Saturday, July 13, 2024

Fungal Infection Prevention: Expanding Access to Cancer Medicines and Treatments

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Fungal infection prevention is a key focus in Pharmac’s proposal to broaden the availability of posaconazole (Posaconazole Juno and Devatis) and voriconazole (Vttack), along with two cancer medicines, pembrolizumab (Keytruda) and nivolumab (Opdivo), for individuals with compromised immune systems, based on specific eligibility criteria.

Proposed new indications for pembrolizumab include advanced triple-negative breast cancer, head and neck squamous cell carcinoma, colorectal cancer, urothelial carcinoma, and Hodgkin lymphoma. For advanced renal cell carcinoma, nivolumab is proposed for funding. Posaconazole and voriconazole will provide preventative treatment for a broader group of immunocompromised individuals, potentially reducing the incidence of invasive fungal infections. If approved, the widened access to these medicines would commence from 1 October 2024 for pembrolizumab, posaconazole, and voriconazole, and from 1 November 2024 for nivolumab.

Fungal Infections and Immunotherapies: Enhancing the Immune System to Combat Cancer

These immunotherapies, also known as immune checkpoint inhibitors, enhance the body’s immune system to combat cancer cells. Administered through intravenous infusions in hospitals, they represent a targeted approach to cancer treatment.

Pembrolizumab is currently funded for metastatic melanoma and advanced non-small cell lung cancer. Nivolumab is funded for metastatic melanoma. The proposal aims to extend the funding of these medicines to a broader range of cancers, potentially benefiting many more patients.

Proposed new indications for pembrolizumab include several types of cancer. For advanced triple-negative breast cancer, which affects up to 20% of breast cancer patients and sees worse outcomes for Māori and Pacific people, the Cancer Treatments Advisory Committee (CTAC) recommended funding in October 2023, with about 80 patients expected to start treatment in the first year. Head and neck squamous cell carcinoma currently lacks effective treatment options, and CTAC recommended funding in April 2022, expecting around 120 patients to benefit in the first year. For unresectable or metastatic colorectal cancer, pembrolizumab could benefit up to 120 patients in the first year, as recommended by CTAC in July 2021.

Funding is also proposed for advanced urothelial carcinoma, the most common type of bladder cancer, with about 120 patients expected to start treatment annually following CTAC’s consideration in October 2023. Additionally, for relapsed/refractory Hodgkin lymphoma, around 20 patients could start treatment annually, with CTAC recommending this in July 2021.

For advanced renal cell carcinoma, which is more common in men and currently lacks targeted treatment options if initial treatments fail, about 120 patients could start treatment annually with nivolumab, following CTAC’s recommendation in August 2017. Posaconazole and voriconazole will provide preventative treatment for a broader group of immunocompromised individuals, potentially reducing the incidence of invasive fungal infections, which have increased due to the rising number of immunocompromised patients, including those undergoing cancer treatment.

fungal

Fungal and Cancer Medicines: Proposed Funding and Expanded Access Timeline

The Anti-infective Advisory Committee recommended funding in September 2022, and CTAC endorsed this in April 2023. If approved, the widened access to these medicines would commence from 1 October 2024 for pembrolizumab, posaconazole, and voriconazole, and from 1 November 2024 for nivolumab.

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For advanced renal cell carcinoma, which is more common in men and currently lacks targeted treatment options if initial treatments fail, about 120 patients could start treatment annually with nivolumab, following CTAC’s recommendation in August 2017.

These antifungal medicines inhibit the growth of fungal infections and are administered as daily tablets. Posaconazole is currently funded for leukemia patients or those undergoing stem cell transplants, while voriconazole is funded for immunocompromised individuals or those with specific infections. The proposal expects around 400 people to start these treatments in the first year of funding.

Posaconazole and voriconazole will provide preventative treatment for a broader group of immunocompromised individuals, potentially reducing the incidence of invasive fungal infections, which have increased due to the rising number of immunocompromised patients, including those undergoing cancer treatment. The Anti-infective Advisory Committee recommended funding in September 2022, and CTAC endorsed this in April 2023.

If approved, the widened access to these medicines would commence from 1 October 2024 for pembrolizumab, posaconazole, and voriconazole, and from 1 November 2024 for nivolumab.

This funding proposal is part of an additional funding package allocated by the Government in June 2024. This financial boost allows Pharmac to fund several new medicines and expand access to already funded medicines for both cancer and non-cancer health conditions.

Pharmac’s proposal to expand access to these critical cancer and antifungal medicines represents a significant step forward in providing comprehensive care for patients with cancer and those at risk of severe fungal infections. By ensuring more patients can benefit from these advanced treatments, Pharmac aims to improve health outcomes across New Zealand, particularly for vulnerable populations with limited treatment options.

 

Resource: Pharmac, July 05, 2024

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