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‘Metastatic pancreatic cancer needs insurance benefit for Onyvide+5-FU/LV’
  • By Kim Yun-mi
  • Published 2020.08.21 15:21
  • Updated 2020.08.21 15:21
  • comments 0

Patients with metastatic pancreatic cancer, notorious for high fatality, need to receive health insurance coverage for Onyvide (irinotecan liposome) in combination with two other medicines, fluorouracil (known as "5-FU") and leucovorin (known as "LV"), an expert said.

Professor Yoo Chang-hoon at the Oncology Department of Asan Medical Center explained about the unmet local needs of metastatic pancreatic cancer and Onyvide’s clinical implication at an online news conference by Servier Korea on Thursday.

Professor Yoo Chang-hoon of the Oncology Department at Asan Medical Center speaks about the unmet local needs of metastatic pancreatic cancer and Onyvide’s clinical implication at an online news conference by Servier Korea on Thursday.

Physicians have no diagnostic method for pancreatic cancer. Most patients with pancreatic cancer get diagnosed only after the disease progressed and the five-year survival is only about 3 percent, Yoo said.

Unlike other types of cancer where survival rates greatly improved with targeted therapies or immunotherapies, pancreatic cancer has been in the dark for over 20 years, he added.

Since the pancreas is located deep in the abdomen and there are few initial symptoms, the early detection rate of pancreatic cancer is very low, at less than 10 percent. At the time of diagnosis, 80 to 90 percent of patients are found to be in the advanced stage.

Metastatic pancreatic cancer’s five-year survival rate is only 2.1 percent, markedly lower than that of the five most common cancer in Korea – 5.6 percent in metastatic gastric cancer, 19.6 percent in metastatic colon cancer, 7.7 percent in metastatic lung cancer, 62 percent in metastatic thyroid cancer, and 39.9 percent in metastatic breast cancer.

“For the past 20 years, the survival rate of metastatic pancreatic cancer inched up only by 1 percentage point,” Yoo said. Gemcitabine, systemic chemotherapy that came out 20 years ago, is still the standard of care for pancreatic cancer.

Yoo attributed difficulty in drug development for pancreatic cancer to the cancer cells’ microenvironment and genetic predisposition. Compared to other carcinomas, the fibrosis surrounding the cancer cells in the pancreas is so severe that it is difficult for a drug to penetrate the cancer cells, he said.

Even though researchers could find genetic mutations of pancreatic cancer patients with the recently advanced genetic analysis, they have failed to develop a treatment that targets Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation that over 90 percent of pancreatic cancer patients have.

However, in 2016, the phase-3 NAPOLI-1 trial on the combination of Onyvide and 5-FU/LV in patients who failed in the first-line gemcitabine-based therapy significantly improved therapeutic effects.

The study pinpointed the significance of the consecutive therapy strategy in metastatic pancreatic cancer, Yoo said.

The results of the NAPOLI-1 trial showed that the combo of Onyvide and 5-FU/LV extended the median survival by 1.9 months, compared to 5-FU/LV alone, and that the mortality rate went down by 33 percent, he said.

Yoo emphasized that Onyvide should receive insurance benefits as a second-line treatment for metastatic pancreatic cancer. The monthly cost of using Onyvide is about 5 million won and a patient normally has to pay about 3-3.5 million won even with the support of the drugmaker.

Yoo claimed that the demand for Onyvide was “significantly high.”

“Medical societies are demanding the government support the insurance benefit for pancreatic cancer treatment but it is important for patients to speak their voice, too,” Yoo said. As pancreatic cancer patients die just one or two years after treatment, no patient group can share the treatment difficulty and speak in one voice.

“Under such circumstances, it is too cruel to calculate the cost-effectiveness of the drug that has already proved survival benefit compared to the conventional therapy,” Yoo said.

Servier Korea, the seller of Onyvide, last month applied for reimbursement for the combination therapy of Onyvide with 5-FU/LV as a second-line treatment in patients who failed a gemcitabine-based first-line treatment.


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