Preface

Colon cancer is a major health issue in the world, including in low- and middle-income countries (LMIC). The majority of patients are in the advanced stage, including metastatic disease in LMICs. Rectal cancers are more prevalent than colon cancer. Treatment is challenging due to limited financial resources and accessibility to resources. There is no doubt that prognostic outcome associated with a cancer diagnosis has significantly improved over time due to multiple factors including but not limited to recognizing the importance of multidisciplinary management, molecular profiling of tumors, and introduction of targeted therapies. Depending on geography, accessibility to targeted therapies may not be available to all.

Most of the patients in LMIC have to pay out of their own pockets for treatment, which is an important limiting factor to accessibility. For precision treatment, a panel of molecular tests needs to be performed. These tests are not easily available across the breadth of countries and are associated with high cost limiting broad-based usage. In order to allow for increased accessibility, several methods have been employed, including limited panel molecular testing of genes for which generic targeted therapy is available and to develop and implement accessibility programs based on financial feasibility. All methods are, in essence, to drive down costs and increase the accessibility of life-saving medications known to improve prognostic outcomes.

Drugs like bevacizumab, cetuximab, trastuzumab, pembrolizumab are very expensive and are out of reach for many patients. The cost of which can far exceed the monthly income of the average person residing in a low- or middle-income country.

Chemotherapy (CAPOX/FOLFOX) in combination with one targeted therapy remains the standard of care for most of the patients who can afford it. The introduction of biosimilars of antibodies that have generally been non-affordable to the larger cohort has certainly driven down the cost and allowed for increased accessibility. Examples of biosimilars include bevacizumab and trastuzumab, which have also been vital to the treatment of patients with colon and breast cancer.

Despite the challenges, it is possible to achieve good outcomes for patients with colorectal cancer within limited resources. By working together, healthcare providers, patients, their families, governments, NGOs, and patient support groups can ensure that patients receive the best possible care and support during their treatment journey.