Conversations Beyond the Clinic

Speaker A: Welcome to let's Talk Rare, the Partners for Access podcast, the show where we explore the latest trends, insights and innovations shaping access to orphan drugs and cell and gene therapies around the world. I'm Georgie Rank and I'm your co host for the show this month. So this month we're taking you inside ESMO 2025, one of the biggest events in the oncology calendar. Our very own Darren Callinan, digital lead, and Rosa Ferrier Matthews, a director and oncology expert at Partners for Access. They were on the ground at the conference speaking with attendees, gathering key insights and capturing the pulse of what's next in cancer care. In this episode, Darren and Rosa share their conversations and reflections from esmo, from breakthrough science and evolving treatment landscapes to the policy and access challenges shaping oncology's future. So let's dive in and hear what they've discovered at ESMO 2025.

Speaker B: So we're here at day one of ESMO. Rosa, what are you most looking forward to?

Speaker C: Uh, so I think I'm looking forward to a few things. I've seen that there will be some data readouts that I'm hoping to be excited and exciting and practice changing. Um, I'm interested to see what's coming down the pipeline even further in earlier stages than phase three. How is it going? Impact pricing and access and payer decisions? Um, I'm curious to see if the, uh, EUHTA is on the minds of, uh, oncologists and of course the pharma people that are here, given that it's now applying to all oncology, if it's a new product. Uh, and finally on a more personal note, I'm looking forward to reconnecting with old faces and meeting new people across the whole oncology community. Uh, so, yeah, very much looking forward to, forward to these days. How about you, Darren?

Speaker B: Yeah, I mean, I'm obviously very excited to see, um, developments in AI in digital and how that's shaping all strands of oncology, from drug discovery all the way through to decision making, um, and post treatment care and follow up for patients. I'm really interested to see and excited to see that a lot of the program is dedicated to those types of topics. Um, likewise. I'm really, uh, excited to see if EU joint HDA is on the radar here and if this audience are aware of the implications, uh, for that. Because I fully expect that we're going to see a lot of practice changing readouts and fantastic developments across oncology here. And I'm at the back of my mind just hopeful that that can translate into something that gets through you. Joint HTA readily. Firstly, we spoke to Drs. Gemma Buckalter and Hayley Carroll from St. Vincent's Hospital in Dublin. Um, and these young oncologists are really giving us their perspectives on the data readouts and the areas that they are most interested in, but also commenting on the impact of policy changes on uh, patient participation in trials, for example. So very interesting to see uh, the oncologist's perspective on what uh, their learnings were at esmo.

Speaker A: ESMO is a great experience for us as young oncologists coming to see all the uh, new exciting data but also interact with all our peers and see those who are most experienced in our fields. Um, I have a special interest in breast and this year ESMA has been really exciting for a lot of the new breast presidential sessions. But also Friday had a couple of really exciting presentations in terms of the monarchy data with the overall survival outcomes, um, showing a positive OS and as well as the ribociclib data from the Natalie trial, which was exciting for Ireland as our own John Crown, Professor John Crown, presented the data there. Um, so it's really exciting how a lot of these trials actually we will be able to move forward and introduce information our practice, um, moving forward.

Speaker C: So ESMO 2025 was uh, a great experience as always. It's great to collaborate with uh, our Irish peers and other European colleagues. Uh, I have a special interest in rare tumours, so sarcoma and neuroendocrine tumors. So these meetings are really great as, ah, those both have small European communities and as um, a small country in Ireland, we need to embrace European collaborations, um, and meet our colleagues at these big event. Um, the topic I found most interesting was a session on Monday morning which was entitled Therapeutic Innovations to Improve Outcomes in Sarcoma. And the sessions were really valuable as they discussed the ways we've approached caring for patients with rare tumors, trial design and what's worked and what hasn't worked, and the way European laws uh, affect our prescribing abilities in rare cancers. And they highlighted different European consortiums and international collaborations which gives valuable opportunity for Irish patients to participate in international clinical trials and something we're hoping to grow in the future.

Speaker B: Fantastic.

Speaker D: Thank you.

Speaker B: We also heard from oncology specialist nurses, uh, Sasha and Judith based in Stockholm in Sweden, um, who spoke to us about very uh, interesting programs in uh, post treatment care that they run in Stockholm that are very well funded and speak to the need for care beyond treatment with patients now living for Longer, given all the developments in oncology. So really interesting perspectives on what that care looks like.

Speaker C: We're here with Sasha and Judith, who are two nurses, and we'd like to hear a bit about your work, what you're presenting here at esmo, and maybe your thoughts about how it went and what did you like the most?

