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Chapter 1: What is the main topic discussed in this episode?
The Clare Byrne Show on Newstalk. With Aviva Insurance.
Now, there's been a landmark breakthrough in ovarian cancer treatment. The NHS has approved this treatment and women are set to benefit over in the UK. But how significant is this news for us here? Janice Walsh is a consultant medical oncologist at St. Vincent's University Hospital and she's with us now. Good morning, Janice. Good morning, Clare.
Chapter 2: What breakthrough in ovarian cancer treatment has been approved by the NHS?
Thank you for being with us. Are you excited about this breakthrough? What do you think it means? I think we're excited about this breakthrough like we've been excited about many breakthroughs. I mean, this drug that we're talking about today is part of a group called antibody drug conjugates. So they're kind of a new targeted therapy. And essentially what they have is two components.
So they have an antibody which sticks to the abnormal cell and then it's attached to a small amount of chemotherapy that is then delivered into the cell and to have a direct killing effect on those abnormal cells.
And I suppose in the land of ovarian cancer, where we've enjoyed very little success, despite a huge amount of investigation and novel drug discovery, this really has displaced drugs for the very first time in 20 years. So in ovarian cancer, this is a very significant move.
So does that mean if it is directly attaching itself to the cancer cell that all of the harmful effects you get with chemotherapy would be vastly reduced? So definitely reduce. Now, they can produce different types of toxicities. And for many of the women who are on these drugs, they will know about it, particularly, let's say, some eye effects.
But in terms of nausea and fatigue, those really debilitating side effects for many of our standard care chemotherapy drugs, where they affect both our abnormal cells and normal cells, it has dramatically reduced that.
So many of the women who would have participated in these trials would have talked about, in addition to the fact that they're delighted to hear that they have better survival as a result of these drugs, they have better quality of life. So I heard this described during the week as a sat-nav, which tracks down the cancer.
Do you think that's an accurate description, that it goes to hunt for the cancer cells? Well, I think it's just one of these targeted therapies and we're moving towards this personalised care. So I think within this group, that is correct. So you mentioned there that not much has changed when it comes to the treatment of ovarian cancer.
Cancer in general, though, is treatments changing very rapidly now because we have had or certainly feels like we've had a number of announcements in recent months. I think cancer care has been radically changed, Clare, over the last five and 10 years.
As a result of better technologies to be able to interrogate both tumour and circulating cells within the body, we have been able to identify targets genes that essentially are switched on, switched off and allowed us then to develop drugs that target those. So I think, you know, for many of us, we came back from Chicago in June.
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Chapter 3: How does the new antibody drug conjugate work in targeting cancer cells?
And every year we're We go over there to essentially network to try and get clinical trial opportunities for our patients and to talk about new developments that are occurring. And honestly, the level of groundbreaking research that is emerging at the moment is really unprecedented.
I would say that every four months we have new data coming out in all different cancer types that very often is practice changing. And I think what's been really encouraging is, you know, I'm a breast cancer specialist. So for us, we've enjoyed progress in breast cancer management for a long time.
But a lot of our very difficult to treat cancers, such as ovarian cancer or pancreatic cancer, have had a really important development. And I should add lung cancer in there, too. Okay, just on lung cancer, we did hear overnight about a development in that area too, where we have this set of proteins identified now in the blood that may accurately predict who is going to develop lung cancer.
Can you tell us a little bit about that? Yeah, I mean, it's fascinating really, isn't it? And this kind of work is happening in all different cancer types. But our problem with lung cancer is very often it is found late and therefore incurable. And if it's not incurable, people have to go through very aggressive chemotherapy and immunotherapy type regimens.
And we know that earlier detection means that patients do better. And of course, the Irish Cancer Society is funding a very large pilot study looking at the early detection of lung cancer at the moment in patients with who are at higher risk.
So I suppose this article, you know, it's very preliminary, but essentially what it's doing is it identified these set of proteins that are in the blood, which are involved in inflammation, which is one of the buzzwords in cancer development at the moment.
And essentially what they have noted is that if you have these proteins, you may be at higher risk of developing lung cancer, particularly if you have been exposed to high risk behaviour. So I suppose the big one would be smoking. And then the other one which you have no control over is possible air pollution.
