We are facing a lot of problems in Latin America with access to innovative treatment, that’s something that, in fact, we have discussed in one of the plenary sessions in this meeting. We do have access to bispecifics, especially in Brazil and Argentina, the other countries in the region are maybe a bit behind. We also have some experience with CAR T-cells and bispecific trials so we do know how to manage patients, how to deliver very good quality of care and the benefit that all these treatments provide to patients that can get into these kinds of treatments with expanded access programmes, through commercially available drugs or even in clinical trials.

What are the challenges involved with bringing CAR T-cells to Latin America?

The challenge for bringing CAR T-cells to Latin America is the cost – it’s a very expensive treatment. So sometimes the pharma industries are not always so enthusiastic about going to a market that is not so economically strong. On the other hand, we do have some issues regarding the government and the involvement of the government with all these kinds of health policies that are expensive but that they also have a benefit for all cancer patients in the region.

That’s the access to the drug or to the treatment, then we have some kinds of barriers that depend on the centres. For CAR T especially you do need some kind of an infrastructure that is not very different from a bone marrow transplantation unit. But you do have to have there in your country a facility that works with the same SOPs that a bone marrow transplantation unit works with. So it’s not feasible to have CAR T in all centres in the region – the region is very huge, there is a lot of diversity, heterogeneity, different people, very broad. So it’s not so easy. I work in a CAR T-cell centre that works with usually clinical trials in my country but it’s not feasible to have it everywhere because you need a very academic… you need a lot of things to build on that infrastructure to have CAR T.

With bispecifics it’s quite different because it’s quite easy to deliver. It’s subcutaneous drugs, everybody can do that. Maybe the main barrier is to manage all the adverse events and having tocilizumab available. Because sometimes tocilizumab is not reimbursed and you need to have tocilizumab in house in order to treat CRS if the patient develops CRS syndrome. So sometimes access to tocilizumab is also a worry.

And education, education to the treating physicians, education to patients, education to caregivers, so that it’s safe to deliver these innovative treatments in these kinds of facilities, centres with all this population that have quite a different way of seeing the disease, knowing about the disease, interacting with the healthcare system that may be in Europe or in the States. So you have to think ahead how to deliver these treatments in centres in Latin America for Latin American patients.

What do you predict in the future with regards to these therapies?

Brazil is doing an excellent job, they are 300 million people. Economically they are doing quite well. Once these kinds of innovative treatments are in the region and we do have some experience, we usually benefit all from that. So it starts usually in Brazil then Argentina then Mexico and all the others, Colombia is doing quite well, so all the other countries join also in this kind of innovative treatment.

I am enthusiastic maybe, hopeful. I really hope that all these treatments get to Latin America and Latin American patients in the future. And I think it is feasible. We have to work on that, we have to work on barriers, we have to work on awareness of the government, the institutions, the centres, the payers, in order to get these treatments for patients but I think we can achieve that if we work as a community towards bringing the better treatments to our patients.

Is there anything else you would like to add?

I do appreciate this opportunity to talk about Latin America, I think it’s quite important that we also have a voice in the myeloma community and we can share our challenges, our barriers, our difficulties and what we want for our patients. I think it’s great that also in the IMS plenary session we discussed about equity, access to treatment, access to treatment worldwide. Because we’re talking about Latin America but it’s not only a Latin American issue. Also patients in other countries, in Europe, in the States, that maybe do not have a really good healthcare insurance do face these difficulties that most Latin American patients face. So I think it’s very important that as a myeloma community we talk about that.