Proposition 54K1605

Proposition de résolution visant à stimuler la recherche sur l'immunothérapie et à améliorer l'accès des patients cancéreux à la thérapie.

General information ¶

Authors

N-VA Jan Vercammen
Open Vld Dirk Janssens, Ine Somers

Submission date

Jan. 25, 2016

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

pharmaceutical industry therapeutics reintegration into working life information cancer medical research resolution of parliament

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo ∉ Open Vld N-VA LDD MR VB

Abstained from voting

LE PS | SP DéFI PVDA | PTB PP

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Discussion ¶

May 19, 2016 | Plenary session (Chamber of representatives)

Full source

I am referring to my written report.

Mr. Speaker, I take the floor on behalf of my colleague Jan Vercammen, who is absent today and apologizes. He asked me to provide the following during the discussion of this proposal for a resolution on immuno-oncotherapy.

Belgium in general and Flanders in particular are in the head group of the latest biotechnological developments. Both academically and industrially, we are at the top of this. Our scientists deliver cutting-edge work on the subject, as is also regularly recorded in the media and during the conference held here in 2015.

Immunotherapy is a promising pillar. It is a new medication that is capable of supporting our own defense system in the fight against various forms of cancer. Our own natural weapons are activated and made more powerful, and the results of this are becoming visible in recent years.

This sector is not only a pearl to our crown in terms of prestige and appearance, but also provides a higher quality of life for the patients involved. It is very hopeful medicine and the sector also provides employment to many thousands of people, from ordinary workers to top brains.

With this resolution, we want to give an impulse to emphasize the importance of this sector, both for the patients through the care in the fight against cancer, as well as for our employment and our economy.

We want to warn our colleagues in this hemisphere of future developments, which will not be limited to the fight against cancer. These developments will confront us with choices. The latest therapies announce themselves as a budgetary challenge. We should not be embarrassed about this. We, as legislators, will be asked for wisdom and persistence. Based on a sound cost-benefit analysis, we will need to assess where and when we can use the scarce resources correctly. This debate will always come back and we definitely want to do so.

Our group will continue to behave as a good housekeeper and housekeeper, paying attention to evidence-based medicine and health technology assessment. We need wisdom and documentation knowledge. We should not let ourselves be chased by often individual files that have no eye for the total cost sheet and the cost-benefit analysis. We can only base our choices on budgetarily feasible and practically calculated dossiers, with transparency on why some proposals do and others do not.

Heightened moral principles will sometimes collide with pepper medication and the economic reality of a health care that must remain affordable to all citizens.

Improving access to treatments such as immunotherapy for cancer patients is obviously essential. This has always been one of our group’s priorities. The implementation of the National Cancer Plan by my colleague, Laurette Onkelinx, when she was Minister of Health is an important example of our interest in the problem. My group, as he has also said in committee, can only subscribe to the objectives of my colleagues’ proposal.

However, we also know that we are talking today about the development and accessibility of treatments that are extremely expensive. Unfortunately, the exchanges that took place in commission did not allow us to obtain clear answers to the questions we legitimately ask ourselves in this context. For what indications and according to what criteria will patients have access to immunotherapy? How many patients will actually have access to the refund of this treatment? What budget is the government willing to devote to this innovative approach while it only makes savings on all levels, including in our health care? As part of the €350 million package for the reimbursement of innovative therapies, what share will be devoted to immunotherapy? Therefore, it seems to me that adopting such a resolution is also a clear commitment that a specific and important budget can be issued.

Today, we have no assurance in this regard. If we fully support the objectives of this text, we simply fear that these are false hopes given to patients. We will abstain today.

Mr. Minister, everyone agrees, specialists and the scientific world included, that immunotherapy is a revolution. This will clearly disrupt the treatment of cancers. For some, immunotherapy is even considered a fourth weapon after surgery, radiation and chemotherapy. This is why we have debated in the committee.

The text presented to you today first addresses the need to invest in research, in particular in clinical research. The industry must remain a major engine of innovation. Our country, which at the time was the specialist in the matter, must in the future remain the leader or one in clinical trials.

It is also important to encourage research into different possibilities of light therapy as a treatment for other types of cancer. Currently, positive outcomes are shown for melanoma and lung cancer but other cancers will be targeted in clinical trials.

Mr Senesael, you just talked about it, the original text did not ultimately address the problem of refunding new light therapies for Belgian patients. This is the so-called financial problem. As the budget is obviously not extensible, as stated in the committee, these treatments must obviously be assessed not only at the medical level but also in relation to the concept of cost-efficiency. We must be able to cover the costs of treatment that we can offer to all. Senesael, we have therefore introduced an amendment, which has also been adopted, to take into account the budget available for innovative medicines and the demonstrable therapeutic added value. The Minister has pledged to carry out this analysis, if necessary.

