Lung cancer treatment takes another forward step
Improvements in lung cancer treatment are set to continue with a PHARMAC decision to extend funding for erlotinib (Tarceva) from 1 January 2014.
Erlotinib and another similar drug gefitinib (Iressa) are tyrosine kinase inhibitors (TKIs) that have changed the way aggressive lung cancer is treated, and improved the prospects of people diagnosed with lung cancer.
Ministry of Health data shows that while colon cancer, prostate cancer, breast cancer and melanoma are most commonly diagnosed in New Zealand, the leading cause of cancer deaths is lung cancer.
TKIs are part of a new wave of targeted cancer medicines, which are particularly effective for patients with lung cancer that harbour a particular genetic sequence. Patients are identified using a diagnostic test called epidermal growth factor receptor (EGFR) testing. For people with this type of disease, targetted TKIs offer more effective, less toxic, and more convenient treatment.
Erlotinib was the first TKI to be funded in 2010, and since then access has been improved and widened so that from 1 January 2014, both erlotinib and gefitinib are funded for people who are newly diagnosed and who have not previously had platinum-based chemotherapy.
PHARMAC Deputy Medical Director Dilky Rasiah says the impact of the change in lung cancer treatments is becoming more apparent.
“For patients identified through testing, the TKIs have three major advantages over the chemotherapy treatments they are replacing,” she says.
“Firstly, and most importantly, they are more effective treatments for some patients. Usually when a new cancer drug or class of drugs becomes available, a three or four month improvement is considered a good advance. For the TKIs, the data show that the improvement in disease-free survival, the main marker for cancer treatment benefit, is 9-12 months. So this really is a significant improvement in lung cancer outcomes in New Zealand.”
“In addition to being more effective, TKIs don’t have a lot of the nasty side-effects compared with traditional platinum-based chemotherapy, which is very difficult for patients to tolerate. This means more people can maintain a good quality of life and continue on their treatment for longer, whereas previously people may have had to stop, or skip doses due to side effects, so again we get better outcomes.”
“The other benefit is convenience for patients. The TKIs are oral tablets that patients can collect from their pharmacy and take at home. By comparison, people had to make several journeys to a cancer treatment centre to receive an infusion of traditional chemotherapy. This could be difficult for people living some distance from a cancer treatment centre, and means people being treated with TKIs for cancer can carry on with life, and be with their families at a time when they need support.
“So, in short, having TKIs is a major advance in making effective treatment more available and convenient for patients.”
Dr Rasiah says the benefits also extend to other cancer patients not directly taking TKIs. Because the drugs can be taken at home, this frees up the hospital infusion services for other people needing cancer treatment, so that overall more people can receive funded cancer treatments in public hospitals.
PHARMAC’s decision to widen access to erlotinib, to become a first-line treatment for lung cancer, follows a price reduction by the supplier Roche.