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Norwegian cancer initiatives receive international attention

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Norway is pioneering precision medicine in cancer with three nation-wide initiatives.

Norway is breaking new ground for precision cancer medicine implementation with three national initiatives that are highlighted in the latest issue of the academic journal Nature Medicine. The article shows the broad stakeholder involvement in the initiatives with 116 contributors with 80 different affiliations.

Kjetil Taskén, Head and Director of Institute of Cancer Research at Oslo University Hospital (OUS). Photo: OUS

Kjetil Taskén, Head and Director of Institute of Cancer Research at Oslo University Hospital (OUS). Photo: OUS

“These initiatives represent a triple-win effect,” said Kjetil Taskén, Head and Director of Institute of Cancer Research at Oslo University Hospital and Professor at University of Oslo. “The patients gain access to modern treatments; the researchers can investigate the effect of different medicines on new indications; and the industry can expand the application of their drugs.”

The three initiatives

  • InPreD is a service for precision diagnostics organised as a national infrastructure within the specialist health service. 
  • IMPRESS-Norway is a nation-wide clinical trial evaluating the efficacy of anti-cancer drugs on new indications. 
  • CONNECT is a consortium of public and private stakeholders driving the implementation of precision cancer medicine in Norway. 

Precision diagnostics for patients

Recent developments in precision medicine offer new medical opportunities for cancer patients, which has ignited a debate in Norway about access to more modern treatments. Though equal access is ensured through Norway’s universal health coverage, the medical possibilities challenge public budgets and has led to delayed access for some patient groups.

“There is a growing, worrying split in the health service, where some patients feel compelled to buy diagnostics and treatments at private clinics, when the opportunity does not exist in the public sector,” said Ingrid Stenstadvold Ross, General Secretary of the Norwegian Cancer Society. “These initiatives are spearheading new solutions for seriously ill cancer patients, wherever they live in Norway, and demonstrate what is possible to accomplish with public-private collaboration.”

Norway is one of the first countries in Europe to have a reimbursement scheme, with additional financial support from the regional health authorities to hospitals, for the gene panel test via InPreD. The infrastructure is being set up at all university hospitals in Norway and patients from all Norwegian hospitals can be referred to InPreD. It is currently only available to patients with no other treatment options. The results from the test are discussed in a weekly molecular tumour board that refers patients to clinical follow-up, IMPRESS or other clinical trials.

Åslaug Helland

Åslaug Helland from Oslo University Hospital presented IMPRESS-Norway at Nordic Precision Medicine Forum 2022 in Stockholm. Photo: Åsmund Flobak

InPreD has screened more than 359 patients, of which 67 patients have been included into treatment cohorts in IMPRESS, as of April 2022. An additional 10-15 per cent of screened patients have been assigned to another clinical trial or drugs through compassionate use programmes. This means about 40 per cent of screened patients have received a new treatment option.

“This is about leaving no stone unturned, about finding drugs for patients who wouldn’t have gotten it otherwise. We want to serve the needs that the patients have in terms of modern treatments in the public healthcare system,” said Taskén.

Clinical trial offers new hope

There are currently 16 drugs available in IMPRESS and the goal is to include 23 drugs by the end of 2022. The first pharmaceutical company to join was Roche, providing eight drugs in January 2021. Novartis entered IMPRESS as second partner in 2021, now contributing four cancer medicines.  

“These initiatives offer patients who have exhausted available treatments, a chance for new treatment options and hope,” said Eli Bergli, Medical Head Oncology, Novartis Norway. “Novartis is proud to be part of the implementation of precision diagnostics, so patients can receive a tailor-made treatment for their disease. These innovative partnerships, where public sector, academia and private industry collaborate in finding the best solutions for the future of healthcare, are ground-breaking and offer patients early access to new innovative treatments.”