In order not to polemize and ⁇ not repeat what has already been said, I will simply say that our group supports this resolution, being convinced, on the one hand, that it highlights, at the heart of the debate, a revolutionary new treatment for cancer treatment and, on the other hand, that it clearly puts forward a new hope for cancer patients.

One in three Belgians will face cancer in their lifetime. These figures immediately show us the importance of a good treatment method. In recent decades, several treatments have been developed: radiation therapy, chemotherapy, hormone therapy and molecular therapy. The common feature of these therapies is that they fight the cancer cells from the outside.

For some cancers, those classical strategies unfortunately do not or barely lead to a solution. The chances of survival in these cancers are sadly low. A classic example of this is melanoma.

After many decades of research, scientists have managed to activate the body’s own immune system, thereby fighting the tumor cell without affecting the healthy cells. There is no need to explain what this enormous progress means.

Several study results in melanoma and lung cancer show that immunotherapy prolongs life, compared to classical chemotherapy. For the first time, this can offer hope to patients who until recently had no chance. In the meantime, clinical trials are also underway for applications on other tumors. Belgium has always played a pioneering role in the development of this therapy. We owe a lot of thanks to Professor Thierry Boon, who has played an important role in his discovery of cancer-specific antigens, the pathways on the cell surface of cancer cells.

On 2 July 2015, together with my colleague Jan Vercammen, I organized the roundtable “Immunotherapy and Cancer”, in which we discussed the results, opportunities and challenges. Based on the conclusions of that round table, colleague Vercammen and I have written this resolution.

Without repeating the whole discussion in the committee, I think it is essential that we continue to support scientific research on immunotherapy in Belgium. At the federal level, we can do this by investing continuously in good and fast procedures for clinical trials, a domain in which Belgium scores very well.

In its pact with the pharmaceutical industry, the minister has announced a number of measures in this regard. That is a good thing for the research.

Important in the emergence of new methods of treatment is a correct and honest communication with the patient, a communication that makes clear what is possible and also what is not possible. It is important not to give patients false hopes.

Once the therapeutic added value has been proven, the matter is to make the therapies accessible to the patient. The Minister has already repaid the first immunogenic medicines and I myself am very pleased with that.

During the discussion in the committee, the question of the affordability of expensive, individualized medicines was raised. But let’s be honest: every health minister must make choices. The Prime Minister’s predecessors had to do that. It will have to do so, and future ministers will have to do so. Affordability is, of course, a legitimate question, but it also requires a broader social debate. What is society willing to pay for medicines that can fight previously incurable diseases? This is not just a problem of the Minister of Health, but of the whole government.

Somewhat unexpectedly, during the discussion in the committee, the debate was also held about staying professional active or later reintegrating it into the labour market, as if that were a punishment. Working when you are sick, if the treatment allows, can be a blessing. It allows people to focus on things other than their illness. This means that they are not isolated. Should work during treatment be mandatory? I would say that the doctor and the patient should be able to make a decision on this subject, based on the patient’s situation, together.

When it comes to reintegration into the labour market, we find that patients after cancer treatment have to deal with a new disaster: they have lost their jobs.

I think cancer patients and, by the way, all patients deserve better. I think those who see work only as a punishment fail the ball. Even after cancer and during cancer treatment, there is a life. I can hope this is also a professional life.

I would like to thank all the colleagues who supported this resolution.

Mr. Speaker, dear colleagues, in the essence, what is in line with this proposal for a resolution, or what should have taken us more broadly, is obviously the issue of access to personalized medicine, which is a major construction ground for the coming years. It should be remembered that unfortunately 65,000 new cases of cancer are recorded annually in our country?

It is true that Belgium is at the forefront in scientific terms. It is important to welcome the researchers who invest daily in the framework of fundamental research or in the framework of clinical research, but also the pharmaceutical sector, and more ⁇ that of immunotherapy.

I would like to draw attention to two specific points of your proposal for a resolution. Should immunotherapy be supported? This is obvious. But the central question is that of accessibility to therapeutic innovations, in this case to immunotherapy.

During the committee work, you stepped back from the initial resolution proposal. With the latter, there was a commitment to ensure and accelerate access to new immunotherapies for patients with metastatic melanoma or other types of cancer – research is just moving forward in this area. With the resolution proposal that is being discussed today, you are taking a step backwards. In addition, the minister (or his representative) was unable to tell me, as part of a question I asked her, what was the budget allocated by her department to repay the immunotherapy. She also failed to tell us what was the budget allocated to access to immunotherapy in terms of patient reimbursement for the year 2016.

