Figure. 2 Overview of measures to integrate AMR strategies into NCCPs 

UICC will continue working with members and task force experts to push for including AMR in national cancer control policies, viewing this integration as a critical first step toward implementation.

Conclusion

In conclusion, Dr. Zürn noted that AMR presents a growing challenge, particularly for cancer patients. Research shows that cancer patients have significantly higher rates of resistant infections and worse outcomes when these infections occur. However, data gaps remain, especially in low and middle-income countries. The cancer community and infectious diseases community need to work together through targeted interventions and global collaboration. If appropriate action is not taken, all gains in cancer control and modern medicine will be at risk, as antibiotics and other antimicrobials are essential to cancer treatment. Addressing AMR in cancer care requires integrating it into national cancer control plans, collecting data on resistant infections in cancer patients, ensuring infection prevention and control measures are in place, implementing antimicrobial stewardship programs, and providing access to appropriate medicines and diagnostics.

(3) Lecture 2

No-one Left Behind – AMR and AI: Medical DX Projects of the Asia Cancer Forum  

Teppei SAKANO, Director of Digital Transformation at the Asia Cancer Forum (ACF), presented on how digital transformation and artificial intelligence can support the global response to antimicrobial resistance (AMR). He focused on how digital infrastructure and AI-based tools can connect frontline clinicians, researchers, and policy makers to address AMR in cancer care.

Digital Infrastructure and Telemedicine Applications

ACF has been building medical digital transformation (DX) projects that integrate medical data platforms, telemedicine systems, and AI-based diagnostic imaging tools. Telemedicine operates in two primary models: doctor-to-patient, where physicians provide care directly to patients through smartphones and apps, and doctor-to-doctor, where expert oncologists support local physicians remotely. 

ACF has developed mobile-based applications allowing clinicians to share images and support each other in real time, with these platforms also used for training and live mentoring through remote connections to surgical rooms.

Telemedicine systems are increasingly integrated with medical devices. A portable ultrasound system with AI can automatically screen patients and alert physicians to abnormalities, with expert support available via teleconsultation for complex cases. Similar structures apply to portable x-ray systems and AI-assisted mammography units operating from mobile units. These solutions have been deployed in various locations, including temporary medical examination sites at elementary schools in Brazil, particularly in areas with extremely low accessibility such as the Amazon region. The technology enables rapid deployment even in disaster or conflict zones, bridging gaps between large hospitals and rural clinics.

Oncology Networks and Humanitarian Applications

A major initiative is a doctor-to-doctor network for oncology developed in collaboration with the National Cancer Center of Japan, where oncology specialists provide teleconsultation to local physicians for difficult cancer cases. This infrastructure has been adapted internationally for infection control and AMR monitoring as well. 

Since 2022, ACF has collaborated with Ukrainian medical authorities to address digital health capacity in conflict-affected regions. Over 1,600 medical facilities have been damaged or destroyed during the war. The ACF team has been installing portable diagnostic equipment with AI screening capabilities and telemedicine connections to Japanese hospitals to support affected areas.

Education is another critical component, with tele-education and observer programs established to train Ukrainian medical professionals. Sixteen medical doctors from Ukraine completed two-month training programs in collaboration with Japanese hospitals and national centers. Through these efforts, the organization identified that AMR has emerged as a significant issue in Ukraine, affecting hospital operations, patient outcomes, and national health resilience. The presence of multidrug-resistant infections is high among trauma and cancer patients, combined with limited access to diagnostics and appropriate antibiotics.

AI-powered Infection Control Platform

ACF has launched an AMR digital transformation project in collaboration with the Japanese government's infection control centers, WHO, and Ukrainian partners. The system is an AI-powered platform that collects, analyzes, and visualizes data on antimicrobial use and resistance trends. Users can input patient data, diagnosis information, and pathogen data to receive AI-generated antimicrobial recommendations. The system connects with laboratories to monitor resistance patterns, provides clinical insights and feedback, and includes access to current infectious disease research and news. Real-time dashboards display facility and regional-level resistance statistics for health facilities and public health authorities.

