Improving access to treatment for
Australia's leading cause of cancer death
A non-small cell lung cancer (NSCLC) immunotherapy combination treatment will be listed on the Pharmaceutical Benefits Scheme (PBS) tomorrow (October 1, 2019).1,2
TECENTRIQ® (atezolizumab), an immunotherapy that works with the body's own immune system to fight cancer, in combination with AVASTIN® (bevacizumab), which interferes with the tumour blood supply,3,4 and chemotherapy (carboplatin and paclitaxel), will be subsidised for the treatment of patients with:
· Previously untreated metastatic non-squamous NSCLC (mNSCLC) – lung cancer that has spread to other parts of the body;1,2 and
· EGFR mutant or ALK-positive non-squamous NSCLC – two genes known to play a key role in some NSCLCs5 – only after the failure of targeted treatments.1,2
NSCLC is our nation's most common form of lung cancer, accounting for up to 85 per cent of all cases.6 Estimates suggest more than 10,800 Australians will be diagnosed with NSCLC this year.6,7
The PBS listing, announced by the Federal Health Minister today, is coinciding with expert calls for ongoing, improved treatment access for all Australians living with the devastating disease.
According to medical oncologist, pharmacologist and translational researcher from Northern Cancer Institute, Professor Stephen Clarke OAM, Sydney, the PBS listing of effective treatment combinations may help to reduce barriers to lung cancer treatment currently facing Australia's low socioeconomic and rural areas.8
"Lung cancer is Australia's leading cause of cancer death, with the disease expected to claim 9,000 Australian lives this year.7
"Concerningly, we are still seeing unacceptable differences in lung cancer survival rates depending on postcode.9 Those from low socioeconomic and rural areas are experiencing lower survival rates compared to the national average, partly due to the challenges they encounter in receiving timely diagnoses and access to treatment,"8 said Prof Clarke.
"Fortunately, treatment for lung cancer has improved substantially in recent years, with our growing understanding of the biology of the disease. Most recently, immunotherapies are being combined with other treatments for lung cancer, including chemotherapy, and these combinations are showing encouraging improvements in lung cancer survival for some patients.10,11
"The listing of such combinations on the PBS is welcome news for clinicians and patients alike, given they are helping to close the treatment access gap, and improve the quality of life of Australians with lung cancer,"
Prof Clarke said.
When NSCLC spreads to other areas of the body, it is known as metastatic NCSLC (mNSCLC), and classified as stage IV, or advanced lung cancer.5 Up to one-in-two cases of NSCLC will have already progressed to stage IV by the time of diagnosis.5,8,12
"Lung cancer often presents with few, if any, symptoms in its early stages,13 and these symptoms, which include coughing, chest pain and weight loss, can be hard to distinguish from other illnesses,"13 said Dr Tristan Barnes, medical oncologist, Northern Beaches Hospital, Sydney.
"This often leads to diagnoses in the later stages of disease, after the lung cancer has spread to other parts of the body, making it very challenging to treat."5,8,12
Retired marketer, Toni, 76, Sydney, was diagnosed with stage IV lung cancer in February last year after an abnormal ECG prompted further investigation.
"I just couldn't believe my lung cancer was so advanced. I had no pain, just breathlessness. Then all of a sudden, I was told I had a virtually terminal cancer.
"In the months following my diagnosis, I lost a lot of weight and was placed on an oxygen machine,
all day and night, even in the shower, and my darling husband, Ronnie, had to push me around in a wheelchair," said Toni.
Toni has since received a number of different treatments under the care of her oncologist, Prof Clarke. Thankfully, she no longer requires oxygen, or a wheelchair.
"I encourage others who have received a lung cancer diagnosis to have hope, because there are more lung cancer treatment options available today than ever before."5
According to Lung Foundation Australia CEO, Mark Brooke, Brisbane, increasing treatment access is crucial to improving a lung cancer patient's quality of life.
"Lung cancer has one of the lowest five-year relative survival rates –17 per cent – compared with Australia's top five most commonly diagnosed cancers, which range between 69 and 95 per cent.8
"Early diagnosis, support for those with lung disease, and equitable access to treatment and care is pivotal to improving Australian lung cancer patient outcomes," Mr Brooke said.
"The PBS listing of an additional NSCLC treatment option arms patients and their carers with hope, and importantly, the potential gift of extra time to spend with their loved ones, to perhaps celebrate an important milestone, such as Christmas, a family wedding, or the birth of a grandchild."
With lung cancer claiming the life of an Australian each hour,7 Roche Australia General Manager, Stuart Knight, is pleased that Roche can offer another treatment option to those living with this devastating disease.
"Roche Australia is committed to improving the lives of Australians with lung cancer through the ongoing development and provision of clinical innovations. The Government's reimbursement of another lung cancer treatment option helps meet the substantial unmet need of this group of patients," said Mr Knight.
About TECENTRIQ, AVASTIN & the chemotherapy combination
TECENTRIQ belongs to a class of medicines known as checkpoint inhibitors, a type of immunotherapy.2,14 TECENTRIQ is a Programmed death-ligand 1 (PD-L1) inhibitor.2,14 PD-L1 is a protein which can make the tumour invisible, stopping the body's immune system from recognising and destroying lung cancer cells. TECENTRIQ attaches to the PD-L1 protein, allowing the immune system to 'see' the tumour.2,10,14,16
AVASTIN belongs to a class of medicines known as anti-angiogenics, which can prevent new blood vessels from forming in the body.3,4 Tumours produce high levels of the protein vascular endothelial growth factor (VEGF), which encourages new blood vessels to grow, thereby providing the tumour with nutrients and oxygen.4 AVASTIN works by attaching to the VEGF protein, 'starving' tumours of their blood supply. It can also help to activate the immune system.17,18
Chemotherapy works to stop cancer cells from growing and multiplying, and can also encourage the tumour to release antigens, which can trigger an immune response against the cancer.5,19
These therapies work together, to help activate the immune system to fight NSCLC.10
TECENTRIQ is associated with immune-related reactions. Based on severity, TECENTRIQ should be withheld and corticosteroids administered. In general, TECENTRIQ must be permanently discontinued for any recurrent Grade 3 or Grade 4 immune-related reaction.2
AVASTIN is associated with an increased risk of perforations, bleeding, high blood pressure, kidney problems, infusion reactions, severe stroke or heart problems, nervous system and vision problems. Immediate cessation of treatment may be required depending on the severity.17
The most common adverse reactions (reported in more than 20 per cent of patients) with TECENTRIQ administered with chemotherapy (carboplatin and paclitaxel) and AVASTN (bevacizumab) in the IMpower150 clinical trial were fatigue/asthenia, alopecia, nausea, diarrhoea, constipation, decreased appetite, joint pain, hypertension, and neuropathy. TECENTRIQ was discontinued for adverse reactions in 15 per cent of patients; the most common adverse reaction resulting in discontinuation of TECENTRIQ was pneumonitis – (inflammation of lung tissue – (1.8 per cent).10
