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Oncologist Urges Kiwi Lung Cancer Patients to be Screened

Oncologist Urges Kiwi Lung Cancer Patients to be Screened for Access to Free Medication

An oncologist is urging hundreds of Kiwi lung cancer patients to contact their doctor to ensure they are screened for a rare form of the disease, which can now be treated for free, under a new initiative.

Patients who are diagnosed with the lung condition, in which a chromosomal rearrangement (ALK) causes lung cells to mutate and eventually spread throughout the body, can now have free access to a medicine, which has been shown to decrease the risk of disease progression or death by 53 percent when compared to the previous standard of care1.

Associate Professor Chris Atkinson, oncologist and medical director of Lung Foundation NZ is calling for the introduction of national guidelines across DHBs to ensure all those living with advanced ALK-positive non-small cell lung cancer (ALK+ mNSCLC) are diagnosed and can access a potentially life-extending medication which has become available in New Zealand.

According to the latest annual figures from the Ministry of Health more than 2,226 Kiwis were diagnosed with lung cancer2 and almost 1800 died3. Non-small-cell lung cancer is the most common form of the disease and makes up about 85 percent of all lung cancers4.

Internationally, an estimated 4-5% percent of people with mNSCLC have a change in the anaplastic lymphoma kinase (ALK) gene5 which results in an abnormal protein causing cancer to grow and spread to other parts of the body.

However, a recent study published by Auckland oncologists and health researchers found the incidence in their sample population was almost twice as high - with 8% of New Zealand patients diagnosed with non-squamous mNSCLC having the ALK-positive mutation 5,6.

The local research also found that those treated with an ALK tyrosine kinase inhibitor (TKI) survived markedly longer than those without this class of medicine (a median of 5.12 years vs 0.55 years) 6.

Unlike other forms of lung cancer, ALK+ mNSCLC is most commonly diagnosed in people with a light or non-smoking history5.

Women are more likely to be diagnosed with this form of the disease than men5 and; prevalence is also higher among Māori, Pasifika and Asian ethnic groups than NZ Europeans6. Lung cancer patients with the ALK gene rearrangement also tend to be younger than most other mNSCLC patients, with a median age of approximately 52 years7.

Associate Professor Atkinson says there is a significant variation in the testing standards of DHBs when it comes to screening for lung cancer and as a result, dozens of Kiwis may be living with ALK+ mNSCLC unaware they have this form of the disease or that there is a new, free treatment programme available to them6.

He says whilst every DHB has access to the technology needed to screen lung cancer patients for the gene mutation which causes ALK+ mNSCLC, there are currently no standards in place to ensure this happens.

“With no national testing guidelines in place, many Kiwis living with this form of lung cancer have effectively been denied immediate access to a free treatment that could prolong their life.

“Unfortunately this is another tragic and unnecessary example of how the health outcomes of cancer patients will vary dramatically according to their postcode,” he says.

Lung Foundation NZ, chief executive, Philip Hope says every patient living with advanced non-squamous non small cell lung cancer who has not already been screened for ALK+ mNSCLC should contact their doctor about being retrospectively tested.

He says patients may require a second test of their lung tissue, which can be a painful and uncomfortable procedure for someone already living with a terminal illness.

Any New Zealander who has been diagnosed with non-squamous non-small-cell lung cancer should immediately check with their doctor to see if they need to be screened for ALK+ mNSCLC.

If the ALK mutation is found, their specialist can then ensure they receive the free treatment option,” says Hope.

He says due to the variation in testing rates across the country, there could be more than 50 Kiwis diagnosed with advanced lung cancer who are unaware they have the ALK+ mutation6.

Under a new initiative from pharmaceutical company Roche, Kiwis who have been diagnosed with ALK+ mNSCLC can access a new medicine Alecensa (alectinib) at no cost prior to PHARMAC funding the medicine.

The programme, estimated to save each patient tens of thousands of dollars, is significant as it removes cost as a barrier to accessing the latest generation medicine for this condition.

Alecensa is a second-generation tyrosine kinase inhibitor that targets the ALK cancer protein, preventing signalling within cells to inhibit their growth and survival.