While we were promised that this information would be given to us in the plenary session, I must note that no information has yet been provided to us on this subject.

It is still, dear colleagues, that I want to tell you that I translate the change of your initial resolution as a noticeable retreat. Your resolution proposal is extremely “frileous” since, in the bottom, you bring back access to immunotherapy innovations for patients to its smallest common denominator.

Even where it is essential to assign ambitions to these patients, I fear that this resolution proposal is just an illusion, a form of deception for them. I find this prodigiously incorrect. That is why I submitted an amendment that I invite you to approve.

In addition, your resolution proposal poses a second problem to me. The Minister of Employment, Mr. Peeters, committed to respecting the agreement of the Ten, i.e. of the social partners, for the entire aspect of reinsertion in the workplace for long-term sick. He promised that this reintegration would be on a voluntary basis and that it would be free of sanctions. But your majority refused to endorse this commitment. We know the reason very well. Let’s call a cat a cat. There is a disagreement between the Minister of Social Affairs and the Minister of Employment in this regard.

I heard my colleague from Open Vld argue that working when you’re sick can be a benefit. I agree, but that is not the goal of the Minister of Social Affairs. What she wants is to force you to work even when you are sick. If we do not, we will be punished. I mean it as proof that, in your budget adjustment, tens of millions are planned as savings through this, with the sick sent back to the CPAS.

If this is not your thesis, you just need to indicate it clearly in your text. That is why I also submitted an amendment to supplement the promotion of employment retention or to optimise the path of occupational reintegration for immunotherapy patients, but voluntarily and without sanctions. Either you vote for this amendment, and then it means that you do not want to force a patient to work, even when he is sick and is unable to work; or you do not vote for it, and that will mean that your goal is to force and apply sanctions. If so, we will therefore not be able to support this proposal for a resolution.

Mr. Speaker, a short response to the obligation to work. During the discussion of this resolution, the Committee on Public Health made it clear that we intended to include a separate point on the ability to continue working during treatment or on reintegration into work after treatment. Why Why ? Immunotherapy—the therapy itself proves it—enables more people to continue working. They are the requesting party. However, this is not possible today. Therefore, it is very important and in the interests of patients that if they can and want to continue working, this is also legally possible.

Mr. Speaker, Mrs. Somers, the reemployment of sick patients, including seriously ills, is neither a discovery nor an invention. It is really terribly ignorant, first and foremost, to patients, including long-term patients. The node is not there. Because effectively, for patients, it is sometimes a good thing, when they are able and are demanding, to be able to continue to invest in a professional activity, possibly tailored to their condition.

But the node is not there. The node is that there is a disagreement in your majority, between Minister Peeters, who wants to respect the agreement of the social partners, of the Group of 10 so that reintegration is on a voluntary basis and without sanction, and your Minister of Social Affairs who wants a mandatory and with sanction return to work. As evidence, the two draft royal arrests are contradictory.

We’ll see what you’ll land on, but your freedom to engage and to write black on white willingly demonstrates how simply embarrassed you’re about the surroundings. You want to make it mandatory and punishable. For patients, this is totally unacceptable.

Mr. Speaker, I would not want to polemize, but this debate by Ms. Fonck, we had during the committee. I would like to quote, in the report, the words of the representative of the minister, who said that the reflection on whether or not to make the course of professional reintegration mandatory is still underway. This means that the decision has not yet been made. So what you do here is an intention trial either to the majority or to the minister. But this is not the case.

So again, and that is why I will be short in my speech, this debate took place in the committee. I am surprised to see the fervor with which we come back with these same debates in the plenary session, which is not really the goal.

In addition, as I remembered, this proposal was adopted by 11 votes and 1 abstinence by the committee. I am a little surprised to hear that in the end, some have returned to their decision.

Unfortunately, I do not know the details of the votes.

I am sorry, dear Mr. Thiery. I have the right to speak in the court. If, afterwards, the colleagues of the majority decide to reopen the debate and make it a part of ping-pong, it is their choice, which must be assumed.

Second, the majority has still not clarified its position on this royal decree concerning the reintegration of patients. This is strange because, a few months ago, you all said here that you are committed to respecting the agreement of the social partners, the Group of Ten. And, today, you retreat and announce that there is no agreement. This is of course questionable.

It is logical and healthy, in a democracy, that when there are stories like these, they can be debated so that everyone assumes their positions. I don’t want this debate to last forever, but if you start a game of ping-pong, it makes sense that we can participate in it.

Of course, the debate must take place. It took place in a committee and I do not see why exactly the same debate should take place in a plenary session. I try to save time for everyone.