The NHIA decided to stop reimbursing new immunotherapies for treating gastric adenocarcinoma and advanced liver cancer due to poor response rates in patients. Doctors are petitioning against this decision. They argued that there are only limited treatment options available for such patients; and the NHIA’s decision could affect the patients’ rights.
The NHIA started providing new immunotherapies for 8 cancers and 11 indications last year. In order to evaluate the effect of the new immunotherapies, the NHIA carries out an assessment every 3 months. From April 2019 to January 2020, total 1159 patients were approved for the treatments. Among them, 760 patients are eligible for the effectiveness assessment. The assessment results show that the response rate in the 192 advanced liver cancer patients was 19.8%; and the response rate in the patients with gastric adenocarcinoma was 9.5%.
Dr Chao Yee of the Taipei VGH pointed out that reimbursement decisions made based on the response rate will devastate patients.
According to Dr Chao, the response rate in advanced liver cancer patients has actually increased from 14.5% to 19.8%. He pointed out that a study conducted by the Taipei VGH on 90 advanced liver cancer patients reveals that the effectiveness of immunotherapies is about 24.4%. This paper has already been published in an international journal.
Dr Chao stressed that whether immunotherapies are effective cannot be judged solely based on the response rate. The recovery of patients’ immunity should also be considered. Using survival rate instead would be more accurate, said Dr Chao. A domestic study on patients with advanced stomach cancer receiving immunotherapies shows that the one year survival rate is 20% and the two year survival rate is 10%. In comparison, patients in the controlled group who only received placebos died within 7 months.
In Taiwan, liver cancer and gastric cancer are in the 2nd and 7th places of the chart of the most deadly cancers. It is very rare for patients with advanced liver cancer or gastric cancer to survive for more than 2 years under conventional treatments.
Dr Chao pointed out that one of the advantages of immunotherapies is low side effect; however, the high price is the main drawback. He is petitioning for patients with advanced liver cancer or gastric cancer, hoping the NHI would continue providing the new immunotherapies for those patients.
Dr Lee Po-Chang, Director-General of the NHIA, replied that he fully understands how doctors feel for their patients. However, according to the NHI experts’ meeting, if there is no significant effect of the immunotherapies, the NHI should reserve the resources for patients who respond better. The NHIA will continue to carry out follow-up reviews.
Since the NHIA started reimbursing new immunotherapies for cancers in last April, total 1500 patients have accessed the treatments. Among them, 24% of the patients have been treated effectively. The NHIA has decided to extend the treatment course to up to 2 years for patients responding well. And for those who are in stable condition, the treatments can be extended for 3 more months.
【2020-03-30 / United Daily】
