Contents
In terms of lung cancer mortality, Poland is second in the EU, just behind Hungary – according to the report “The picture of lung cancer in Poland” prepared by HealthQuest in April 2016. – According to specialists, the reason for such a high position in this ranking is the poor diagnostics and lack of access to modern treatment methods.
Lung cancer is the most frequently diagnosed malignant neoplasm in Poland. Due to its very poor prognosis, it is the most common cause of death due to malignant neoplasm. The state’s expenditure on its treatment is lower than in other European countries; take up only 2 percent. funds allocated by the National Health Fund for oncological drug programs. Therefore, Polish patients have very limited access to modern molecularly targeted and immunological drugs, says Dr. Maciej Niewada from the Department of Experimental and Clinical Pharmacology of the Medical University of Warsaw, co-author of the report “The image of lung cancer in Poland” published in April 2016.
Treatment methods
The choice of treatment method depends on the stage of the disease. Due to the fact that lung cancer is diagnosed in a very late stage, only 20% the most common cases of non-small cell lung cancer are diagnosed in stage I and II, when the tumor can still be operated on. The remaining cases can only be treated with chemotherapy or radiation therapy. Sometimes a combination therapy is performed, combining all three methods of treatment with surgery, radiotherapy and chemotherapy. The most modern methods of treatment with proven effectiveness are molecularly targeted therapy and immunotherapy. This modern approach requires a very precise determination of the type of lung cancer. This is done by analyzing a fragment of the tumor. Such tests are performed by genetic diagnostics laboratories. In Poland, due to insufficient financing of cancer treatment and the limited access of cancer patients to reference centers, too few of them are performed, which means that patients lose the opportunity to receive the optimal treatment for them.
Molecularly targeted therapy
Molecularly targeted treatment requires a thorough diagnosis that determines the genetic structure of the tumor. Thanks to such research, it is possible to discover the “Achilles’ heel” of a given cell and apply a drug targeted directly at it. Molecular diagnostics is the cornerstone of personalized medicine, which means it enables you to use the therapy that will be most effective for you. The use of a molecularly targeted drug requires determining whether the patient’s cancer cells have a disorder that is affected by the drug. – The rules of targeting in pharmacotherapy are almost the same as in shooting. We will only hit when the weapon is aimed with the greatest accuracy – explains Prof. Dariusz Kowalski from the Department of Tumors of the Chest and Lungs of the Oncology Center in Warsaw. Thanks to molecularly targeted therapies, it was possible to extend the life of palliative patients with lung cancer by up to five times.
Immunotherapy and the immune system
In the latest report of the American Society for Clinical Research (ASCO), immunotherapy used in the treatment of neoplastic diseases was recognized as the greatest achievement of 2015. Drugs used in immunotherapy are designed to stimulate the human immune system to fight cancer cells by itself. The organs that are part of the immune system play a very important defense function, they protect against infections or cancer. The immune system can also create cells of long-term immune memory, remembering information about pathogens with which the body has come into contact (a mechanism used, among others, in vaccination).
When cancerous cells emerge, the immune system is blocked by the tumor and hostile cells become invisible and impossible to fight. Modern immuno-oncological drugs unblock the immune system, thanks to which it can fight cancer again. Research results show that immune therapies also support the long-term memory of the immune system by enabling a long-term anti-cancer response.
In 2015, an immunocompetent drug – anti-PD-1 monoclonal antibody – was registered in the EU, and thus in Poland, for use in adult patients with inoperable or metastatic melanoma. Subsequently, this therapy was approved for the treatment of locally advanced or metastatic squamous and non-squamous non-small cell lung cancer. The data obtained from the clinical trial show that when the preparation is used in the second line of treatment (i.e. in patients who have failed the first treatment) in patients with squamous cell lung cancer, the two-year survival rate is 23%, which is almost three times more than in the case of patients with squamous cell lung cancer. chemotherapy. In another study in second-line treatment of non-squamous lung cancer, the data show that the one-year survival rate is 51% in patients treated with an immune drug, compared with 39% in the group of patients treated with chemotherapy.
Immuno-oncological therapies offer a chance for long-term survival and good quality of life in patients with advanced neoplastic diseases, for whom these chances were previously very small. One of the many benefits of immunotherapy is that it can be used and effective in many types of cancer because it works by activating the patient’s own immune response, unlike traditional treatments.
Immunology is the future in cancer treatment. Thanks to it, cancer can become a chronic disease – emphasizes oncologist prof. Piotr Rutkowski.
Polish patients are worse off
Patients with lung cancer in Poland have worse access to modern drugs than in other European countries, despite the fact that their prices are among the lowest in the EU. We have the longest reimbursement procedures in Europe (after Romania), which means that decisions on reimbursement of new drugs are taken for a very long time. From the registration of the drug to the moment when it begins to be used by Polish patients, it takes an average of two years and three months, while in Germany only less than four months. According to the report “Availability of innovative cancer drugs in Poland against the background of selected European Union countries and Switzerland” prepared by the Alivia Oncology Foundation in 2015, out of the 30 most widely used cancer drugs in the EU, as many as 12 in Poland are unavailable at all, because the National Health Fund their does not refund. Access to reimbursed drugs is often difficult due to restrictive eligibility criteria for treatment imposed by the Ministry of Health, which tries to limit the number of patients and the costs of their treatment. Specialists emphasize that if we want to improve the effects of lung cancer treatment, we must improve access to modern diagnostics and innovative drugs, including by introducing financing for innovative drugs with proven effectiveness, including pre-registration drugs under the so-called emergency access. Fifteen organizations supporting oncological patients from all over the country postulate that as part of the currently conducted work on the amendment to the Reimbursement Act, emergency access to drugs should be introduced. Currently, there are no regulations in the legal system that would make it possible to include patients using life-saving drugs in the treatment, who are at the post-registration stage, but before the reimbursement decision is made. This is especially important for patients for whom no treatment option is available. According to the authors of the report “The picture of lung cancer in Poland”, it is also necessary to apply other AOTMiT assessment criteria for innovative oncological drugs, including increasing the cost-effectiveness threshold and increasing the National Health Fund’s expenditure on cancer treatment and searching for additional sources of financing. The Ministry of Health has announced that the amendment to the Reimbursement Act will increase the availability of innovative drugs thanks to new methods of financing them. Soon it will be discussed by the Sejm.