“InPreD, IMPRESS and CONNECT are core initiatives for the implementation of precision medicine in Norway, and Roche is a proud partner,” agreed Kristin Krogsrud, Healthcare System Partner, in Roche Norway. “In addition to the important goals of establishing genetic testing in clinical practice and generation of scientific data, we see the work around development and piloting novel reimbursement methods as key to be able to improve patient’s access to personalized treatment.”

The four Norwegian regional health authorities recently decided to reimburse drugs in Stage 3 cohorts in the IMPRESS trial. The pharmaceutical industry pays for the first 16 weeks and, if the patient achieves a response after 16 weeks in the trial, the treatments can be reimbursed permanently from the public healthcare system. This is the first mechanism for a pay-for-performance model in precision cancer medicine in Norway ever.

Jan Frich, Deputy Chief Executive Officer at South-Eastern Norway Regional Health Authority.

Jan Frich, Deputy Chief Executive Officer at South-Eastern Norway Regional Health Authority.

“We have had a great and close collaboration with the hospitals in the establishment of a national infrastructure in the Specialist Health Service for precision diagnostics in the cancer field (InPreD),” said Jan Frich, Deputy Chief Executive Officer at South-Eastern Norway Regional Health Authority. “The high inclusion numbers in the IMPRESS-study after referral from InPreD confirm that we are on the way to succeeding in establishing the necessary ecosystem for advanced diagnostics and clinical studies in the Specialist Health Service. This is something we are very proud of.”

Connecting public with private

The third initiative is CONNECT, a public-private consortium consisting of 28 partners, with Oslo Cancer Cluster being the project coordinator. The common goal is to drive the implementation of precision cancer medicine in Norway.

“Oslo Cancer Cluster is a neutral facilitator and an intermediator between public and private. They have been with us since we started working on these national initiatives. Among other things, Oslo Cancer Cluster has been a great supporter in bringing in the pharmaceutical companies in IMPRESS,” said Taskén.

The Norwegian Health Directorate is one of the observers in CONNECT and a coordinator for the National Strategy for Precision Medicine. 

“We follow the work in CONNECT with great interest as it investigates new ways of implementing precision medicine,” said Grethe Foss, Project Leader for Precision Medicine at the Norwegian Health Directorate. 

Taskén stresses one reason for the success of these initiatives is that they are not about profiling individual institutions or people but about coming together with shared objectives. 

“There has been trust and we have been able to act together. The fact that these initiatives now receive international attention can hopefully lead to an expansion of our efforts, that more companies and institutions join, so that more cancer patients gain access to the cancer treatments of the future.”

 

Learn more

Fremtidens kreftbehandling frokostmøte 2022

Challenged politicians about cancer

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Where are the Norwegian political ambitions for cancer treatment? We need more public-private collaboration on cancer.

Breakfast and political conversations on cancer are the hallmark for our meeting series Fremtidens kreftbehandling. On 21 April 2022, health officials, politicians, patient spokespeople and industry representatives met to discuss the future of cancer treatments. They all agreed: we need more public-private collaboration on cancer.

As introduction, Ketil Widerberg, general manager of Oslo Cancer Cluster, presented the results from a recent survey by Kantar of the Norwegian population’s views on health policy. The survey showed a majority want more modern cancer treatments with less side effects at public hospitals. They want the same treatment options as in other Nordic countries. They also think the public health service should pay for cancer treatments that work.

“We believe cancer can go from being a deadly disease to a disease people live well with, but we can’t get new treatments to the patients if the public and private sector don’t work together,” Widerberg said. “When we build roads, we assess the economy on a broader scale than when we assess new treatments. Is this really the kind of politics we want?”

A cancer revolution underway

The people’s wishes are clear, but how can doctors offer more modern treatments to their patients? In the first panel discussion, Anne Karin Rime, president of the Norwegian Medical Association, Jan Frich, deputy CEO of the South-Eastern Regional Health Authority, and Ingrid Stenstadvold Ross, general secretary of the Norwegian Cancer Society discussed how patients can gain access to precision medicine, which means the right treatment to the right patient at the right time.