And I think this signature has also been identified to be activated in people with diabetes. Benign conditions such as COPD, chronic obstructive pulmonary disease, so people you would see going around with oxygen needs, or pulmonary fibrosis.
And when they looked then at that signature in trials that have used various anti-inflammatory medication, what they did note was that those patients who'd received the anti-inflammatory medication had a lower incidence of lung cancer now. Is this practice changing? Absolutely not. But is it hypothesis generating? Yes. And it needs to be tested in bigger populations.
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Chapter 4: What are the significant benefits of this new treatment for ovarian cancer patients?
So the trial that was published there recently that came to the fore on the basis of the NHS approval. was patients who had their cancer had grown on first-line treatment. So this was up against our standard second-line treatments. And there are trials at the moment now moving that Mervituximab into first-line that are ongoing at the moment.
And some of those will potentially open in Ireland, we hope. I suppose it is worthwhile saying that AbbVie, who is the company who owns this drug, they opened a compassionate access programme for our patients. And we are very grateful for all of those because as we wait for the drug approval process, we obviously do not have it in Ireland at the moment.
It's going through that reimbursement process. But for patients to be able to access this drug for them is so reassuring. Their quality of life is better. It gives oncologists the ability to get experience with these drugs because maybe we didn't participate in the clinical trials and would originally have found this data.
And of course, it saves the exchequer, our taxpayer, you know, thousands and thousands and thousands of euros. So it is available to at least some ovarian cancer patients in Ireland right now? It is open right now and a compassionate access for second line patients who express this folate receptor alpha.
So there are specific patients who will not benefit, but obviously those, your oncologist would discuss that with you. Okay. We have been talking a lot about the drug approval process here in Ireland on the show this week in relation to Friedrich's Ataxia and the Skyclarus drug. And there has been a huge demand for that drug from patients.
But on the general issue of the drug approval process in Ireland, Janice, there is an argument or there are people who believe that it is very slow in this country. Is that your experience or do you have a view on it? Oh, there's no question.
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Chapter 5: How does this treatment compare to traditional chemotherapy in terms of side effects?
It is extremely slow and it is a great frustration for all of us as oncologists. I understand the difficulty that our government has in terms of these drugs because they are very expensive. But our process is is extremely slow and certainly one of the slowest in Europe.
That is why I suppose we are particularly grateful for companies that open compassionate access programmes because otherwise our patients do not benefit. And that, you know, for curable type drugs, this is a big issue because we know that for those patients who relapse with metastatic disease, it is both devastating and extremely expensive. So it's a false economy.
And is there any way that you can see off the top of your head that that process could be speeded up further? Like what's delaying it? Do you know? We are continually engaged. Very often it's just the funding piece at the end where it has gone through and the drug has been approved and then it's trying to find the money to pay for it. So it is not a process I'm directly involved in.
I know, I understand that. But I'm sure you're at the end of it, you know, in that you know that there's a drug there that you, if you could get your hands on it, you could use it and must be frustrating when at times you can't.
Beyond frustrating, Clare, can you imagine having those conversations with patients where they see this as a real indicator that they will live a little longer and live with a better quality of life? So it is an extremely difficult conversation and one that unfortunately we have many of. Yeah, you see, there's another side to this, but I think it is related to it.
Like today in the Irish Times, there was a news story, which we've covered on the programme earlier, where these huge companies that are multinationals operating in Ireland have made public filings to the US authorities.
And this tells us that the likes of Johnson & Johnson, AbbVie, the company that you mentioned there, Bristol Myers Squibb, they're paying an absolute fortune in corporation tax here in Ireland, AbbVie. paid $431 million to the Irish Exchequer in 2025. And I suppose if you're looking at the balance here, I mean, that's the money that they're bringing into this state.
And are we then quibbling about what we are paying for the drugs that they are producing? I know it's tangential to what we're discussing, but it is there. The numbers are clear. And so... considering that we're having this conversation, you know, that's the bare facts of it. I mean, I think it's important that we have a robust system.
I mean, as you know, the drug prices are incredibly high often and they are ever coming. You know, we have a pipeline that every four months, I would say every single one of us involved in different areas of cancer are looking for new things because new things have been approved. So I understand the frustration. We have to come up with some model where, you know,
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