Vice President Joe Biden and Dr. Jill Biden host the national Biden Cancer Summit in Washington, D.C., on Friday September 21, 2018.


Africa is experiencing a cancer crisis that threatens both the current health and the future wellbeing of the continent. Inspired by the Biden Cancer Initiative’s ambitious goal of doubling the rate of progress against cancer, BIO Ventures for Global Health (BVGH)—through its African Access Initiative (AAI)—is committed to quadrupling progress in Africa by empowering local oncology professionals with the cancer care resources and capabilities available in high-income regions.

Africa’s cancer crisis is attributable to many complex and interrelated factors, including insufficient preventive, diagnostic, and treatment services; inadequate clinical and research infrastructure; and severe shortages of trained healthcare providers. Africa also has a high burden of infections that increase cancer risk. Many of the 64,000 and 82,000 annual liver and cervical cancer deaths, respectively,[1] could be prevented by hepatitis B and human papilloma virus (HPV) vaccines, which are not widely available on the continent. In addition, most cancers are diagnosed at a late stage, which contributes to poorer outcomes. For example, 5-year relative survival rates for breast cancer are 46% in Uganda and 12% in The Gambia, compared with 90% in the United States.[2]

Compounding the continent’s healthcare systems inadequacies are the unique tumor epidemiology and biology of patients of African descent (in Africa and globally), which suggest that diagnostic and therapeutic protocols developed for other ethnicities may not be optimal for African or African diaspora populations. Such population differences are particularly pronounced for breast and prostate cancers. The prevalence of triple-negative breast cancer—an especially aggressive tumor that lacks the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) and thus is not responsive to hormonal therapies (such as tamoxifen, aromatase inhibitors, or luteinizing hormone-releasing hormone agonists) or trastuzumab—has been estimated at 55% in Nigerian and Senegalese breast cancer patients[3] and 30% in African-American patients,[4] vs. 16% in Caucasian-American patients.[5] The International Agency for Research on Cancer has projected nearly 115,000 new breast cancer cases in sub-Saharan Africa in 2018.[6] Extrapolating the data on triple-negative breast cancer in Nigerian and Senegalese women yields an estimated 63,000 new cases of this deadly disease across the region this year. Similarly, the incidence of and mortality from prostate cancer, a common malignancy in both Africa and the United States, are greatly elevated in men of African ancestry.[7]

Urgent action is needed to stem the tide of Africa’s cancer epidemic. AAI is a global public-private partnership, developed and led by BVGH, that engages pharmaceutical and biotechnology companies, including Pfizer and Takeda; African governments and healthcare providers; and leading cancer centers to address the lack of access to quality clinical care that underlies the cancer crisis. Thirty-three hospitals across five countries – Cameroon, Côte d'Ivoire, Kenya, Nigeria, and Rwanda – are participating in AAI.

AAI activities are driven by the self-defined healthcare needs of participating countries and hospitals, as articulated in (1) comprehensive hospital needs assessments developed by BVGH, and (2) governments’ national cancer control plans (NCCPs). BVGH is pleased to announce the completion of 25 hospital needs assessments. These assessments have revealed the following critical cancer care needs, which align with the priorities defined by the NCCPs:

Affordable medicines for high-prevalence cancers including breast, cervical, colorectal, leukemia, liver, lymphoma, and prostate, which combined represent over 80% of adult cancers diagnosed across the AAI hospitals.

Diagnostic and treatment technologies, including imaging, pathology laboratory, and radiotherapy equipment. Immunohistochemistry (IHC) capabilities are particularly important for accurately assessing the ER, PR, and HER2 status of breast tumors, to properly differentiate patients who could benefit from hormonal therapies and trastuzumab from patients who will need alternative treatment. A study of Nigerian and Senegalese breast cancer patients found that 76% of their tumors were ER-negative, 80% were PR-negative, and 83% were HER2-negative.[8] The 25 hospitals that have completed needs assessments reported a total of over 6,900 breast cancer patients diagnosed annually. The ability to confidently determine breast tumor ER, PR, and HER2 expression at those hospitals could potentially prevent over 5,200 women each year from being treated inappropriately with hormonal therapies, and over 5,700 women annually from receiving trastuzumab, which would not be effective against their tumors.