Trial data of Alecensa has shown it to stop patients’ ALK+ lung cancer progressing for a median time of almost three years, which is more than three times longer than crizotinib, the previous standard of care for ALK+ mNSCLC8. Treatment with the medicine also resulted in a higher number of complete or partial responses and significantly decreased the risk of progression or death by 53% compared with the previous standard of care8.

Unlike current treatments, the medicine is also able to penetrate the blood-brain barrier, which is important as this type of cancer commonly spreads to the brain if left untreated8,9.


References

1. Peters, S. at al. Alectinib versus Crizotinib in Untreated ALK-Positive Non-Small-Cell Lung Cancer. N Engl J Med. 2017. 377(9): 829-838.

2. Ministry of Health. Selected Cancers 2015, 2016, 2017. 22 May 2019. Available from https://www.health.govt.nz/publication/selected-cancers-2015-2016-2017 Accessed: September 2019.

3. 2015 Ministry of Health Cancer Deaths. Available from: https://www.health.govt.nz/publication/selected-cancers-2014-2015-2016 Accessed: August 2018.

4. American Cancer Society. Available from: https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/what-is-non-small-cell-lung-cancer.html Accessed: August 2018.

5. Chia, P. et al. Prevalence and natural history of ALK positive non-small-cell lung cancer and the clinical impact of targeted therapy with ALK inhibitors. Clin Epidemiol. 2014; 6: 423-432.

6. McKeage, M. J. et al. Screening for Anaplastic Lymphoma Kinase (ALK) gene rearrangements in nonsmall cell lung cancer (NSCLC) in New Zealand. Intern Med J. Accepted Author Manuscript. Available from https://www.ncbi.nlm.nih.gov/pubmed/31318119 Accessed September 2019.

7. Puey Ling, C. et al. Prevalence and natural history of ALK positive non-small-cell lung cancer and the clinical impact of targeted therapy with ALK inhibitors, Clin Epidmiol. 2014; 6: 423-432.

8. Camidge, D. Ross et al. Updated Efficacy and Safety Data and Impact of the EML4-ALK Fusion Variant on the Efficacy of Alectinib in Untreated ALK-Positive Advanced Non–Small Cell Lung Cancer in the Global Phase III ALEX Study. J Thorac Oncol. 2019. Volume 14, Issue 7, 1233 - 1243.

9. Gadgeel S, Peters S, Mok T, et al. Alectinib versus crizotinib in treatment-naive anaplastic lymphoma kinase-positive (ALK+) non-small-cell lung cancer: CNS efficacy results from the ALEX study. Ann Oncol. 2018;29(11):2214–2222.

Alecensa Consumer Panel

Alecensa® (alectinib) 150mg capsules is a Prescription Medicine used for the treatment of adults with ALK-positive advanced non-small cell lung cancer.

Do not use Alecensa if: you or your partner are pregnant or you are breastfeeding.

Tell your doctor if: you have liver problems; you have lactose or galactose intolerance, congenital lactase deficiency or glucose-galactose malabsorption; you are planning a pregnancy or plan to breastfeed. Tell your doctor if you are taking any medicines.

Tell your doctor immediately or go to your nearest Accident and Emergency Centre if you notice any of the following: shortness of breath or difficulty breathing with cough and/or fever; yellowing of the skin or whites of the eyes; slow heart beat; new or worsening of muscle pain/problems that don’t go away, tenderness or weakness; decreased urine output with swelling of legs, ankles, and around eyes with confusion, tiredness, nausea, chest pain or pressure.

Possible common side effects may also include: rash including increased sensitivity to sunlight (follow sun protection guidelines); diarrhoea and constipation, nausea and/or vomiting; tiredness, dizziness; swelling of hands, feet, legs or around eyes; eye problems like blurred or impaired vision, black dots or white spots in your vision or double-vision; headache, inflammation in your mouth, change of sense of taste, and weight gain.

Alecensa has risks and benefits. Ask your doctor if Alecensa is right for you. Use strictly as directed. If symptoms continue or you have side effects, see your healthcare professional. For further information on Alecensa, please talk to your health professional or visit www.medsafe.govt.nz for Alecensa Consumer Medicine Information.

Alecensa will be funded by PHARMAC from 1 December 2019. A prescription charge and normal oncologist fees may apply.


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