IPM Take
This roadmap challenges a weak point in cancer policy: systems often pay for medicines before they know how best to use them. Dose, duration, sequencing and combinations are not academic details. They shape toxicity, quality of life, waste, budgets and patient outcomes. For IPM, treatment optimisation should be treated as part of access policy, because access to a medicine is incomplete if the system cannot define its safest, most effective and most sustainable use.
Executive Summary
A 2026 Journal of Cancer Policy article presents a multistakeholder roadmap from the Cancer Medicines Forum, co-chaired by the European Organisation for Research and Treatment of Cancer and the European Medicines Agency. The roadmap argues that marketing-authorisation trials often leave important treatment-use questions unanswered, including optimal dose, duration, schedule, sequence and combinations. EORTC states that these gaps create challenges for clinicians, patients and healthcare systems, and that the roadmap proposes strategic actions to embed treatment optimisation into oncology research and policy.
Why it matters
- Payers / HTA bodies: Need evidence on dose, duration and sequencing to avoid paying for avoidable toxicity, overtreatment or inefficient medicine use.
- Clinicians: Need practical evidence after approval to guide real-world treatment decisions, not only trial-based proof that a medicine can work.
- Patients / advocates: Should push for optimisation studies that protect quality of life and reduce unnecessary treatment burden.
Until now, oncology access has often focused on one milestone: approval. But approval usually confirms that a medicine can work under trial conditions. It may not show how to use that medicine most effectively in daily care.
What has changed is the policy framing. The Cancer Medicines Forum places treatment optimisation inside the access debate. This means asking whether current evidence is enough to guide dose, duration, schedule, sequencing, combinations, discontinuation and use in real-world patient groups.
The eligibility issue is broad. It affects patients receiving approved cancer medicines where the best use remains uncertain. For personalised oncology, this matters because targeted therapies, immunotherapies and combinations can be expensive, toxic and clinically complex. If systems do not answer optimisation questions, patients and payers carry the cost of uncertainty.
The implementation message is sharp: Europe needs evidence systems that continue after approval. Treatment optimisation should not be an afterthought. It should be part of how regulators, HTA bodies, payers, clinicians and researchers make cancer innovation usable, affordable and patient-centred.
