in oncology. In particular, the need for real-world evidence in Canada is not matched by the necessary infrastructure and technologies required to integrate genomic and clinical data. Since healthcare systems in many developed nations face similar challenges, we adopted a solutions-based approach and conducted a search of worldwide programs in personalized medicine, with an emphasis on precision oncology. This search strategy included review articles published between 1 January 2016 and 1 March 2021 and hand-searches of their reference lists for relevant publications back to 1 December 2005. Thirty-nine initiatives across 37 countries in Europe, Australasia, Africa, and the Americas had the potential to lead to real-world data (RWD) on the clinical utility of oncology biomarkers. We highlight four initiatives with helpful lessons for Canada: Genomic Medicine France 2025, UNICANCER, the German Medical Informatics Initiative, and CANCER-ID. Among the 35 other programs evaluated, the main themes included the need for collaboration and systems to support data harmonization across multiple jurisdictions. In order to generate RWD in precision oncology that will prove acceptable to HTA bodies, Canada must take a national approach to biomarker strategy and unite all stakeholders at the highest level to overcome jurisdictional and technological barriers.

Keywords: clinical utility; funding; next-generation sequencing; personalized medicine; precision medicine; precision oncology; real-world evidence; tumour-agnostic.

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Conflict of interest statement

We have read and understood Current Oncology’s policy on conflicts of interest disclosure and declare the following interests: Winson Cheung has received funding for research from AstraZeneca, Bayer, GlaxoSmithKline, Janssen, Pfizer, Roche, and Taiho. Tracy Stockley has received honoraria from and sat on advisory boards for Amgen, Astellas, AstraZeneca, Bayer, Bristol Myers Squibb, Janssen, Merck, Novartis, and Pfizer. She has received funding for studies at Princess Margaret Cancer Centre (Toronto, ON, Canada) and/or performed educational sessions for AstraZeneca and Pfizer. Geoffrey Liu has received honoraria from and has sat on advisory boards for Merck, AstraZeneca, Hoffmann-La Roche, Takeda, Pfizer, Bristol Myers Squibb, Novartis, Eli Lilly, and AbbVie. He has received funding for studies at Princess Margaret Cancer Centre and/or performed educational sessions for AstraZeneca, Takeda, Boehringer Ingelheim, and EMD Serono. Harriet Feilotter has received honoraria from, sat on advisory boards for, and/or performed educational sessions for AstraZeneca, Roche, EMD Serono, Novartis, Bayer, Pfizer, and Astellas. She has received research funding from Bayer, EMD Serono, AstraZeneca, ThermoFisher, Amgen, Roche, Delphi Diagnostics, Canexia Health, and Eli Lilly. Daniel Renouf’s disclosures include research funding and honoraria from Bayer and Roche, and travel funding and honoraria from Servier, Celgene, Taiho, Ipsen, and AstraZeneca. Jackie Manthorne is representing the Canadian Cancer Survivor Network, and any funding received for representation of the network on advisory panels or committees has been directed to the network and not to Manthorne in either a personal or professional capacity.

Figures

Figure 1
Figure 1
The Genomic Medicine France 2025 initiative provides one model for nationwide sharing of cancer genomic data. Shown here are two hubs where data are generated and disseminated. The Collecteur analyseur de données (CAD) in Paris is a National Center for Intensive Calculation, capable of processing and analyzing large volumes of data and providing primary services for professional healthcare providers in the framework of their care pathways (in silico tests, and aids to decision-making in diagnosis, establishing prognosis, and designing therapeutic strategies). The town of Évry has established a Centre de Référence, d’Innovation, d’eXpertise et de transfert (CRefIX) through public–private partnerships with key national players. Other such hubs can be established using the process outlined here. R&D, Research and Development.
Figure 2
Figure 2
UNICANCER, another French initiative, structured its network of Comprehensive Cancer Centers around seven inter-regions corresponding to a set of regional research coordination centres, or ‘canceropoles’. These include: Grand Ouest (West), Grand Sud Ouest (South-West), Île-de-France (Paris and suburbs), Nord Ouest (North-West), LARA (Lyon, Auvergne, Rhône-Alpes), and PACA (South-East areas). The canceropoles work in association at the territorial level with teams from state-funded scientific organizations (including the Institut National de la Santé et de la Recherche Médicale, the Centre National de la Recherche Scientifique, and universities), university teaching hospitals, FCCCs, the pharmaceutical industry, and players in biotechnology, with the aim of enhancing cooperation and data sharing. FCCC, French Comprehensive Cancer Center.
Figure 3
Figure 3
The German Medical Informatics Initiative. The German Federal Ministry of Education and Research provides funding to several consortia within the scope of its Medical Informatics Initiative. Each consortium comprises multiple university hospitals, plus additional partners such as research and higher education institutions, businesses, and non-university hospitals. The consortia work together to create a cross-organizational basis for the exchange of data from research and patient care.
Figure 4
Figure 4
The CANCER-ID Project, operating across multiple countries in Western Europe as well as in the USA, provides a model for sharing of genomic data, specifically for the implementation of liquid biopsies in cancer care. The consortium partners comprise a network of experts in the fields of tumour biology, biomarker development, clinical sciences, and bioinformatics.
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