Addressing the next frontier in oncology access

Innovation in oncology has always moved quickly, but the current wave of highly personalised therapies is forcing healthcare systems to confront a more difficult question than ever before: not just can we develop these treatments, but how do we make them accessible in practice?

A recent article in Value & Outcomes Spotlight by ISPOR explores this challenge through the lens of individualized neoantigen therapies (INTs), a promising new class of cancer treatments designed specifically for each patient’s tumour.

Unlike traditional oncology treatments, INTs are built around mutations unique to an individual’s cancer. In theory, this allows for a highly targeted immune response and the potential to improve outcomes, particularly in earlier stages of disease where preventing recurrence is critical. It is an exciting step forward scientifically, but it also introduces a level of complexity that healthcare systems are not yet fully equipped to handle.

One of the most immediate challenges is evidence. Many of these therapies are assessed using endpoints such as recurrence-free survival, which are clinically meaningful but do not always translate neatly into the long-term outcomes that payers are used to evaluating. This creates a familiar tension: patients and clinicians are ready to move forward, while decision-makers remain cautious in the face of uncertainty.

At the same time, traditional health technology assessment frameworks struggle to capture the full value of these therapies. When a treatment has the potential to be curative, or to generate wider scientific benefits beyond the individual patient, standard cost-effectiveness approaches can feel insufficient. There is a risk that innovation is undervalued simply because it does not fit neatly into existing models.

Then there is the question of scale. Unlike many advanced therapies that target very small patient populations, INTs could be applicable across a broader group of cancer patients, particularly as they move into earlier lines of treatment. This raises important questions around affordability and system readiness. Even highly effective therapies can face barriers if health systems are not designed to absorb them.

Perhaps most importantly, these challenges do not exist in a vacuum. Access to new cancer treatments already varies significantly across countries, shaped by differences in infrastructure, funding, and reimbursement processes. Without careful planning, therapies like INTs risk widening these gaps further, rather than closing them.

What is encouraging is that the conversation is beginning to shift. There is growing recognition that new approaches are needed, from more flexible assessment frameworks to innovative payment models and the use of real-world evidence to support earlier access. These are not entirely new ideas, but their application is becoming more urgent as the nature of innovation changes.

From a health economics perspective, individualized neoantigen therapies feel like a turning point. They highlight the limitations of current systems, but also the opportunity to rethink how we define and measure value in healthcare.

Ultimately, patient-centricity is often described as a goal, but innovations like INTs force it into reality. If a therapy is truly designed for an individual patient, then our systems for evaluating, funding, and delivering it need to reflect that same level of personalisation.

How we respond to this challenge will not just determine access to one class of therapies, but will shape the future of oncology innovation more broadly. Link to the article: https://www.ispor.org/publications/journals/value-outcomes-spotlight/vos-archives/issue/view/patient-centricity-in-healthcare/addressing-barriers-to-timely-and-equitable-access-in-oncology--the-case-of-individualized-neoantigen-therapies