Treatment reimbursed for devastating lung cancer
with average survival of less than a year1
The first immunotherapy to be Pharmaceutical Benefits Scheme (PBS) listed for the treatment of small cell lung cancer (SCLC)2-5– a devastating form of the disease1– will be available from Sunday, March 1, 2020.2-5
Federal Health Minister, The Hon. Greg Hunt MP, today announced the reimbursement of TECENTRIQ®(atezolizumab) – an immunotherapy that works with the body's own immune system to fight cancer,6
– in combination with chemotherapy (etoposide and carboplatin), for the treatment of patients with previously untreated extensive stage small cell lung cancer (ES-SCLC).2,3,5
The announcement is coinciding with the 8th Biennial Australian Lung Cancer Conference (ALCC) in Melbourne.
SCLC accounts for up to 15 per cent of all lung cancers,7 with an estimated 2,000 Australians expected to be diagnosed with the disease in 2020.7,8 Most patients diagnosed with SCLC survive less than one year from diagnosis.1
According to medical oncologist, Dr Steven Kao, Chris O'Brien Lifehouse, Sydney, historically there have been very few treatment options available to those diagnosed with SCLC.1,9 Patient access to new treatments on the PBS is therefore critical to improving survival.
"Survival rates for SCLC are unacceptably low. This is partly due to the aggressive, fast-growing nature of the disease, and to the few recent advances in the management of SCLC.1,9
"For those diagnosed with ES-SCLC, chemotherapy has been the standard treatment option for many decades.1,10 More recently however, immunotherapy has been added to the standard of care,"11 said Dr Kao.
"Reimbursement of ES-SCLC treatments is an important step forward, potentially in both prolonging, and improving the quality of life for all Australians diagnosed with this devastating disease."
SCLC is considered to be extensive stage when it has spread throughout both lungs, or to lymph nodes on the other side of the chest, or has metastasised to other areas of the body,12 noting up to two in three patients reach extensive stage cancer before diagnosis.12
"There are often few, or no symptoms present in the early stages of SCLC, and most patients are diagnosed
at a very late stage, often after the cancer has already spread, making it very challenging to treat,"12,13 said
Associate Professor Tom John, Peter MacCallum Cancer Centre, Melbourne.
"SCLC spreads rapidly and has a higher propensity than other cancers to spread to the brain, with 40-50 per cent of patients developing brain metastases.14 The disease also commonly spreads to the liver, bones and adrenal glands.15
"These debilitating symptoms, coupled with the stigma surrounding lung cancer and its poor survival rates, can significantly compromise the psychological wellbeing and social lives of those living with the disease, and their loved ones,"16 A/Prof John said.
Happily married truck driver, father-to-two and grandfather-to-one, Glen, 58, Sydney received a heart-breaking diagnosis of ES-SCLC, and was informed he had less than 12 months to live.
"I had two lumps on my neck that I thought were just cysts. I assumed they were harmless, so delayed getting them checked out. When I finally visited the doctor and went through eight difficult weeks of tests, I was eventually diagnosed with ES-SCLC, and told I had less than 12 months to live.
"Given I'm a husband, a dad, and a grandpa, this news was absolutely devastating for all of us. I wanted to be here to see my grandson grow up," said Glen.
Advised of the limited therapy options then available for ES-SCLC, Glen was referred to Dr Kao, who placed him on treatment immediately – a regime he has since continued to receive every three weeks, with his doting wife of 35 years by his side.
"After being told it was unlikely I would live to see the following year, I've since returned to work, am back in my shed with my motorbikes and hot rods, and have just celebrated my grandson's fourth birthday.
"SCLC is a horrible disease. Treatments work differently for everyone, so having options available is so important, because they can give those affected, and their families, more time," Glen said.
According to Lung Foundation Australia CEO, Mark Brooke, Brisbane, the availability of an immunotherapy for ES-SCLC will be welcome news to the Australian lung cancer community.
"There has been a long-standing, unmet clinical need in SCLC, with no change to standard treatment options, or life expectancy for the disease, in three decades.9
"Given many of those diagnosed with SCLC and their loved ones continue to face a heart-breaking prognosis, the Government's reimbursement of the first immunotherapy for ES-SCLC3-5,17 will be warmly received by the lung cancer community," said Mr Brooke.
About the TECENTRIQ and chemotherapy combination
TECENTRIQ is an immunotherapy that works with the body's own immune system to fight cancer cells.6 Belonging to a class of medicines known as checkpoint inhibitors, TECENTRIQ is a Programmed death-ligand 1 (PD-L1) inhibitor.3,18 PD-L1 is a protein that can stop the body's immune system from recognising and destroying lung cancer cells, making the tumour 'invisible'.19 TECENTRIQ attaches to the PD-L1 protein, allowing the immune system to 'see' the tumour.3,18,20,21
For the treatment of ES-SCLC, TECENTRIQ is used in combination with chemotherapy.2,3 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.22,23 These therapies work together to help activate the immune system to fight ES-SCLC.20
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.3
In the pooled data from TECENTRIQ clinical trials, the most common adverse events (side-effects) observed were fatigue, decreased appetite, nausea, cough, shortness of breath, fever, diarrhoea, rash, back pain, vomiting, decreased muscle strength, joint pain, itching and urinary tract infection.3 The most common side effects reported in ≥20 per cent of patients who received TECENTRIQ in IMpower133 were hair loss, nausea, anaemia, fatigue and decreased appetite.20
About lung cancer
Lung cancer begins when abnormal cells grow and multiply in an uncontrolled way in one, or both lungs.22
Lung cancer can be classified as either primary (originating from the lung), or secondary (when the cancer starts growing in another part of the body and spreads to the lungs).22 There are two main types of primary lung cancer – small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).24
SCLC is less common than NSCLC, accounting for approximately 15 per cent of all lung cancers.7 SCLC is an aggressive, highly complex form of lung cancer, characterised by extremely rapid growth, and early, widespread metastases.1
As with other types of lung cancer, SCLC is most commonly diagnosed in those over 60 years of age, although the disease can also afflict younger people.25,26 The most common risk factor for developing SCLC is tobacco exposure, including cigarette smoking and second-hand smoke inhalation.27,28
Disclosure
Dr Kao, Prof Boyer, A/Prof John, A/Prof Richardson and Mr Brooke have received no honorarium or compensation for involvement in this announcement. The opinions presented by Dr Kao, Prof Boyer, A/Prof John, A/Prof Richardson and Mr Brooke are their own. Dr Kao, Prof Boyer, A/Prof John, A/Prof Richardson and Mr Brooke have been briefed by Roche or VIVA! Communications on the approved use of this product and the requirements of Medicines Australia's Code of Conduct.
