Reinforcing local actions in Asia during the pandemic era

Challenges due to the COVID-19 pandemic have not stopped ESMO’s commitment in Asia. After the cancellation of the 2020 Pan Asian adaptation projects of its guidelines, ESMO worked together with Asian national oncology societies in order to develop a new plan of guideline adaptations enabled by virtual teleconferencing technologies. The kickstart will take place on March 12-13, 2021 with the first Virtual Pan Asian adaptation of the ESMO Clinical Practice Guideline in Early Colon cancer, coordinated by the Japanese Society of Medical Oncology.

More Virtual Pan Asian adaptations will follow on Renal Cancer (May 2021, Singapore Society of Oncology), Squamous Head Neck Cancer (June 2021, Korean Society of Medical Oncology), the project concluded by an adaptation of the ESMO Clinical Practice Guideline on Prostate Cancer, hopefully as a physical presence meeting in November 2021 in Singapore (coordinated by SSO).

Addressing Asian ethnicities in the ESMO Guidelines

For many regions, de novo development of guidelines is not feasible because of lack of time, expertise and resources, and thus adaptation such as customising high-quality existing guidelines to the local context is a valid alternative. Early stages of the ESMO Pan-Asian Guideline Adaptation (PAGA) project date back to 2016 when at the 2016 ESMO Asia Congress it was agreed by ESMO and the Japanese Society of Medical Oncology (JSMO) to convene a special guidelines meeting, endorsed by both societies. The aim was to adapt the ESMO Consensus Guidelines to take into account the ethnic differences of the Asian cancer patient population.

“It is key to consider the Asian ethnicity in terms of drug reaction and biomarker. For example, we identified the ethnic differences in the toxicity profile of some agents such as irinotecan and regorafenib for metastatic cancer patients, without any difference in efficacy of chemotherapeutic agents and regimen,” explains Prof. Takayuki Yoshino from the National Cancer Center Hospital East, Kashiwa, Japan, International Coordinator of Guidelines adaptation in Asia-Pacific region since the project started. “The ESMO Clinical Practice Guidelines provide high-quality and evidence-based recommendations for sustainable cancer care. However, there are a few evidences from Asian clinical trials to be cited, and for this a re-assessment in the Asian population is important to address clinical practice in the region.”

So far 7 of the “parental” ESMO Clinical Practice Guidelines have been adapted to Asia. The PAGA project has seen the active participation of experts from oncology societies in China (CSCO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO), Taiwan (TOS).

A tool for advocating for new drugs development in Asia

For the guideline adaptation, methodology was implemented last year and currently requires an active, systematic and participatory effort. “We extract all recommendations from the relevant ESMO guidelines, construct a questionnaire which is then sent to two key opinion leaders assigned by each national oncology society of the Asia-Pacific region,” describes Prof. George Pentheroudakis from the University of Ioannina, Greece, and ESMO Chief Medical Officer. The experts are invited to answer whether each recommendation is a) acceptable (science), b) applicable (approval, reimbursement and local restrictions), and provide comments. Recommendations without consensus on acceptability or applicability are discussed by Asian and ESMO experts. “We have refined the process over time, and we will now have to figure out the best way to streamline further adaptations as well as a strategy to update the PAGAs.”

Built on strong scientific evidence, the Pan-Asian ESMO Guidelines may also support those countries where resources are lacking to advocate for improving cancer care locally. “I am confident that the PAGA project will be useful to promote availability of new drugs in Asia and the proposal to the Regulatory Agency in each Asian country,” comments Yoshino. “So far, the project has been positively recognised as reflected by the citations of the publications and number of page downloads from Annals of Oncology. Also, adapting the ESMO Clinical Practice Guidelines to local evidence has shown to improve uptake of the guidelines in the Asian region.”