Antibiotic resistance is the greatest threat to cancer patients

The writer is executive director of the Global Antibiotic Research & Development Partnership

Cancer survival rates have never been higher, but nor have the costs of treating cancer, with the escalating price of powerful new drugs being the main driver. Given that the number of clinical trials for new cancer drugs is at an all-time high, and with the vast majority of new drug treatments costing more than $283,000 in the US per patient per year, this trend is expected to continue.

But such progress comes at a cost: a lack of investment in other kinds of drugs, particularly antibiotics, often a cancer patient’s last line of defence. 

Infections are the second-leading cause of death among cancer patients, and lead to one in five being hospitalised during treatment. Given that many cancer therapies weaken the immune system, making patients more susceptible to infections, this is to some extent to be expected. But increasingly clinicians see infections that are becoming drug-resistant — antibiotics once effective against them no longer work. Without new and effective antibiotics, this is only going to get worse, with more people surviving cancer only to die of an infection that was previously treatable.

Both in lives saved and in monetary terms, investing in new cancer drugs without building up an effective arsenal against infections is a false economy. 

Yet that is precisely what we see. In 2020, oncology companies received nearly $7bn in investment, an increase of 900 per cent since 2011. In contrast, pharmaceutical companies raised just $160mn for antibiotic research, a decline over the decade.

Commercial activity and research in antibiotics have been in decline since the 1980s. One reason often cited is that developing antibiotics is not profitable. Given that courses of antibiotics tend to be short, and good practice dictates sparing use in the face of rising drug resistance, it is certainly a less lucrative market compared with cancer and some other diseases.

In fact, antibiotics can be profitable. But the issue is with typical development costs cited at more than $1bn and annual revenues are often less than $100mn, with a delayed return on investment — if any. In contrast, the revenues for cancer drugs are much higher and it is a growth market, with global spending expected to increase from $196bn in 2022 to $375bn by 2027. Arguably, this is not sustainable.

Figures of this size can distort the market, drawing investment away from the development of other important drugs, such as antibiotics. Also, it may perpetuate the public perception that cancer drugs have more value in saving lives: people are terrified of cancer and yet barely aware of the threat posed by antimicrobial resistance (AMR).

At first glance it’s easy to see why people feel like this. Nearly 10mn people a year die from cancer, a figure that is expected to rise, making it the second-biggest killer after cardiovascular disease. In fact, infections may actually kill more people, but these deaths are usually attributed to different underlying causes, including cancer.

By some estimates, infections claim as many as 13.7mn lives a year, of which nearly 5mn are associated with drug-resistant bacteria. Even conservative estimates show AMR is already one of the world’s biggest killers. If we allow this to continue, it’s just a matter of time before drug-resistant bacteria claim more lives than cancer. 

We need to revive the antibiotics R&D pipeline, to ensure that we continue to obtain new and effective antibiotics in the face of the spread and growth of drug-resistant bugs. Organisations like mine are showing that it is possible to accelerate the development of, and access to, antibiotics with the potential to target World Health Organization priority pathogens — the multi-drug-resistant bacteria that pose the greatest threat to human health, not least cancer patients. Our aim is to develop five new antibiotic treatments by 2025.

Lower-income countries, will account for almost three-quarters of cancer deaths by 2030. Despite the common view that overuse is the main cause of drug resistance, limited access to essential antibiotics is also contributing to the rise of AMR in these countries and urgently needs to be addressed.

The antibiotics market is failing. And this failure is tied to the success of the cancer drug market — because cancer drugs are so lucrative, antibiotic development could be seen as an opportunity cost. Ultimately, there will be an urgent imperative to step in and act — and a role for governments. To invest in powerful new cancer drugs without ensuring that patients also have the safety net that antibiotics provide is to fail them.