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Global Realities of ASCO Innovation: Perspectives From Latin America
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Released: August 07, 2025

John Marshall
John Marshall, MD
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Interview With Dr Carlos Barrios

 

John Marshall, back for Oncology Unscripted in our global tour post-ASCO 2025 to think about, okay. All this really cool new stuff. Lots of new therapies, lots of curves showing big deltas, with these new therapies across a bunch of different disease types.

 

But not everybody's excited because not everybody has the same access that say we do here in the United States. And there's a lot of controversy about that. And as you know, we've been taking a little bit of a world tour. We are now wintertime in South America and being joined by Dr. Carlos Barrios, who's been kind enough to join us and give, if you will, a south of the equator perspective from South America perspective. And so, Dr. Barrios, welcome to Oncology Unscripted. Tell the audience a little bit about you, and we'll get right into it.

 

Carlos Barrios, MD: Thank you very much, John. A pleasure being here. I've heard, wonderful things about your, program and all your activities in this regard. I think that you are very much appreciated for doing that. And, concerning myself, I am a medical oncologist, my practice tool breast cancer. And I'm currently my, most important title is I'm coordinating the Latin American Cooperative Oncology Group. Okay. That we started a number of years ago here in the region. And that's essentially what I, I try to do most of the time.

 

John Marshall, MD: Tell me a little bit more about your practice. Where is it located? How big is your group? That kind of thing.

 

Carlos Barrios, MD: Oh, I'm part of a very big group called Onco Clinicals Group and in the unit in Port Alegre in South Brazil. And I mainly see breast cancer patients most of the time. I see a few other situations, but mostly I'm a breast doctor.

 

John Marshall, MD: So, one of the papers that I happen to know that came out in breast cancer, was this, treatment of, breast cancer with emergence of resistance being detected with a fancy blood test and then switching the treatment earlier than say, clinical progression. And I realized that it was a bit of a controversial paper on. On a couple of fronts, but when you see something like that and you know, expensive, fancy therapies, a fancy blood test, what's that like? Can you apply those things right away to your practice there in Brazil or are those things that take time for you to have access to?

 

Carlos Barrios, MD: What you're referring to was this SERENA-6 study that actually, speaks about using ctDNA data, on, changing what you are doing before clinical progression. but the two situations actually, the same kind of principle, bringing something new to clinical practice and as we were discussing before, I think that is very, very important and critical for everybody to recognize that it's one of the most important, if not the most important discrepancy in, universal discrepancy, at the present time, people may not be aware of this, but pharmaceutical industries in general have the United States as the main market. if a new drug gets into the market, 65% of what is consumed of that drug, it's in the United States about 20 to 22%, it's in the five main countries in Western Europe, and 7% it's in Japan. So, that if you adds what actually sells new drugs into the market in the first five years, it's end up being 90% in those three or four markets.

 

John Marshall, MD: Let me, let me kind of drill down on that.

 

Carlos Barrios, MD: That leaves only 10% for the rest of the world.

 

John Marshall, MD: Rest of the world and we're talking about, you know, what is that 6 billion people? I always say that it,

 

Carlos Barrios, MD: billion people currently in the world.

 

John Marshall, MD: yeah.

 

Carlos Barrios, MD: And only 1 billion actually, have some kind of access at the present time.

 

John Marshall, MD: Yeah, and this is the statistic I use, is that only one in seven of us on the planet has access to the kind of cancer care. And so, if you give me a little sense about what, how, how did we move on from that? I mean, there is a lot of turmoil going on right now in the United States, as you know, around healthcare. Who should get it?

 

Your country has. Struggled over time. There is two, I think, tiered systems where some people have insurance, some people don't, and your different access accordingly. That's true in Europe's true everywhere, frankly. where does it stand right now in your country and what would you advise if you were, if in the White House right now?

 

Carlos Barrios, MD: You are asking a very, very difficult question.

 

John Marshall, MD: Come on.

 

Carlos Barrios, MD: It doesn't have a, doesn't have an answer.

 

John Marshall, MD: Right, right.

 

Carlos Barrios, MD: If this is a problem that is important, everybody recognizes if there is an answer to this situation, probably we would have already found a way to solve this because it's very, very difficult to live with this kind of discrepancy.

 

In Brazil, for example. Then I try to address your question specifically, but just to tell you, in Brazil as an example, 80% of the population does not have any access of to any of the new advances. Only 20% of the population actually does. Okay.

 

John Marshall, MD: I interrupt? Lemme, lemme interrupt. For our audience on that, I just wanna be very clear. So, if you identified an MSI-high colon cancer patient…

 

Carlos Barrios, MD: 80% of the population will not have access to immunotherapy now. Okay. So that obviously has a consequence in terms of, The results has an out, consequence in terms of survival. Okay? So, it's not a small problem. Okay? So, you ask me for a solution, and obviously it doesn't have a one kind of solution, but I have some ideas in this regard.