The project integrates infection control data collection with AI-driven diagnostics and optimal antibiotic recommendations. It has been implemented in Ukraine in collaboration with government public health centers and hospitals. The system is provided free of charge to clinicians, hospitals, and pharmaceutical companies developing new antibiotics. The overarching concept is to ensure no one is left behind in the global fight against AMR through AI and medical digital transformation.

(4) Discussion

Dr. Iwasaki, moderator of the discussion session, opened by asking Dr. Zürn to clarify the definition of AMR for a diverse audience including non-medical students. 

Dr. Zürn explained that AMR stands for antimicrobial resistance and encompasses all medicines used to treat infections, including antibiotics, antifungals, antivirals, and antiparasitics. She noted that the public may better understand the terms 'drug resistance' or 'superbugs.' AMR occurs when medicines taken to fight infection no longer work. While resistance exists across all therapeutic areas, its acceleration is driven by inappropriate and overuse of medicines, such as doctors prescribing antibiotics for viral infections or using antimicrobials as growth hormones in agriculture and livestock. She emphasized that the research and development pipeline for new antibiotics and antifungals is not advancing at the pace needed, particularly compared to blockbuster cancer treatments.

Dr. Iwasaki characterized AMR as a worldwide crisis, sometimes called a 'silent pandemic' with potential to cause greater health impacts than COVID-19. He noted that AMR is a threat to all countries globally. He emphasized that currently there are no effective therapeutic options for treating AMR infections, creating a significant challenge for physicians managing affected patients. Cancer patients are particularly vulnerable because they face both the underlying disease and treatment-related immunosuppression, making them fragile and susceptible to infection.

Dr. Iwasaki asked how AMR infections should be properly managed. Dr. Zürn explained that guidelines vary by region. When cancer patients develop fever with neutropenia, initial standard treatment is monotherapy. However, once an AMR pathogen is identified, management becomes more complex, potentially requiring admission to intensive care and more complicated intravenous formulations. She stressed that empirical treatment must be adapted to local surveillance data, including antibiogram information, and that guidelines must be facility-specific, current, and based on surveillance data. She noted that guidelines from the American Society for Clinical Oncology (ASCO) and Infectious Diseases Society of America (IDSA) from 2018 are outdated. The main message is that guidelines must be updated and the cancer and infectious diseases communities must collaborate at national and facility levels to ensure antimicrobial stewardship alongside cancer treatment.

Dr. Iwasaki described Japanese hospital practice, which typically involves isolating infected patients and selecting appropriate antibiotics for AMR pathogens. He noted that many cases are complicated with mixed infections, so proper antibiotic use is essential. He acknowledged that while guidelines exist, they require updating for current situations. He emphasized that proper information and correct understanding are critical for doctors and nurses. He suggested that Mr. Sakano’s application tool could be valuable for showing infection prevalence status and proper treatment approaches.

Mr. Sakano explained that his team is focusing on Ukraine as an AMR epicenter. The CDC has announced that AMR is spreading from Ukraine to the rest of the world. A critical issue is that wounded soldiers take seven to ten days to transfer from the frontline to hospitals, and then are transferred to neighboring countries like Poland, Romania, Germany, and Switzerland, spreading AMR during these transfers. During transfer, patients acquire many pathogens, but medical data including testing results and antibiotic usage information are not shared between clinicians. This data sharing failure is a major problem. Additionally, clinicians use multiple antibiotics to prevent patient death, but without knowing what medications were previously prescribed, the usage multiplies and escalates. Studies indicate that trauma patients have a 50% higher mortality probability due to AMR issues in Ukraine.

Dr. Iwasaki noted that soldiers and cancer patients share common features: both are in poor situations for infection control and are physiologically weak. He observed that Mr. Sakano's system serves two purposes: accumulating correct information about infections and current AMR infection status, and providing doctors and medical personnel with proper guidance on using antimicrobial drugs and infection control methods. He stated that such systems are needed not only in Ukraine but also in other countries, including Japan and developed nations, which currently lack nationwide or region-wide capability to capture AMR infection status. He emphasized that new drug development is difficult from a business perspective and requires national, government, and global support.