“We are living in a kind of cancer revolution. There are many extremely promising treatments on the way, especially in precision medicine,” Stenstadvold Ross said. “The current system assesses the cost and effect of a treatment by looking at an average patient group. For lung cancer, it will typically be 60-plus men with a history of smoking, but if I developed lung cancer, my characteristics wouldn’t fit this description.”

Rime argued that these new, revolutionary medicines have made the doctor’s job more complicated.

“The role of the doctor has changed from deciding the best treatment for the patient. Now the doctor also needs to think about society as a whole: what can we afford to treat? It is extremely difficult for a doctor to know there are treatments or diagnostics that may help the patient, which they can’t offer,” said Rime. “Diagnostics become more important now and offering genetic tests to all patients to identify which treatment will work.”

Frich agreed that more precise diagnostics is the solution.

“The key to personalised treatment is good diagnostics,” Frich commented. “The last two-three years, much has happened in personalised medicine. We have created a national plan for advanced diagnostics and set aside resources for this. An infrastructure for precision diagnostics is being built. The CONNECT collaboration with the pharmaceutical industry work on a large clinical study called IMPRESS, which is supported with NOK 60 million from the regional health authorities.”

Make your voice heard

The system needs to change so that patients can take part in the cancer revolution. Gloria Traina is a PhD and advisor at the Specialist Health Section in the Norwegian Ministry of Health and Care Services. They are working on a Strategy for Personalised Medicine to be launched before 2023.

“There has been some success getting precision medicine to Norway and there are many new initiatives, including InPred, IMPRESS and CONNECT. We now see there is a need for a revised strategy,” Traina explained.

More public-private collaboration

While the new strategy materialises, patients are still waiting for access to better treatments. In the debate, politicians were challenged to declare their ambitions for Norway.

”I want to see more political vision. The European Union has launched a Cancer Mission, the goal is to improve the lives of 3 million people by 2030. What are Norway’s ambitions?” Stenstadvold Ross asked.

“We need to look at how we rig the decision-making systems, for example by involving clinicians and patients, how we attract clinical studies and how we implement personalised medicine,” Karl Kristian Bekeng from the Labour Party (Arbeiderpartiet) said. “When it comes to collaboration on new technologies and new medicines, there should be a lot more public-private collaboration. This should not be a replacement of the public health service, but an improvement of the public health service.”

Sylvi Listhaug from the Progress Party Association (Fremskrittspartiet) criticised the decision-making system.

“I think many patients – and the population as a whole – question why Norway is so late in implementing new medicines that can save lives and give better quality of life. I also think there are many desperate doctors, who see there are medicines that can give their patients a better life, which they can’t offer. The way we do this in Norway is completely out-dated. It doesn’t work. We are putting forward a new bill to Parliament now to change the whole system,” Listhaug announced.

Hege Edvardsen, senior adviser in LMI, represented the pharmaceutical industry in the debate and challenged the politicians to become more hands-on.

“We see that political decisions do not agree with what is actually delivered in the health service,” said Edvardsen, “It is important to strengthen the public-private collaboration. We have done a lot in oncology, but we are still struggling to get access to new treatments and we are lagging behind other Nordic countries. We need to consider the entire ecosystem when we talk about these things. If we wish to increase the number of clinical studies and attract research investments to Norway, we must also become better at solving the access part.”

The meeting also included mingling between the participants and the audience, which sparked further conversations and reflections. The debate will continue in our communication channels and at our next meeting during Arendalsuka at Clarion Hotel Tyholmen on 18 August 2022 (08:00-09:30). We hope to see you there!

Watch the meeting here (in Norwegian):

 

 

This meeting was a collaboration between Oslo Cancer Cluster, Norwegian Cancer Society, LMI, AstraZeneca, Janssen and MSD.

logos of organising partners

 

New partners join precision medicine consortium

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Five new partners have joined CONNECT, a public-private consortium driving the implementation of precision cancer medicine in Norway, coordinated by Oslo Cancer Cluster.