 

The first step in my idea is that we need to put everybody together. Governments needs to be there. The societies needs to be there. Patients need to be there. Society overall needs to be there. need to be there. Okay. And pharmaceutical industries need to be there. Okay. and I think the main problem in my view is that pharmaceutical audience, industries actually price their drugs, Okay, and that's another very big discussion, how drug pricing is actually, done. But they price the drug to, for the, the, the main market. So, whatever the United States can pay, okay. They decide on the, on the price. the United States, according to what I know, okay. doesn't negotiate prices with the pharmaceutical vendors. So, they can put whatever the price they want. Okay. So, my main solution at the present time, that would change immediately. This situation, I Would be for the United States to start negotiating prices with the pharmaceutical industry because if you drop the price in the United States, you are gonna be making access possible to a number of different places in the world.

 

So, there are many players. It's a very complex issue. Okay. But that's one single signature. Okay. And your president had been signing a number of different things that you can agree or not. But if he would sign something like this okay. And Congress would approve it; I think that that as a single measure would have a significant impact in access all over the world.

 

John Marshall, MD: So, let me, let me, let me.

 

Carlos Barrios, MD: That's my take

 

John Marshall, MD: No, I love it. We are totally aligned because the Biden administration before passed a law that then said two years ago there were gonna be 10 drugs that we were gonna negotiate. This past year was 15 drugs, and of course the pharmaceutical industry, whose entire business model depends on what you just described.

 

Is it like doesn't want this, but the payer, whether it's the government or our health and private health insurance, et cetera, would like something like this because then we could, what's the value of the individual product? And to me the point is exactly as you're taking it, then the easy solution is that you then start selling at a lower price, but to many, many more people. And so,

Carlos Barrios, MD: absolutely. So, the point is that we need to identify it is like we do every single day. We have to make a correct diagnosis and try to interfere with the process in a very direct and practical way. And, in my opinion, that's the single. Most important measure that can happen in order to, it is not the only one, but certainly it's the single most important measure that actually can make access much more prevalent all over the world for all these drugs.

 

John Marshall, MD: And I think one further complicating factor, at least here in the States, and I think it's probably true in other places too, is that we as healthcare providers are. Also, middlemen in this chain of command is that we are making money. We are supporting hospital systems and care on the backs of this markup, that's out there.

 

And so, that, that's another lobby advocacy group that is sort of counter to this change. but I couldn't agree more that we need to get together and all of us, that list you gave was exactly the invitation list that I would agree with.

 

Carlos Barrios, MD: And you know, and there are a lot of people saying a number of things in this regard, but I think that we can all agree universally that we lack leadership in many, many areas. The world lacks leadership at the present time, and the one thing that I ask for is governments everywhere. Doesn't necessarily need to be the United States, but in this kind of situation, do not want the government to give me the answer or give me the solution. just want the leadership to be strong enough to put all the players together, everybody into a room and lock the door and tell them, I will let you leave once you give me a plan, a strategy, a solution, because that leadership is absolutely essential for these things to move on and, hopefully improve the lives of people all over the world.

 

 When I came back to Brazil from the United States, after my training, I, it took me about five years on, this was 1996, 95, 96, to start a clinical research program. Okay. And the main reason, okay. What motivated me to develop this clinical research program was exactly what you say. If patients do not have access, you may be able to offer us access, at least for some of them in clinical research. And I think that that's one of the beauties of clinical research that can provide access even before the drug, this effect.

 

So, I see patients very willing to participate in this kind of activity. And we actually have been able to help; we have in our center specific by now. More than 3,500 patients over the last years have actually participated in clinical research trials. And so, I think that then, it's a small step, but it's something that everybody can do if people actually, take the responsibility of building this kind of possibility for patients.

 

John Marshall, MD: Let me be a little dark about that comment though, because what that has created is less expensive. If you will, more engaged patient population to do clinical research. So, in many ways now, the United States patients are not participating in trials because they don't have to, because people around the world are, I always used to say, dying, to get on clinical trials when we would then reap the benefit from that. So even though I am very, very appreciative and I agree with your strategy for access, there is a dark side to that of others doing our research for us.

 

Carlos Barrios, MD: No, I think that that's a consideration. The issue is that one of the critical aspects of clinical research that needs to be addressed and improved is the fact that we need to make it more accessible to different patient populations across the world. So, I think that goes to the fact that you need to look—and a lot of industries are actually looking for that specifically—trying to put more diversity into clinical trials. Because you can make the opposite argument and say that most of the trials that have been conducted so far have been conducted in the Caucasian, white population, and they do not necessarily have the results that apply to other populations.

 

So again, an issue to be discussed, but I would be very in favor of more and more clinical trials opening up to different patient populations all over the world.

 

John Marshall, MD: Carlos Barrios, thank you so much for taking time out of a busy day. I know that you’re at a meeting yourself and things are running around. It really matters a lot to me that you've done this and shared your feelings and your region's issues with all of us. And as you say, I hope one day that your wish comes true and that we all find ourselves in that big room together, with the door locked, until we solve the problem.

 

Carlos Barrios, MD: I hope that happens, and I would encourage you in the US to push for that important process because I think that’s one single thing that actually can have a consequence all over the world. So, John, thank you very much for the invitation, and congratulations again for your program.

 

John Marshall, MD: My pleasure.