Essential medicines for pediatric oncology in developing countries

Abstract

The burden of cancer in children in low and middle income countries (LMICs) is substantial, comprising at least 80% of incident cases globally, and an even higher proportion of cancer-related deaths. With survival rates exceeding 80% in high income countries, it is imperative to transfer these successes to LMICs. A major challenge is the poor availability of safe, cost-effective chemotherapy. A list of 51 drugs-chemotherapeutics, infectious disease agents, and supportive care medications-is proposed as essential to improving the survival of children with cancer in LMICs with an additional 13 drugs identified as being of further value.

Access to Cytotoxic Medicines by Children With Cancer: A Focus on Low and Middle Income Countries

“…A further list of "Indispensable Medicinal Products" is referenced on the Agency of the Republic of Slovenia for Medicinal Products and Medical Devices website (http://www.jazmp.si/en/human_medicines/indispensable_medicinal_ products/), illustrating the challenge of finding the most complete and relevant list of medicines at the country level for inclusion in the study. The strongest correlation was between the density of physicians in a population and the number of SIOP essential drugs; [5] a plausible cause-and-effect relationship. The number of physicians per capita is a decidedly important variable as it is associated with the child, infant and maternal mortality rates, after controlling for the Gross National Product per capita, the Gini coefficient of income inequality, and the female literacy rate.…”

“…The study began following the methods of Kirby et al [13] who explored the access, in 81 low and middle income countries, to the 15 antimicrobial drugs proposed in the SIOP EML to be essential in the supportive care of children with cancer. [5] Kirby et al used the WHO compilation of national essential medicines lists (http://www.who.int/selection_medicines/country_lists/en/) as their data source (identified as Source A here). Our study used additional sources of information, mainly the WHO Essential Medicines and Health Products information portal (http://apps.who.int/medicinedocs/en-Source B), supplemented in a few instances by lists obtained from the WHO offices in individual countries, and Internet searches where updated EMLs were known to the authors but not included in the WHO websites.…”

“…Independently, the Essential Medicines Working Group of the International Society of Pediatric Oncology (SIOP) has proposed a list of antineoplastic drugs and those used for supportive care, with a focus on low and middle income countries, that provides a notable expansion of the EMLc. [5] The 2013 EMLc included only 14 antineoplastic drugs, four of which are corticosteroids. Missing from this list and included in the SIOP EML are bleomycin, carboplatin, cisplatin, dacarbazine, etoposide, hydroxyurea, ifosfamide, and vinblastine; all included in current standard treatment protocols and a number of these are in the adult WHO EML.…”

Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings

“…Although biomarkers can guide clinical decision-making to start or stop an antifungal, empirical treatment paradigms persist. Until rapid and reliable diagnostics are validated for care in pediatric immunocompromised patients, the emphasis in resource-limited countries should remain on ensuring the availability of basic antifungal medications—at a minimum, a derivative of amphotericin B and fluconazole [101]. We hope that healthcare providers, regional and national health leaders, and policymakers will use the collective information presented here to address current challenges in diagnosing and treating fungal infections in children with cancer in LMICs.…”

“…Three major categories of antifungals are regularly used in children with cancer and fungal complications: polyenes, triazoles, and echinocandins. Amphotericin B (AmB) and fluconazole are the two antifungals listed by the Working Group on Essential Medicines of the Pediatric Oncology in Developing Countries committee of the International Society of Paediatric Oncology (SIOP) [101]. However, in up to one-third of countries in low-resource areas, these medications are not included in the national essential medicines list [102].…”