The five latest additions to the public-private consortium CONNECT include the Norwegian Directorate of Health (Helsedirektoratet), the Norwegian Medicines Agency (Statens Legemiddelverk), and pharmaceutical companies Lilly, MSD and Janssen.

The Norwegian Directorate of Health and the Norwegian Medicines Agency are the most recent public partners to join this unique national public-private partnership.

“The Norwegian Medicines Agency is happy to have joined CONNECT as an observer. Personalised medicine is currently high on the agenda, and we look forward to the extended opportunity for dialogue with national and international stakeholders, provided by CONNECT,” said Karen Marie Ulshagen, Strategic Director, Timely Access, Norwegian Medicines Agency.

The ten pharma companies who co-founded CONNECT in December 2020 are now accompanied by Lilly, MSD and Janssen, all sharing the same vision to drive the implementation of precision cancer medicine in Norway.

“CONNECT represents a collective effort between partners in the healthcare industry (private, public and voluntary sectors) and has the potential to build a culture which fosters innovation, collaboration and development of competency with the increased benefit for the individual patient as the core priority,” said Hilde Enserink, interim Medical Director and Oncology Lead, MSD Norway.

“With our focus on precision cancer medicine in our pipeline and our belief that dialogue and co-operation between all stakeholders is the right way forward, CONNECT fits very well with our purpose in Janssen. In the end though, it is the patients that matter the most and we hope CONNECT will eventually lead to a wider and earlier access to new precision cancer medicines for cancer patients in Norway,” said Sverrir Valgardsson, Medical Affairs Lead, Janssen Norway.

Ravinder Singh, Senior Clinical Research Scientist, Nordic Medical Lead, Lilly, complemented: “The implementation of precision medicine in Norway is a very important measure for Norwegian cancer patients, but at the same time very challenging considering the technological, medical, and regulatory aspects. A united front to facilitate precision medicine, where the pharmaceutical industry is seen as a partner rather than a financial contributor, will be of use for the academic milieu, the industry itself and for Norwegian cancer patients.”

Other CONNECT partners are the Norwegian Pharmaceutical Industry Association (Legemiddelindustrien – LMI), the Norwegian Cancer Society (Kreftforeningen), the Norwegian Institute of Public Health (Folkehelseinstituttet) and the tech companies NEC and PubGene. The unique blend of participants enables CONNECT to address current obstacles facing precision cancer medicine in Norway.

Gathering experts to find new solutions

CONNECT was initiated by 22 founding partners in December 2020 and is coordinated by Oslo Cancer Cluster.

Since its establishment, CONNECT has carried out its activities through four working groups gathering experts from the different university hospitals, authorities, industry and the Norwegian Cancer Society. The working groups had regular digital meetings since February 2021, where they created a joint understanding of the challenges and opportunities associated with the introduction of cancer precision medicine in a public healthcare setting and started the first initiatives.

CONNECT has also offered open, educational meetings and some are still available to be viewed via the CONNECT webpage Recordings of past events.

The next public meeting will take place during Arendalsuka and be held in Norwegian. The topic is How to succeed with precision cancer medicine – Research and collaboration that brings us further. The event will include conversations about emerging research and treatment opportunities for cancer patients in Norway.

Collaborating with national clinical study

CONNECT has facilitated dialogue meetings between industry representatives and the national initiatives IMPRESS-Norway and InPreD.

IMPRESS-Norway is a national clinical study in precision cancer medicine, which is testing off-label treatments on cancer patients based on molecular changes in the patient’s tumour. Patients with advanced cancer disease can receive molecular diagnostics through InPreD (Infrastructure for Precision Diagnostics) and are discussed in a national molecular tumour board. Patients who are eligible for the treatments available in IMPRESS are then offered to participate in the clinical study.

The pharmaceutical company Novartis agreed this week to contribute six new medicines to IMPRESS-Norway to treat up to one hundred patients. More information about this will be published in English next week.