Speaker D: We have a poster, uh, about our work. We work as the rehabilitation nurses at the center center for Cancer Rehabilitation in Stockholm. And we describe how we work with our patient that are referral to us. We have an interview guide with the patient. First time we meet them, before. The first time we meet them, they fill up some assessments, uh, before our consultation. So together with the patient, we can, um, make rehabilitation plans according to their needs.

Speaker C: So we work as a multiple multidisciplinary team.

Speaker D: Yeah, so that's. Yeah.

Speaker C: Thank you.

Speaker B: And Judith, you were explaining just there, uh, how patients feel informed about their treatment plan when they're working directly with the, uh, their treating clinician. But afterwards, the rehab, there seems sometimes to be a gap in understanding what's available to them.

Speaker D: Yeah, they feel like somebody's really monitor them. They know who to contact, they know who to talk to when they have maybe side effect or problem. But once the primary treatment has finished, most of them feel like they are just left by themselves and they don't really know what to do. Meanwhile, also they're struggling with how to get back to their normal life, how to maybe get back to work and just to. To try to live a normal life. So a lot of people actually have problem with existential problems. They feel like, who am I? And many of them also have this kind of question, like, do I really want to. To continue living my life the way I did before getting sick? So there's a lot of psychological effect that we see, apart from maybe physical limitation that we see in these people, which I think that is very important maybe to look at it more because as you look now, so many people are living longer. We have, like, survivals, not like before. Many people maybe died. The treatment, new treatments are coming. People are living longer, but with that life that they have, also more problems are coming with it. You understand? They need more support, which I feel like we really need to work more on that side. They're not getting the attention that they need as it is of today.

Speaker B: Subir, thank you so much, Judith, for that. Really appreciate it. And, uh, really excited, um, to learn more about what, uh, this rehabilitation plan looks like in the Swedish context and how that could be replicated across the. The World. Thank you. Uh, I'm here with Fadil in a very busy poster hall here on day uh, four of esmo. Uh, Fadil is presenting work on artificial intelligence and how that can uh, support multidisciplinary teams, uh, in making breast cancer decisions. And um, uh yeah, some of his research is really interesting related to aligning uh, treatment decisions, uh, in hard to reach population, uh, and not well supported uh, population. So Fadil, it would be great if you could tell us about your research.

Speaker E: Thank you very much for having me with you. I'm um, Fadil. I'm from Bosnia and Herzegovina, currently uh, working in Turkey. My research uh, was based in assessing the CHATGPT decisions compared uh, to the multidisciplinary team decisions on breast cancer patients. Uh, coming from a middle income country, uh, we're faced with many uh, issues of the developing uh, healthcare and uh, making it as accessible as possible. One of them would be the overburden of doctors, uh, from the patient, uh, amount, amount of patients and everything that comes with it. Uh, Bosnia and Herzegovina is estimated to have only uh, 20 or 21 oncologists per 10,000 patients, which uh, is a challenging number. So what we were thinking about is solving this issue by adopting uh, ChatGPT or artificial intelligence into our cancer practice where uh, we tried to prove that CHATGPT is useful with its assumptions and uh, recommendations for treatment of uh, breast cancer patients. We've taken 91, uh, patients with newly diagnosed disease to check uh, if um, they had any other uh, malignancies or if their age was appropriate, if they were included into any ah, other clinical trial. If they were not. We've taken them into our study. We've taken all of their demographic, um, uh, information as well as disease information, um, comorbidities, etc. We've put it a hormonal expression. We've put it into ChatGPT, uh, and asked for um, how it would treat the particular patient, what would be the first line, follow up, uh, etc. After that we gathered all of these uh, opinions and uh, made a uh, big table out of it. We've given it to four, uh, different oncologists coming from different centers to evaluate it and compare the multidisciplinary team decisions. Like this decision that was already made by professionals with the one that was made by ChatGPT and give it a score from 1 to 4. One being the lowest score. I do not agree with at all. 4 being the highest score. I agree completely, uh, with it. We've proven that, uh, the mean rating was uh, 3.31 with a standard deviation of 0.5, uh, which for us is a good sign, especially because ChatGPT is uh, a large language model that is still under development. We use the previous version, uh, of it, which was 4.0. Like right now we have chat GPT5. Um, and yeah, we've proven that for a lot of cases that are guideline, uh, guided and that have a lot of information and a lot of input that can be, uh, assessed by just following guidelines, ChatGPT can be a useful tool. And uh, we've concluded that as of right now, it wouldn't take over the, the job of an oncologist, but can be a very good helpful tool while assessing the patient. Thank you.

