Medical and surgical management of metastatic bowel cancer (mCRC) has improved over recent years, but treatments for mCRC patients that deliver even modest incremental life-extending benefits remain limited compared to those available for patients with other common cancers.
With just over one in ten (13.4%) mCRC patients surviving five years after diagnosis, there is a clear clinical need for new treatment options.
On 18 August 2020, the House of Representatives Standing Committee on Health, Aged Care and Sport established an inquiry into the approval processes for new drugs and novel medical technologies in Australia, with a particular focus on the treatment of rare diseases and conditions where there is a high and unmet clinical need.
In our submission, Bowel Cancer Australia highlighted the limited number of treatment options available for metastatic bowel cancer patients, despite bowel cancer being the third most diagnosed cancer and Australia’s second deadliest cancer, claiming more than 100 lives each week.
When detected early, nearly 99% of bowel cancer cases can be successfully treated, but up to half of the estimated 16,938 Australians diagnosed with bowel cancer each year already have metastatic disease at diagnosis or will go on to develop it.
The Inquiry is about Australians who are waiting for access to therapies that are often a standard of care globally but are currently unavailable in Australia. In recognition of this, Bowel Cancer Australia placed the patient experience at the forefront of our submission.
One of those patients was Nicole Cooper, who was diagnosed with Stage IV bowel cancer at age 32, just eight months after becoming a mum.
“I was told my fate was all but sealed: the statistics for people with my cancer, at the late stage we found it, were terrible, and I would be lucky to live past 18 months,” Nicole said.
“I would be given palliative chemotherapy to try to delay the inevitable. But the medical and surgical teams all agreed: my diseased liver was inoperable, and eventually, the cancer that had ripped through my bowel and liver would take the rest of me.
“I chose to get a second opinion. The second opinion was this: my situation was dire, but not without hope.
“The chemotherapy regime I had been offered was adequate, perhaps in a scenario when all other therapies had been exhausted; but we were at the start of my life fight when there were still many paths to test. Diagnostic tools to leverage. PET scans. Genomic testing. Global gold-standard therapies. Novel treatments. And the longer we could keep me alive, the more chances we had.
“I chose option two. Three and a half years after my diagnosis, I am alive.
“I have had more than thirty rounds of chemotherapy. A bowel resection. Two liver resections. Six lung resections. And at this moment - I have no cancer.
“Cancer is Australia’s most significant disease burden. One in thirteen Australian’s will face a bowel cancer diagnosis in their lifetime. Yet, Australian’s cannot reasonably expect to be connected with today’s best practice cancer medicine, let alone new drugs and novel medical technologies,” said Nicole.
“Median overall survival rates for patients with metastatic bowel cancer have increased over the last three decades from 5 months to 34 months. I am contributing to that improving statistic, thanks to the bold and innovative management of my cancer by my care team.
“Folfirinox, my first-line treatment, has been established as a valuable therapeutic tool in patients with unresectable liver metastases. Similarly, dual immune-checkpoint blockade is a proven therapy for MSI-high colorectal cancers, and BRAF or MEK inhibition has been demonstrated as valuable for BRAF-positive subgroups.
“Yet, access to these therapies is severely limited in Australia, be it by a patient’s inability to fund a drug’s exorbitant price, by the lack of practitioner awareness of their application, and/or by a lack of commitment in the medical profession to match the patient to the therapy most likely to save or extend their life.
“There must be a better way to do cancer. A more efficient way, that leverages global best practice, aligns drug approval processes and fast tracks critical drug funding.
“Sitting in a body that is now free of cancer, two years beyond my heralded expiry date, I know my medical team still hold a bag of alternative plans - new drugs, novel therapies - and are looking every day for ideas to add to their stash. This degree of world-leading, game-changing cancer care is every Australian cancer patient’s expectation and should be their right,” Nicole said.
Bowel Cancer Australia is committed to ensuring better health and patient outcomes irrespective of stage at diagnosis - whether it be greater access to bowel cancer screening; timely access to colonoscopy and surgery; or access to affordable treatment options for the 52,892 Australians currently living with or beyond the disease.
The charity has been and will continue to be a strong advocate for a streamlined approval process for effective treatments for bowel cancer.
The AIHW identifies bowel cancer as a chronic disease. At Bowel Cancer Australia, we know that timely access to affordable treatment options will help make this a reality, by enabling more bowel cancer patients with metastatic disease to live their best possible life.