 

The speakers, chairpersons, introducers and organizers of Cancer Crosslinks 2020Oslo Cancer Cluster

Cancer Crosslinks 2020

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Engaging presentations by leading international and Norwegian oncology experts at the 12th Cancer Crosslinks “Progress in Cancer Care – A tsunami of promises or Game Changing Strategies?”.

Oslo Cancer Cluster’s annual meeting gathered more than 350 delegates from all over Norway at the Oslo Cancer Cluster Innovation Park, and more than 50 participants followed the live stream. The record high participation shows the large interest in translational cancer research and the importance of the programme for the Norwegian oncology community.

Cancer Crosslinks has become one of the largest national meeting places for oncologists, haematologists, translational researchers, regulatory experts and industry representatives. The meeting offers a full day educational program.

The aim of the conference is to stimulate broader interactions between researchers and clinicians, to encourage translational and clinical research, and to inspire collaborations. Novel partnerships between industry, academia and authorities are essential to deliver new treatments and diagnostics to Norwegian cancer patients.

“At the start of 2020, cancer patients have more treatment options than ever before. Immuno-oncology is firmly established as the fourth pillar of cancer treatment and the tremendous progress in the field is reflected in increased survival rates,” said Jutta Heix, Head of International Affairs, Oslo Cancer Cluster. “However, many patients do not benefit from novel treatments and we still have significant gaps in our understanding of the complex biological mechanisms. Deciphering this complexity is a task for the decade to come. The Cancer Crosslinks 2020 speakers are shedding light on emerging concepts and key challenges and discuss how they are addressing them to advance cancer care.”

The audience at Cancer Crosslinks 2020.

The audience at Cancer Crosslinks 2020. Photo: Cameo Productions UB/Oslo Cancer Cluster

An inspiring programme

Referring to a record number of new oncology drug approvals in recent years and an enormous global pipeline of drugs in late-stage development, this year’s programme addressed the question “Progress in Cancer Care – A Tsunami of Promises or Game-Changing Strategies?”. Distinguished international experts from leading centres in the US and Europe presented emerging concepts, recent progress and key questions to be addressed for both solid and haematological cancers.

Cancer researchers and clinicians from all of Norway enjoyed excellent presentations and engaging discussions with speakers and colleagues.

“Cancer Crosslinks 2020 gave me an opportunity to listen to talks by international top scientists, and discuss some of the latest developments in translational cancer research with meeting participants from academia and industry in a relaxed and inspiring setting,” said Johanna Olweus, Head of Department of Cancer Immunology at the Institute for Cancer Research.

“Cancer Crosslinks is always a meeting that makes me proud of being part of Oslo Cancer Cluster. It is inspiring to see Norwegian and international participants come together to discuss recent progress in cancer research and how to develop cancer treatments for the patients,” said Øyvind Kongstun Arnesen, Chairman of the Board, Oslo Cancer Cluster.

The day programme was complemented with an evening reception in the city center where speakers and delegates continued their lively discussions and listened to an inspiring talk by Ole Petter Ottersen, President of Karolinska Institute, at Hotel Continental in Oslo.

Cancer Crosslinks was established by Oslo Cancer Cluster in 2009 in collaboration with the pharmaceutical company Bristol-Myers Squibb.

“Cancer Crosslinks 2020 has been a fantastic conference, where the presenters have given an excellent description of current and near future achievements within cancer research and the importance of understanding the underlying biology of cancer to rationally give patients the correct cancer therapy. In particular within immunotherapy, there is a need to understand the dynamic complexity of tumor immunology and how to apply the best and tailored immuno-oncology based treatment strategy for cancer patients,” said Ali Areffard, Disease Area Specialist Immuno-Oncology, Bristol-Myers Squibb.

This year, the pharmaceutical company Sanofi Genzyme Norway was a proud co-sponsor of the meeting.

