Pat Garcia-Gonzalez
When Pat Garcia-Gonzalez’ stepson, Max, was diagnosed with chronic myeloid leukemia (CML) in 1988 at the age of 14, the Internet was still in its infancy and decades away from the networking resource it has become today. Told that Max would need an allogeneic stem cell transplant to survive, the family searched around the world for 2 1/2years among the available bone marrow donor registries to find a human leukocyte antigen match for the lifesaving therapy, but they were unsuccessful. Max died 3 years later.
A decade after that, Ms. Garcia-Gonzalez launched The Max Foundation (https://themaxfoundation.org), a global nonprofit organization that aims to accelerate health equity for patients with cancer. Starting out as a small nonprofit organization in Latin America to help other families with children diagnosed with leukemia receive education and support services, The Max Foundation has grown into an international resource providing access to cancer treatment to more than 134,000 children and adults with cancer in 77 low- and middle-income countries.
In July 2023, the foundation instituted its first program in the United States—Max GPS, a patient navigation service in Seattle—to reduce health-care system barriers for patients with cancer, especially those living in medically underserved and underrepresented communities, with the goal of expanding the program nationally.
“The fragmented health-care system in the United States is such a shame, because there are so many resources available for people with cancer, but often they cannot access those resources,” said Ms. Garcia--Gonzalez, Chief Executive Officer of The Max Foundation. “All of us interested in cancer care need to help patients navigate the medical system, so every patient can feel safe accessing care in the United States.”
The ASCO Post spoke with Ms. Garcia-Gonzalez about how The Max Foundation’s efforts are resulting in greater access to high-quality cancer care, especially for patients in low-resource countries.
Bringing Cancer Care to Low-Resource Countries
Please talk about the reach of The Max Foundation globally and its impact on care for both children and adults with cancer.
When we launched the foundation in 1997, we expected to hear from parents who had children with leukemia in Latin America, but we started receiving e-mails from people all over the world, many from those living in low- and middle-income countries, telling us that someone in their family was diagnosed with some type of cancer, but that treatments were not available in their country. There is nothing worse than hearing your loved one has cancer—and because of where you live, you cannot access existing treatment.
We started out as a very small grassroots organization to help people navigate their way to resources. An important milestone was reached in 2001, which changed our trajectory. We received a call from someone in Honduras who was seeking help for access to imatinib for a man diagnosed with CML. We contacted the drug manufacturer for a humanitarian donation, and that event started the development of our model to access life-saving cancer therapies in low- and middle-income countries.
Since then, we have helped bring 10 million doses of cancer therapies each year to 77 low-resource countries through partnerships with a variety of pharmaceutical companies. Moreover, we have developed a global network of more than 500 physicians and nearly 400 hospitals and medical institutions, as well as several local nongovernmental organizations and patient associations.
How are you able to provide access to essential cancer medicines in developing countries that have different governance structures?
At the center of our four-pronged access model is the patient and the treating physician. We have collaboration agreements with health-care providers in the countries we serve, and they send us requests for essential cancer medicines. We also have dedicated and knowledgeable teams in these communities who help solve many logistical problems and ensure the medicines reach the patients.
We have a priority list of drugs needed in these countries, and we partner with seven pharmaceutical companies to procure those drugs. Then we partner with international distributors to ensure the drugs are shipped directly to the nearly 400 hospitals we serve. We are able to track individual treatments for each patient served, which allows us to forecast future needs for specific drugs.
Our dream is to be able to provide any medicine a patient with cancer needs. For chronic myeloid leukemia, that dream has come true.
Providing Treatment for Advanced Breast Cancer
You recently created the Max Access Solutions program to deliver treatment for patients with hormone receptor–positive/HER2-negative advanced breast cancer in nine countries across Africa, Latin America, and South Asia at no cost to the patient. Please talk about how you are able to accelerate care for patients with breast cancer in these countries, and what has been the impact so far?
We launched the program in 2022 and have been working with hospitals in these countries to identify the infrastructure they need to diagnose advanced breast cancer, which is very complex. We are engaged with the American Society of Clinical Pathology, the ABC [Advanced Breast Cancer] Global Alliance, and the companies Cepheid and Novartis AG to provide diagnostics, treatments, and physician training in this cancer and identify the barriers to care for patients. Such barriers include poor access to screening, delayed diagnoses, inadequate disease management, and the lack of therapeutic interventions.
We have the first supply of medicines for advanced breast cancer now on their way to several low-resource countries in Africa, Latin America, and South Asia. Most recently, Lilly has agreed to provide access to abemaciclib free of charge to patients with advanced breast cancer in Kenya.
Ending the Stigma of Cancer
Why have you decided to add advanced breast cancer to the types of cancer The Max Foundation is focusing its efforts on?
Breast cancer is the most common cancer worldwide. Globally, about 2.3 million women are diagnosed each year with breast cancer, and nearly 700,000 die of the disease.1 Although breast cancer incidence is relatively lower in low- and middle-income countries compared with high-income countries, breast cancer mortality in low-resource countries is higher.2
The treatment protocol for metastatic breast cancer fits our drug access model, which includes targeted therapies and oral medications that have a good safety profile and that do not require a lot of supportive care. It becomes more difficult to provide systemic treatment, such as chemotherapy, which may have treatment-related toxicities and may discourage treatment adherence.
We want all organizations involved in breast cancer treatment to join us, so we can help patients with all types of breast cancer access the treatment they need. Historically, we engage with patients and patient advocacy organizations in low-resource countries to provide, in addition to medicines, patient education and support.
There is a high level of stigma attached to cancer in these countries, because the disease is considered a death sentence. Through our efforts, we hope to bring quality cancer care to underserved patients in low-resource countries, as well as in the United States, and show that cancer does not have to be a death sentence—and end the stigma of cancer. n
DISCLOSURE: Ms. Garcia-Gonzalez is Chief Executive Officer of The Max Foundation.
REFERENCES
1. World Health Organization: Breast cancer key facts. Available at www.who.int/news-room/fact-sheets/detail/breast-cancer. Accessed January 16, 2024.
2. Manson EN, Achel DG: Fighting breast cancer in low- and middle-income countries: What must we do to get every woman screened on a regular basis? Scientific African e01848, 2023.