Mr. Sakano highlighted the dramatic decline in antibiotic development. In Japan during the 1990s, 27 new antibiotics were approved; from 2010 to 2020, only three were approved—approximately one-tenth the previous rate. In the United States, antibiotics comprised 20% of all new drug pipelines in the past; now only 6% are antibiotics. Pharmaceutical companies are reluctant to develop new antibiotics, with only 3,000 scientists globally now working on this compared to 50,000 previously. His focus is to demonstrate to pharmaceutical companies how proper antibiotic usage through data systems can extend product lifetimes and generate profit, potentially encouraging pharmaceutical development. By targeting and limiting antibiotic usage, revenue can be maintained while preserving drug effectiveness.

Dr. Zürn noted that Mr. Sakano’s application tool could be amazing if implemented, but noted challenges in linking laboratory data and cancer registries, particularly in low and middle-income countries (LMICs). She emphasized that these challenges should not prevent attempts. The first step is bringing cancer and AMR communities together to recognize the importance of merging data.

A student asked what policy changes LMICs could adopt to ensure responsible antibiotic use among practitioners, given challenges of poor lifestyles, limited resources, and easy availability and overuse of antibiotics. Dr. Zürn emphasized patient awareness of what AMR is, AMR risks, and infection prevention and control. For practitioners, she recommended guidelines based on local, up-to-date surveillance data for infections in cancer wards and facilities. Guidelines should be harmonized at national and local levels with microbiological support. She stressed that cancer and infectious disease departments should coordinate when procuring antimicrobials alongside cancer medicines, using the WHO model list of essential medicines as guidance but adapted to local needs.

A student noted that antibiotic usage is higher in animal medicine than human medicine but questioned why the focus is on human medicine when most emerging infections have zoonotic origins. Dr. Zürn acknowledged the issue and explained the recent Quadripartite Agreement that brings agriculture, environment, human, and veterinary sectors together to address AMR collaboratively through a One Health approach. Antibiotics are misused in animals as growth hormones due to lack of education. The FAO and World Animal Health Organization have guidelines and standards, though education remains needed in resource-limited settings.

Dr. Iwasaki added that huge volumes of antibiotics are used in agriculture and animal feeding, and attention must focus on non-medical fields alongside medical applications when considering total antibiotic consumption and its role in creating AMR pathogens.

A student asked whether standards exist for antibiotic use in animals. Dr. Zürn stated that guidelines exist from the FAO and World Animal Health Organization, but education is lacking in resource-limited settings. For humans, the WHO has the AWaRe (access, watch reserve) classification and WHO model list of essential medicines guidance. However, global guidance must be adapted at national, regional, and facility levels based on local surveillance data.

A student asked about AI progress in addressing challenges of multidrug-resistant microbes, including discovering new antibiotics. Mr. Sakano explained that the application imports surveillance data from WHO and governments plus clinical data and published papers. AI instantly updates with changes, which humans cannot do as quickly. However, accuracy and phantom data results must be continuously checked. The team uses new AI models from ChatGPT, Gemini, and Claude, etc., recognizing clear advantages in using modern AI. 

Dr. Iwasaki added that AI is widely used in drug development beyond infectious diseases, helping identify proper targets and supporting multiple phases of drug development, with pharmaceutical companies increasingly utilizing AI tools. He expressed hope that AI could help develop drugs for AMR pathogens.

A student asked how low-income countries should proceed with publishing national guidelines when lacking evidence from clinical research and funding. Dr. Zürn advocated for increased randomized controlled trials in low and middle-income countries, acknowledging challenges but emphasizing need for data. She recommended using the WHO Model List of Essential Medicines as a model but adapting it to country-specific needs through national committees. She mentioned CDC Africa has guidelines on AMR and cancer. Most importantly, she urged that national cancer control plans include infection management, infection prevention and control, and procurement of appropriate antimicrobials and diagnostics. 

Dr. Iwasaki noted that collaboration between oncologists and infectious disease specialists is essential, and cited the National Cancer Center of Japan's decision decades ago to establish an infectious disease control department as recognition of this importance.

5) Assignment 

Students were given the following assignment: 

Imagine you are advising a health ministry in Asia. How would you integrate AMR measures into the country’s National Cancer Control Plan (NCCP) while ensuring fairness and sustainability? Focus on collaboration between sectors such as health, education, and environment.