Spending on cancer medicines has increased rapidly worldwide, driven by the introduction of immunotherapy and targeted therapy. Australia exemplifies this trend, with cancer medicines representing one of the largest and fastest-growing areas of expenditure for Australia’s public medicines funder, the Pharmaceutical Benefits Scheme. While this growth reflects therapeutic innovation and expanded clinical use, it has intensified concerns around the real-world safety, effectiveness, and value of novel therapies once adopted into routine care. Randomised clinical trials remain essential for regulatory approval but often provide limited insight into outcomes in broader, more heterogeneous populations, particularly as many therapies enter practice via accelerated pathways based on surrogate endpoints. Population-based cancer registries offer an important resource for postmarket surveillance when linked with national administrative datasets such as dispensing and hospitalisations records. However, limitations in registries’ timeliness, disease stage ascertainment, biomarker and genomic data capture, and information on recurrence and progression constrain their current utility. This perspective examines the Australian population-based cancer registry landscape, highlighting its strengths, untapped potential, and critical gaps. We outline priority enhancements required to realise a robust, whole-of-population cancer medicine surveillance system that can inform clinical practice, policy, and sustainable health care decision making.
B. Daniels, N. Meagher, J. Ruiz et al.· ESMO real world data and dig...· 0 citations
The incidence of early-onset colorectal cancer (CRC), commonly defined as diagnosis prior to age 50, is increasing. Studies of patients diagnosed prior to age 35 as a distinct subset of all early-onset patients have yielded inconsistent results. We extracted prospectively collected data from consecutive patients with metastatic colorectal cancer (mCRC) entered in the multi-site Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) Australasian registry. We focused on comparing demographic and clinicopathologic characteristics of those diagnosed < 35Y with remaining early-onset patients (35-49Y) whilst including a comparison to older patients (≥ 50Y) as a reference point. Molecular data were examined from 2015 when testing became reflexive. From July 2009 to December 2023, we identified 4399 patients with mCRC, including 133 (3.0%) < 35Y, and 537 (12%) 35-49Y. The proportion of < 35Y among newly diagnosed mCRC increased per calendar year (odds ratio 1.07, 95% CI 1.02-1.11). Gender, ECOG performance status and primary tumour location were similar for < 35Y and 35-49Y. Compared to 35-49Y, < 35Y had more de novo metastatic disease (79% vs. 70%; p = 0.04), BRAF V600E mutations (32% vs. 10%, p < 0.001) and deficient mismatch repair (dMMR) tumours (9.8% vs. 2.8%, p = 0.008). Rates of chemotherapy, rates of liver resection and overall survival (OS) were similar between < 35Y and 35-49Y. Multiple differences were observed between < fand 35-49Y, most notably a higher rate of BRAF V600E mutations and dMMR cancers. Collectively, these findings may inform the interpretation of clinical outcomes, refine screening approaches and advance understanding of CRC tumorigenesis in younger patients.
C. Williams, A. Jalali, Samuel Smith et al.· International Journal of Can...· 0 citations