Two ICIs are now funded, as of 1 April 2023, for patients with locally advanced and metastatic non-small cell lung cancer (NSCLC) who meet the eligibility criteria.4 Pembrolizumab (Keytruda)5 and atezolizumab (Tecentriq)6 are two of a number of ICIs approved for use in New Zealand as treatments for NSCLC and a range of other cancers. Durvalumab (Imfinzi), another ICI, is funded for stage III, locally advanced, unresectable NSCLC as adjuvant therapy after definitive chemoradiation.7 Some other ICIs that may also benefit cancer patients are available only if funded privately.
The checkpoints targeted by pembrolizumab and atezolizumab are the programmed death-1 (PD-1) receptor and its ligand PD-L1, respectively.
- Pembrolizumab (Keytruda) is funded for the treatment of advanced NSCLC as first-line treatment, either as monotherapy or in combination with another agent.4
- Atezolizumab (Tecentriq) is funded for people with advanced NSCLC as second or later-line monotherapy.4
The full eligibility criteria for these ICIs are detailed in the 7 March funding decision.4
Lung cancer is the leading cause of cancer-related death in Aotearoa. Most people with lung cancer are diagnosed with advanced disease, at the locally advanced or metastatic stage.
The incidence of NSCLC for Māori is threefold, and Pasifika twofold, compared with non-Māori non-Pacific peoples. Comparatively, Māori and Pacific peoples are also diagnosed at a younger age, with later-stage disease and experience worse outcomes from NSCLC.4
It is anticipated that the newly funded treatments for NSCLC will improve patient survival times and help achieve outcome equity, particularly for Māori and Pacific peoples. Additionally, better treatment may reduce the stigma associated with lung cancer, alleviating some of the less visible burden on patients.8
The eligibility criteria for pembrolizumab and atezolizumab have been constructed in a way that aims to remove barriers to treatment access (eg, a possible six-weekly intravenous infusion dosing regimen for pembrolizumab; three-weekly is the norm).
Pharmac estimates that, in the first year of funding, over 450 people with advanced NSCLC will begin treatment with pembrolizumab (increasing to over 700 per year after three years), and over 300 people with advanced NSCLC who have received prior chemotherapy will begin atezolizumab (decreasing to around 20 people per year after three years, as more people access first-line treatment).4 It is hoped that these measures, and an increased focus on early diagnosis, will contribute to achieving health equity and significant health benefits.
Pharmac has also created a temporary criterion for the first three months of funding to simplify the transition to publicly funded treatment for people currently on privately funded treatment or on compassionate access.