Opportunities for data mining and systems reengineering

(UroToday.com) The 2024 Advanced Prostate Cancer Consensus Conference (APCCC) included a session on global access to advanced prostate cancer in low- and lower-middle-income countries, and a presentation by Dr. Fernando Maluf which discussed the opportunities for big data mining and systems remodeling in Brazil’s Unified Health System.

From an epidemiological point of view, there are challenges for cancer epidemiology in Latin America. This is secondary to significant epidemiological differences, often inadequate data collection, under reporting of cancer diagnosis and mortality, and different healthcare systems, access to medicines, hospitals, surgery and radiation:
In Brazil, ~25% of patients are covered in the private sector, compared to 75% covered in the public sector. However, 60% of health expenditure occurs in the private sector, compared to 40% in the public sector. Dr. Maluf notes that 88% of new drug launches are consumed in the US, Europe or Japan. For example, so far only ADT + docetaxel is approved in Brazil for advanced prostate cancer.

Brazil has a population of 203 million inhabitants, representing the 7^th most important oncology market in the world, and the 9^th the most powerful economy in the world. In addition, Brazil and Latin America have great potential for clinical research. Among LACOG member institutions, there are 32,624 new cancer cases per month, including 2,623 new cases of prostate cancer.

One of the key projects underway in Brazil is to transform public hospitals in the less favorable socio-economic areas of the country into clinical research units. There are several important reasons to do clinical research in Brazil:

• Improving patient healthcare access to new drugs/technology from phase 3 clinical trials
• Cost containment
• Overcome the limitations of access to medicines in the public system
• Generation of new jobs
• Enhancing biodiversity through the inclusion of Brazilian patients in multicenter international clinical trials
• Development/investment in healthcare chain with artificial intelligence for a large database of real patient information

This work has already begun, implementing six research unit centers throughout Brazil as part of the Love for Research project:
The goal of this project is the implementation of 20 research centers by 2024 and up to 50 centers by 2026. This will boost clinical studies in the North, Northwest and Midwest regions, strengthening the ecosystem of the program of research and working together with public health agencies. .

A second ongoing project promotes trials of innovative treatments for common tumors in developing countries and rare tumors in developed countries. Dr. Maluf is the PI of the LACOG 0218 HERCULES trial, which is a single-arm phase 2 clinical trial in penile squamous cell carcinoma (n = 33) evaluating cisplatin + 5-FU + pembrolizumab followed by maintenance pembrolizumab in patients with metastatic disease. :

A third ongoing project promotes practice-changing trials for common tumors in developing/developed countries, but it can be done due to the characteristics of Brazil’s public health system (SUS). One such trial is the REDEMPTED trial for muscle invasive bladder cancer:
A fourth project promotes access to oral oncology drugs. This is done through the Sim Para Quimio Oral project, leveraging celebrity awareness to accelerate six times faster access to oral oncology drugs for over 50,000 cancer patients/year. A fifth project is to improve education and gather consensus statements for developing countries:
Dr. Maluf concluded his presentation by discussing the opportunities for big data mining and system remodeling in Brazil’s Unified Health System with the following messages: