Analysis of 2023 World Health Organization cancer Essential Medicines List and concordance with resource stratified guidelines

Background The Essential Medicines List (EML) and Resource Stratified Guidelines (RSG) both prioritize high-value medicines. We compare the 2023 EML cancer medicines list to global cancer statistics, examine the proportion of EML therapies recommended by RSGs, and identify gaps that merit evaluation by the EML Committee. Methods We compared the 2023 EML medicines for adult cancers with cancer incidence and mortality data from GLOBOCAN2022. We cross-referenced the EML with two RSGs (National Comprehensive Cancer Network (NCCN) and National Cancer Grid (NCG) of India), and evaluated preferred treatments in RSG that were not recommended by the EML. Findings The 2023 EML included 64 cancer medicines for 219 tumor-specific indications. The greatest number of medicines are listed for leukaemia (n = 37, 17%) and lymphoma (n = 33, 15%). While some common cancers (eg, hepatocellular carcinoma) have no EML listed medicines due to the low clinical benefit, we identified some cancers (eg, esophageal and gastric) with effective therapies that should be evaluated by the EML for inclusion. Cancers with no listed medicines comprise 34% of cancer deaths globally. Among EML indications with a NCCN RSG, 42% (35/84) and 73% (62/84) were recommended by the NCCN Basic and Core Guidelines, respectively. Among EML indications with a NCG RSG, 163/196 (83%) and 175/196 (89%) were recommended by the NCG Essential and Optimal guidelines, respectively. Interpretation We identified some effective medicines which should be evaluated for inclusion in the EML. Prioritisation of cancer medicines was similar between the EML and NCG India, but discordant between with NCCN RSG.