Complementary training in key skillsets including diagnostic imaging and pathology; medical, radiation, and surgical oncology; oncology nursing and pharmacy; and clinical trials. AAI hospitals reported that they were well below their self-determined capacity—across these skillsets—needed to manage their cancer patient load. Of the above skillsets, medical oncology, radiation oncology, and oncology nursing are the most needed, with hospitals reporting capacities of 29%, 32%, and 37% of needed staff numbers, respectively.

With the results of the assessments in place, BVGH is engaging partners to address the identified needs through customized projects including:

Developing pricing models and coordinating agreements under which companies would provide African governments and hospitals with affordable, sustainable access to priority medicines. BVGH is partnering with the Nigerian Federal Ministry of Health to roll out a pilot drug access program at eight leading Nigerian hospitals. The Federal Ministry and BVGH held a Cancer Stakeholder Consultation with representatives from the eight hospitals and eminent cancer experts from the United States to finalize the list of drugs that will be included in the pilot program. The prioritized drugs are FDA-approved to treat the most common cancers in Nigeria including breast, cervical, colorectal, liver, and prostate.

Coordinating and managing training opportunities for African oncology professionals. Such opportunities include the placement of Merck & Co., Inc. (MSD) clinical trial and diagnostic laboratory experts at hospitals in Kenya and Rwanda for three-month training programs. BVGH and partners are also coordinating a breast cancer-specific diagnostic pathology workshop in Nigeria that will include training on the use of IHC to determine the ER/PR/HER2 status of tumors. In partnership with United States cancer experts, BVGH will launch a virtual mentorship program to assist Nigerian oncologists with the diagnosis and treatment of their patients.

Organizing the placement of and affordable purchase agreements for critical technologies. BVGH coordinated the placement of five laboratory instruments—donated by Pfizer—at a leading Nigerian hospital, thus supporting the hospital’s efficient and accurate diagnosis of cancer patients and informing the development of appropriate treatment plans for each patient.

Implementing the African Consortium for Cancer Clinical Trials (AC3T) to fast-track patient access to new and innovative cancer therapies and assess the efficacy and safety of such therapies in African populations and settings.

BVGH and its current partners are inviting additional pharmaceutical and biotechnology companies with strategic interests in cancer and Africa to join AAI in quadrupling progress against cancer on the continent through product access and capacity building. Please contact Jennifer Dent at jdent@bvgh.org for more information.

 

[1]International Agency for Research on Cancer, “Cancer Fact Sheets.” Cancer Today, 20 Sept. 2018 <http://gco.iarc.fr/today/fact-sheets-cancers>.
[2]Dent J, et al. BIO Ventures for Global Health. Africa’s emerging cancer crisis: a call to action [White paper]. Seattle: 2017.
[3]Huo D, et al. Population differences in breast cancer: survey in indigenous African women reveals over-representation of triple-negative breast cancer. J Clin Oncol. 2009 Sep 20;27(27):4515-21.
[4]Newman LA and Kaljee LM. Health Disparities and Triple-Negative Breast Cancer in African American Women: A Review. JAMA Surg. 2017 May 1;152(5):485-493.
[5]Newman LA and Kaljee LM. Health Disparities and Triple-Negative Breast Cancer in African American Women: A Review. JAMA Surg. 2017 May 1;152(5):485-493.
[6]International Agency for Research on Cancer, “Cancer Fact Sheets.” Cancer Today, 20 Sept. 2018 <http://gco.iarc.fr/today/fact-sheets-cancers>.
[7]Lachance J, et al. Genetic Hitchhiking and Population Bottlenecks Contribute to Prostate Cancer Disparities in Men of African Descent. Cancer Res. 2018 May 1;78(9):2432-2443.
[8]Huo D, et al. Population differences in breast cancer: survey in indigenous African women reveals over-representation of triple-negative breast cancer. J Clin Oncol. 2009 Sep 20;27(27):4515-21.

To learn more about AAI, contact Katy Graef