ATOM Coalition Seeks to Ensure Equitable Cancer Care in Low- and Middle-Income Countries

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A new global health initiative, the Access to Oncology Medicines (ATOM) Coalition, may be capable of reducing the burden of suffering and death from cancer in low- and middle-income countries by improving patient access to essential cancer medicine. Gilberto Lopes, MD, FASCO, MBA, will highlight the work of the coalition, and its future potential, during an Education Session at the 2023 ASCO Annual Meeting.

Gilberto Lopes, MD, FASCO, MBA

Gilberto Lopes, MD, FASCO, MBA

Overview of the ATOM Coalition

The ATOM Coalition is a global initiative established by the Union for International Cancer Control in partnership with the Sylvester Comprehensive Cancer Center. Its other partners include pharmaceutical companies, foundations, and professional associations such as ASCO and the American Society for Clinical Pathology.

Launched in May 2022, the coalition has since aimed to not only improve cancer medicine availability, but to also increase each country’s capacity to properly diagnose cancer and manage their supply of vital medications. The coalition has prioritized generic and biosimilar medicines currently on the World Health Organization’s (WHO) Essential Medicines List to treat cancers that cause the heaviest mortality in low- and middle-income countries.

“These are vital, lifesaving cancer medications for the most lethal cancers in ATOM Coalition target countries,” explained Dr. Lopes, who is Associate Professor and Chief of the Division of Clinical Medicine, Medical Director for International Programs, Associate Director for Global Oncology at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and Co-Chair of the ATOM Coalition. “They include medicines for lung, colorectal, breast, cervical, prostate [cancers, as well as pediatric cancers],” he added.


In 2020, there were over 10 million deaths from cancer worldwide—70% of which occurred in low- and middle-income countries, according to the WHO. Additionally, the WHO forecasted that most cancer deaths over the next decade will continue to occur in these countries.

The ATOM Coalition has identified 46 target countries that need greater access to cancer medicines and support services to bolster their capacity for long-term drug scalability and sustainability. The countries are spread over seven regions: Africa, North and South America, the Eastern Mediterranean region, Europe, South Asia, and the Western Pacific.

Within these countries—with a combined population of about 2.5 billion—there were 3.5 million new cancer patients in 2020 and 2.3 million premature cancer deaths.

“By 2040, we project a staggering 4 million cancer deaths within these countries,” Dr. Lopes warned.

Next Steps

The ATOM Coalition is currently working on the selection of its initial subset of countries for focused country capacity-building engagement and plans to phase in other countries over time. Each country will be selected based on a range of readiness criteria—including the presence of ATOM Coalition partners, health systems preparedness, diagnostic capability, essential medicines already on their national Essential Medicines List, and other access programs.

“When the first subset of targeted countries is determined, our focus will shift to the ATOM Coalition operating model’s two main tenets: increasing availability and affordability of cancer medicines and increasing target countries’ capacity to use them appropriately,” Dr. Lopes noted.

The coalition will work toward this goal by collaborating with governmental agencies and other stakeholders in these countries to assess needs, offer training, and provide capacity-building assistance. Additionally, the coalition will support generic, biosimilar, and originator drug manufacturers to develop, register, and supply essential cancer medicines at affordable prices. It will also seek to use voluntary licenses for patented essential medicines and new drugs of significant public health importance for these countries.

In October 2022, the Medicines Patent Pool and Novartis AG—both supporters of the ATOM Coalition—signed a voluntary licensing agreement to increase access to nilotinib, an oral medication used in patients with chronic myeloid leukemia, which is on the WHO Essential Medicines List for the treatment of cancer. This has allowed participating generic manufacturers to supply generic versions of nilotinib and is the first license that the Medicines Patent Pool has signed for a cancer treatment as well as the first time a company is licensing a patented cancer medicine through a public health–oriented voluntary licensing mechanism. This mechanism was instrumental in increasing access to human immunodeficiency virus medications in lower income countries.

Continued Engagement Needed

Moving forward will require continued engagement with all relevant stakeholders, including the private sector, national government, and local civil society organizations. Other key elements that the ATOM Coalition is building to ensure success include a governance structure and an engagement strategy led by the coalition’s council and its partners in each country—which will be supported by local coordination groups and sustainable funding sources.

Dr. Lopes emphasized that the coalition may need more seed funding and more ongoing funding for its long-term viability. Potential sources include pharmaceutical companies and related royalty agreements, development agencies, and foundations.

Although the coalition faces daunting challenges ahead, Dr. Lopes is confident of its eventual success.

“We have the energy, expertise, and collective will to reach our lofty goals. We must succeed. It’s too important for the future of these countries,” Dr. Lopes concluded.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.