Reciprocal recognition of tumour-agnostic and rare-indication approvals across regulators
When a trusted regulator approves a cancer drug for a rare genetic target, other countries should recognise that approval within months instead of repeating years of review.
Tumour-agnostic and biomarker-defined rare indications (NTRK fusions, MSI-high, RET, BRAF V600E) are approved at different times in different regions, and many countries never review them at all, leaving patients without access. Reliance pathways (Project Orbis, Access Consortium, WHO collaborative registration) show regulatory reliance works. The proposal is a formal reciprocal recognition agreement for defined categories, with automatic provisional authorisation in participating countries within 90 days of a reference approval, shared post-marketing obligations, and pricing negotiated in parallel.
- Regulatory divergence between regions · Regulatory divergence means a drug approved in one country can take years to reach another, or never arrive.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.