Why is addressing the bacterial AMR threat so crucial to cancer care patient outcomes?

Dr Najy Alsayed from the Menarini Group, a UICC partner, examines the growing threat of antimicrobial resistance for people with cancer, highlighting alarming global data, its clinical and economic impacts, and the urgent need for integrated surveillance, stewardship, and patient-centred care strategies.

Ahead of the World Antimicrobial Awareness Week (WAAW), it is fundamental to consider the accelerating threat of bacterial antimicrobial resistance (AMR) – the fact that the bacteria causing infections are increasingly resistant to the drugs designed to mitigate their related infections. This results in global epidemiological, geographical, clinical, and economic impacts, all of which are supported by robust and documented facts and data.

According to a World Health Organization report, published in October 2025 and based on 2023 data examining 23 million bacteriologically confirmed infections in 104 countries, it was ascertained that approximately one in six laboratory-confirmed bacterial infections were caused by bacteria resistant to antibiotics. This data also highlighted a worrying rise in bacterial resistance across approximately 40% of pathogens in the period between 2018 and 2023.

It is also well documented how today the AMR threat contributes towards millions of deaths and generates billions of dollars in costs to the global economy.

More specifically, global data collected in 2019 and 204 countries, published in the Lancet in 2022, demonstrated that 1.27 million deaths were directly due to a drug-resistant bacterial infection, whilst a further 4.95 million deaths were associated with bacterial AMR.[1] These are people who died directly from an infection or as result of an illness, such as cancer, but whose treatment was made harder or impossible by a drug-resistant infection.

Many consider the projections published in the Lancet in 2024 particularly alarming as indicating a rapid increase in AMR mortality rate which could lead  to over 10 million deaths in 2050, with 1.91 million attributable deaths and 8·22 million deaths associated with AMR.[2] 

Additionally, a 2024 report issued by the World Organization for Animal Health (WOAH) shows how the AMR threat could have a staggering economic and social impact.[3] Indeed this report highlights an estimated burden of USD 66.4 billion per year to cover in-patient infections attributable to antibiotic resistance, and a projected 1.7 trillion annual reduction in global economic output and 28 million people living in poverty by the year 2050.  

With regards to people living with cancer, it is imperative to consider how immunosuppression and frequent in-patient care therapies make this patient group significantly more susceptible to AMR. This was demonstrated by recently published data, which confirmed how cancer patients are at a 4 to 6.8 times higher risk of contracting an infection depending on their cancer type and geographic location.[4]

Furthermore, a significantly increased risk has been also confirmed in the out-patient setting where resistance levels are 3 times higher compared to non-cancer patient groups.[5]

If one considers the implications of the above in oncology patient management, it becomes clear that we need to act now. Such action should lead to adopting a series of significant steps aiming at allowing physicians to continue using innovative breakthrough oncology therapies whilst securing the targeted clinical outcomes and potentially save lives.  

Five major steps that could be put forward 

1. Incorporate AMR surveillance within the cancer patient journey, to understand how common resistant infections are, how they change over time, and what their impact is on outcomes.

2. Adopt stewardship measures (the optimised use of antimicrobial drugs in terms of selection, dose, duration, and treatment method) to support empirical evidence and, if appropriate, de-escalate target antibiotic therapies

3. Apply caution in order to guarantee an appropriate use of antibacterial prophylaxis, with the aim of not only protecting the present but also securing the future 

4. Strengthen a multi-disciplinary patient management approach

5. Encourage greater involvement of people living with cancer and their families for a better understanding and optimisation of the expected outcomes of both antibiotic and cancer treatments.

Menarini strongly believes that fighting the threat of AMR goes beyond its already steadfast and longstanding commitment to improve and potentially help save lives of people living with cancer. It is also a critical and necessary contribution if society is to safeguard the achievements and the progress made by modern medicine within the last few decades. 

Menarini also seeks to provide clinicians and the people under their care with, innovative diagnostics solutions and potentially life-saving therapies that target unmet medical needs for both cancer and AMR-related infections. This should contribute to an integrated and targeted therapies alongside a multi-disciplinary patient management approach aimed at optimising outcomes.  

The AMR threat is, however, significantly exacerbated by what is recognised as a ‘broken model’, in other words, a depleted antibiotics pipeline alongside patients' poor access to novel antibiotics. This is illustrated by the fact that out of the 16 approved antibiotics over the last decade, only two could be made available to clinicians and people with cancer within high-income countries, with even a further limited access in middle to low-income countries.

The above alarming facts call for bold, immediate, coordinated, and decisive action by all key stakeholders, including policymakers, so society may swiftly and efficiently address the challenges that arise and effectively curb the AMR threat. This would be particularly critical for those patients who are most vulnerable, such as immunocompromised oncology and transplant patients.

References 

1. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Volume 399, Issue 10325, p629-655, February 12, 2022

2. M. Naghavi et al. 2024 Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. Volume 404, Issue 10459, p1199-1226 September 28, 2024

3. WOAH 2024, Final Report of the 91st General Session – Paris, May 2024

4. M. Bassetti et al. Infect Dis Ther 2025, Laupland et al. Eur J Clin Microbiol Infect Dis. 2020, 2. Cecilie H. Blimark et al., Lancet 2025 

5. V. Gupta et al.The Lancet Oncology 2025: Incidence and prevalence of antimicrobial resistance in outpatients with cancer: a multicentre, retrospective, cohort study. Volume 26, Issue 5, May 2025, Pages 620-628