Speaker B: Fantastic. Thank you, Vadil. Really interesting, uh, and really interesting to see how, uh, well aligned the different, uh, oncologists in terms of what ChatGPT aligned with and that ChatGPT as an intermediary between what was already decided with multidisciplinary teams. So there is clearly a role in overstretched, uh, multidisciplinary teams and speeding up their decision making. And there's been a way to do that. So thank you for that's really interesting research.

Speaker E: Thank you. Thank you very much.

Speaker C: I'm here with Sylvia Byrne and, and I'll let you introduce yourself and if you'd like to give us your highlights or what you're looking forward to the Most here at ESMO 2025.

Speaker E: Perfect.

Speaker C: Thank you, Rosa. So nice to meet you all. I'm Sylvia Byrne, COO and co founder of Rubicare. And Rubicare is the first AI virtual clinic for cancer survivorship. We bring discontinuity of care outside the hospital by bridging this gap and empowering patients to get the care that they need. I really enjoyed ESMO today. I got really great insights about, uh, quality of life and also how sexual health is very important and underseen in cancer patients. And what I'm looking for is, um, to get to know a lot of supportive care oncologists that believe in quality of life after care and also partnerships with cancer centers. Thank you very much and good luck with your next funding round that I know starting soon and hope to hear more in the future. Thank you so much. So now we're here on the last day of, um, Esma, um, with our bags packed, with our feet dearly sore from walking so much, uh, but very deeply inspired and full of ideas and excited about the future in oncology. And, and for these patients, um, you've just heard a couple of the testimonials and the people that we spoke to, just a small fraction of the inspiring people that have been here at ESMO in Berlin this year. Um, and now I think both Darren and I would like to just give some of our thoughts. What were the highlights, what did we learn and like to hear more about and maybe. Darren, would you like to get started?

Speaker B: Absolutely. Rosa?

Speaker A: Yeah.

Speaker B: As you said it's very inspiring to see the pace of developments uh, across oncology indications gives you a lot of hope for what's to come in the future. I guess from an access perspective there's a lot to consider. Um, we saw a lot of interesting data from different treatment classes in the same indication. So a lot of discussion about what sequence optimisation will look like for different patients. So while patients have choice and will react differently to ah, different treatments, that obviously gives uh, clinicians a lot of, a lot of options. But from a axis perspective and picoscoping, uh, it's going to be quite interesting uh, how this plays out in the future. Another point I think from an access perspective that was interesting. I mean at one point uh, there was 9,000 people to see readout from a trial in non small cell lung cancer indication and were very excited by the data that they saw. But it was from a trial that only had a Chinese patient population. So it'll be interesting to see if the magnitude of benefit that was demonstrated in trials like was shown in that trial be enough to overcome the lack of having European patient data in the trial.

Speaker C: If I could just add something on that, um, one of the trials readouts that was most exciting and maybe I'll speak about it in my highlights, uh, there was also a marked difference between north, um, America, uh, Europe and the rest of the world. Uh, and that was one of the questions actually from the public was what does this mean? And is it possible that just the standard of care in different regions is different in this indication? This was in um, first line breast cancer metastatic triple negative. Um, so yeah, this is a really good point how populations around the world, um, either because of genetics they may react differently to products or is it more on the standard of care? And it seemed to be the consensus at least in that situation that it was more the standard of care that varies so much and what any. As we know there's a lot of inequality in access and not everything is available to all patients everywhere and then it impacts how trial data can be interpreted.

Speaker B: Absolutely, absolutely. Um, so yeah, a lot of things to consider from an access perspective given the clinical developments that we've seen so far. Personally I was very happy with the poster session that we were involved with. Um, the level of engagements that we got was incredible. It was supposed to be a 45 minute session. I think we were there for more than two hours. Uh, and that engagement came from real, uh, wide variety of stakeholders. So obviously there were industry stakeholders there who were interested to see how a large language model could help them with pico prediction. We also heard from national level HTA bodies who are ah, talking about how this could be used in their own practice because they have the same strong struggles uh, in terms of predicting what PCOS might be and how to do that kind of work. We also had somebody from the JCA Commissioning Group uh, come by to talk to us about the work that they've been doing and uh, to comment on the exercises um, that they had published that we had included in our study. Uh, so it was really interesting to have a conversation with somebody who's at the coal face and who really liked our approach and felt that it was something that uh, all stakeholders uh, could be involved with using. So that was really good validation to get from somebody who's really involved in the process. And I guess my final kind of general note on the conference itself itself is that ah, the audience as might be expected, spans all types of stakeholders that are really dedicated to improving the lives of, of patients with cancer. And that's reflected really in the contributors that we had, um, in our voxpoc, the people we spoke with, ah, oncologists, ah, junior oncologists, uh, really excited about some of the developments in their areas of specialism. Specialist nurses who are thinking about life beyond treatment now and what happens uh, to patients that are now living longer than ever before. How are we supporting them, uh, with that extended time that they have. Um, it was also interesting to speak with AI researchers who are looking to fill the gaps in uh, where there are ah, multidisciplinary teams that are overwhelmed with the amount of patients that they have to cover and how AI might play a role with that. I mean talk about an excellent application of the technology and even startup founders as well. So who are really trying to learn what developments are coming and where they might uh, go with their business as a result. So each with their own specialism, each with their own perspective and goals from the conference, but really everyone sharing the same goal, uh, which is really inspiring.