“It was great to be able to provide a platform for interaction between the Norwegian scientific cancer environment and top international research capacities. Therefore, it was with huge enthusiasm Sanofi Genzyme co-sponsored this important conference. New treatment options in oncology are developing fast, where new treatment modalities provide clinicians with additional and superior options. New treatments specifically targeting the malignant cells, as well as activating the host immune response towards the cancer, provides tools to significantly improve current cancer treatments. This year’s Cancer Crosslinks conference gave an excellent insight into this,” said Knut Steffensen, Medical Advisor Hematology Nordic & Baltics, Sanofi Genzyme.

Interview with Prof. Jason Luke

View the interview with Prof. Jason Luke, by HealthTalk, in the video below:

Interview with Prof. Michel Sadelain

View the interview with Prof. Michel Sadelain, by HealthTalk, in the video below:

The speakers at Cancer Crosslinks 2020

Jason J. Luke, Director of the Cancer Immunotherapeutics Center, Associate Professor of Medicine, University of Pittsburgh Medical Center and Hillman Cancer Center

Jason J. Luke, MD, FACP, Director of the Cancer Immunotherapeutics Center, Associate Professor of Medicine, University of Pittsburgh Medical Center and Hillman Cancer Center, USA. Photo: Cameo UB Productions/Oslo Cancer Cluster

Stefani Spranger, Howard S. and Linda B. Stern Career Development Assistant Professor, Koch Institute for Integrative Cancer Research at MIT, Cambridge

Stefani Spranger, Howard S. and Linda B. Stern Career Development Assistant Professor, Koch Institute for Integrative Cancer Research at MIT, Cambridge, USA. Photo: Cameo UB Productions/Oslo Cancer Cluster

Harriet Wikman, Professor, Group Leader, Center for Experimental Medicine, Institute of Tumor Biology, University Medical Centre Hamburg-Eppendorf

Harriet Wikman, Professor, Group Leader, Center for Experimental Medicine, Institute of Tumor Biology, University Medical Centre Hamburg-Eppendorf, Germany. Photo: Cameo UB Productions/Oslo Cancer Cluster

Vessela Kristensen, Professor, Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital

Vessela Kristensen, Head of Research and Development and Director of Research at the Dept. of Medical Genetics, Oslo University Hospital, Norway. Photo: Cameo UB Productions/Oslo Cancer Cluster

Peter A. Fasching, Professor of Translational Gynecology and Obstetrics, University Hospital and Comprehensive Cancer Center Erlangen-EMN

Peter A. Fasching, Professor of Translational Gynecology and Obstetrics, University Hospital and Comprehensive Cancer Center Erlangen-EMN, Germany. Photo: Cameo UB Productions/Oslo Cancer Cluster

Karl Johan Malmberg, Professor, Group Leader Dept. of Cancer Immunology and Director STRAT-CELL, Oslo University Hospital, Norway.

Karl Johan Malmberg, Professor, Group Leader Dept. of Cancer Immunology and Director STRAT-CELL, Oslo University Hospital, Norway. Photo: Cameo UB Productions/Oslo Cancer Cluster

Michel Sadelain, Director, Center for Cell Engineering, Memorial Sloan Kettering Cancer Center

Michel Sadelain, MD, PhD, Professor, Director, Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, USA. Photo: Cameo UB Productions/Oslo Cancer Cluster

Bjørn Tore Gjertsen, Consultant Hematology, Haukeland University Hospital, Norway.

Bjørn Tore Gjertsen, Professor of Hematology, Centre for Cancer Biomarkers CCBIO, Dept. of Clinical Science, University of Bergen, Norway. Photo: Cameo UB Productions/Oslo Cancer Cluster

Hermann Einsele, Professor, Chair, Dept. of Internal Medicine II, Head of the Clinical and Translational Research Program on Multiple Myeloma, Wuerzburg University Hospital

Hermann Einsele, Professor, Chair, Dept. of Internal Medicine II, Head of the Clinical and Translational Research Program on Multiple Myeloma, University Hospital Wuerzburg, Germany. Photo: Cameo UB Productions/Oslo Cancer Cluster

 

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