The Gut Cancer Foundation (GCF) has today provided feedback to Pharmac as part of their consultation process for funding the liver cancer treatment, lenvatinib (Lenvima). Lenvatinib is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps stop the spread of cancer cells.
This submission follows a period of sustained advocacy by GCF on behalf of liver cancer patients, after Pharmac announced the issuing of a Future Procurement Opportunity (FPO) for the cancer treatment bevacizumab (Avastin) back in August.
Bevacizumab forms one part of the immunotherapy treatment, atezolizumab (Tecentriq) + bevacizumab, which is standard of care for patients with unresectable, advanced hepatocellular carcinoma (HCC) in many other countries. Back in June, this treatment was named as one of those being funded by the $604 uplift in Pharmac’s budget.
HCC accounts for 90% of liver cancer diagnoses in New Zealand and patients with advanced/ unresectable HCC, have been waiting for a funded systemic treatment option for 16 years. The announcement of this procurement process has led to an additional delay which GCF have urgently addressed with Pharmac.
GCF has written urgent letters to Minister David Seymour and Paul Bennett (Pharmac Chair) leading to direct, open, and transparent discussions with the Senior Therapeutics team at Pharmac.
During this process, we have constantly emphasised the deep inequities embedded in HCC diagnosis in Aotearoa New Zealand, the fact we are an absolute outlier with our patients having no access to systemic treatments, and the fact that further delays to funding will cost lives.
Following the completion of the initial FPO process for bevacizumab, Pharmac announced their plans for patients with advanced, unresectable HCC:
undertake a streamlined, efficient tender process for bevacizumab including its use in combination with bevacizumab, for the treatment for advanced, unresectable HCC
undertake a period of consultation relating to the funding of Lenvatinib for patients with advanced, unresectable HCC
What does this mean for patients?
Further GCF discussions with Pharmac have sought assurances that these processes are in fact the most efficient possible. Pharmac’s tender documentation states clearly that preferences will be given to suppliers that are able to support patient access the treatment by April 2025.
As such we do not expect atezolizumab + bevacizumab to be listed as a funded treatment option until April 2025 at the earliest. We will continue to work with Pharmac and pharmaceutical companies to ensure this treatment is available at the earliest opportunity.
However, subject to a period of consultation, it is hoped that lenvatinib will be listed as a funded treatment from 1 December 2024. Whilst our preference is absolutely for access to atezolizumab + bevacizumab, we welcome the imminent option of lenvatinib as an interim measure, to bridge the gap until such time that the preferred treatment option is funded.
Who will be eligible for lenvatinib?
The current Pharmac application to fund lenvatinib includes the following patients:
Patient has unresectable hepatocellular carcinoma; and
Patient has preserved liver function (Childs-Pugh A); and
Transarterial chemoembolisation (TACE) is unsuitable; and
Patient has an ECOG performance status of 0-2; and
Patient has not received prior systemic therapy for their disease in the palliative setting.
In our submission to Pharmac, GCF is advocating for a widening of criteria number 5 in first line to include:
patients with contraindications to atezolizumab and/or bevacizumab and
second line access for patients who have progressed on or are intolerant to atezolizumab and/or bevacizumab and remain fit enough for treatment.
We have also made it expressly clear accessing lenvatinib when it becomes funded should in no way stop patients accessing atezolizumab + bevacizumab if/ when this preferred treatment becomes available.
Timelines
2 October 2024: Consultation for lenvatinib closes.
24 October 2024: Tender process for bevacizumab closes.
1 December 2024: Proposed date that lenvatinib becomes funded.
Mid-December 2024: Consultation process for atezolizumab + bevacizumab opens*
April 2025: Target date for funding of atezolizumab + bevacizumab*
*these dates are indicative only and are subject to the result of Pharmac procurement process, and commercial contract arrangements.