Speaker C: And yeah, I guess from my, from my side, um, I was very impressed by some of the standout readouts and think this year was highly dominated by ADCs. Although we had great readouts throughout different classes, different cancer types, um, but not to go on and on with different readouts. I think I would like to call out um, three, four, um before going into them. Uh, it's also quite nice, um I came from an academic background before starting in, in market access and it's quite nice to go back to seeing um, this really detailed lab date and experiments. Um, and yes very big kudos to all the academics that were around here and doing great job and even in the basic science, um, extraordinary. So on the actual phase three data readouts that we got that everyone kind of agreed that these three four that I'm going to mention were practice changing. Um so first we have PLAAT 7 keytruda. Um so uh, between pharma across pharma, uh collaboration in uh bladder cancer in perioperative cisplatin, ineligible patients, um and this one cuts the risk of death by half. So uh, definitely very impressive and everyone was expecting this to very quickly once uh approved and there's access um, to become the standard of care. Um, another one that again expected to be practice changing was in her two in her positive breast cancer in, in early lines uh, they had both neoadjuvant and adjuvant data, both positive trials. But I guess for me the adjuvant setting was particularly impressive. They had a head to head trial versus catsilla and they reduced recurrence and they reduced recurrence or death by 53%. So again very, very impressive and very good for these patients. And then to mention one of the most underserved, um and with worse prognosis populations in cancer, um first line metastatic, first line metastatic, um breast cancer in this case, um, patients that were ineligible for PD L1 inhibitors. Um so we actually had a bit of a dramatic session with back to back readouts from competitors. So Trudalvi and Datraway, um, both of them showed PFS improvement versus chemo, uh, but only datroway showed OS benefit with the improvement of five months versus the comparator. But actually personally what I like the most in that session was the discursion. So the invited speakers to comment um, on both readouts and Agarido Castro. Um, and she in my opinion expertly compared the different trial populations, how the trial designs were different and how those impact how you interpret results and what are the important considerations like crossover being allowed in trials or not. Um and really putting it into context and it will now be interesting to see what do payers do with this? Um, how are they going to evaluate two trials in exactly the same population? Ah, same class of treatment. So both are uh, antibody drug conjugates. Um, so are we going to see both, uh, approved or reimbursed in most countries? Is there going to be restrictions for some patients or not? So very curious to see how these results are going to be parsed out by payers, um, and then eventually by clinicians when it gets to practice. And I'm sure the clinicians will try to make the decisions that will be best for their patients. But yeah, we can confidently say, I think that ADCs are here to stay. Uh, and then I think just another highlight, um, something that is very close to my heart. With CAR ts M we didn't have any big readouts from commercial CAR ts. Um, it seems like we're in a bit of a lull right now. But interestingly we had uh, the principal investigator in the Barcelona hospital that is developing the famous RE001AH Car T. Um, and they revealed they have some additional trials coming in. Different indications, different um, methodologies for the CAR T. But very impressively they're tackling a solid tumor now, um, which um, there aren't any approved commercial therapies, uh, CAR Ts for solid tumors. So impressive to see who's going to get there first. Um, and the results that we can see from an academic center. But yes, all of this was very impressive from um, market access perspective. Um, of course hoping that this is going to help patients as much as possible. Um, but it will be very interesting to see how payers deal with all of this. Again with the CAR T's, it's a big challenge. How do you price that? How do you use them as comparators or not? Uh, for the commercial CAR T's because the development is very different so they're not necessarily comparable. Uh, but yeah, all of this was fascinating and living here tired but um, inspired, uh, I guess. Over to you Georgie and Owen. Thank you for having us on this podcast.

Speaker B: Thank you for listening to the discussion. You can find more information about this subject and other matters relating to rare disease and cell and gene therapies on the Insights section of our website, uh, www.partnersforaccess.

Speaker D: Com.