Major breakthroughs have been realized in controlling cancer in the past five decades. However, for patients in low- and middle-income countries (LMICs), many of these advances are nothing but an aspiration and hope for the future. Indeed, the greatest challenge we face in oncology today is how to reconcile small, incremental and significant improvements in the management of cancer with the exponentially increasing costs of new treatments. Emerging economies are attempting to address this important issue of access to cancer medications. In this Review, we examine how LMICs are using generic and biosimilar drugs, expanding participation in clinical trials, implementing universal health-care schemes to pool resources, and using compulsory licensing schemes as well as increasing multiple-stakeholder public-private partnerships to increase access to cancer medications for their citizens. Any truly effective programme will require multiple stakeholder involvement - including governments, industry and civil society - to address the issue of access to medication. Only with the creation of a global entity to fight cancer that is supported by a global fund - for example, in the mould of the GAVI alliance and the International Finance Facility for Immunization - will we truly be able to improve cancer care in LMICs and drive down the high mortality rates in these regions.
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