"In the past, the medical insurance for patients with EGFR gene mutation in advanced non-small cell lung cancer only included some first/second generation targeted drugs, but this adjustment included the third generation targeted drugs, which is like adding many new weapons to oncologists. There is a wide choice of drugs, so don't worry too much about the patient's economic endurance. " Professor Long Hao, director of the Lung Cancer Institute of Sun Yat-sen University and chief physician of the Chest Department of the Cancer Hospital affiliated to Sun Yat-sen University, said, "Take osetinib as an example. After entering the new medical insurance catalogue, it is expected that the decline may reach about 60%. After the official price reduction in March 1, many lung cancer patients came to ask and were ready to start taking medicine. "
Targeted drugs change the living conditions of lung cancer patients in China.
According to the latest global cancer burden data in 2020, there will be 820,000 new cases of lung cancer in 2020 alone, and 7 1 10,000 people will lose their lives due to cancer, which is the cancer with the highest morbidity and mortality in China.
According to different histopathological features, lung cancer can be divided into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), most of which are NSCLC, accounting for 80%-85% of all lung cancers. Unfortunately, about 75% of patients in China were found in the middle and late stage, and the 5-year survival rate was very low.
Previously, there were only chemotherapy and local radiotherapy for patients with advanced lung cancer. Even if the treatment plan is careful, the average survival time of patients with advanced lung cancer is only 8- 10 months. This situation continued until 2003. The first generation of targeted drugs for lung cancer is aimed at EGFR mutation, a common driver gene in patients with non-small cell lung cancer, which blocks the signal transduction of cancer cells and hinders the growth of cancer cells.
"If chemotherapy is to destroy 1000 enemies and self-harm 800 at the same time, then targeted therapy is a precise attack only on cancer cells, and the side effects are far less than chemotherapy, so it is surprising that lung cancer patients with EGFR mutation positive have achieved good results after using targeted drugs." Professor Long Hao said that compared with traditional chemotherapy, the survival time of patients with lung cancer without progress was prolonged to 9.5 months.
Since then, more and more targets have been found, and targeted drugs for lung cancer are constantly being updated. At present, the research targets are EGFR, ALK, ROS 1 and so on. With the wide application of the second generation sequencing technology in clinic, more and more rare targets of lung cancer with low mutation rate have been found, such as c-Met, Her-2 and RET. "At present, there are more than 65,438 targeted drugs for lung cancer on the market.
"EGFR mutation seems to be a gift from God to Asians," Professor Long Hao pointed out. "The mutation rate of EGFR (epidermal growth factor receptor) in patients with lung adenocarcinoma in China is about 60%, while that in the United States is only about 10%. Therefore, targeted drug therapy has become an indispensable part of lung cancer patients in China. At present, targeted drugs against EGFR have been produced to the third generation. In addition to being suitable for patients with the first generation of drug-resistant lung cancer, oxitinib has also been approved for the first-line treatment of non-small cell lung cancer and has become the first-line recommendation of NCCN guidelines for non-small cell lung cancer. Studies have shown that the total survival time of patients after first-line use can reach 38.6 months, more than 3 years. "
More and more lung cancer patients can coexist with cancer for a long time, and lung cancer is gradually changing into a chronic disease, which is mainly due to the development of targeted drugs in the past decade.
After targeted drugs enter medical insurance, the decline can be as high as 60%
"Many patients with advanced lung cancer are very painful when they come to the hospital. They couldn't sleep all night and coughed. After examination, they found a genetic mutation. They went home with targeted drugs, put the medicine bottle on the pillow, and took a pill after getting up. Nothing happened. After several years, they lived well without any side effects. I often joke that you can live a normal life and do whatever you want. " Professor Long Hao said when talking about the survival changes of lung cancer patients in recent years.
The good effect of targeted drugs can be seen. However, for a long time, high drug prices have set a barrier for lung cancer patients. Professor Long Hao said that at the initial stage of listing, the price of innovative drugs is often higher due to research and development costs, patents and other factors.
In order to promote the accessibility of innovative drugs and fully meet the needs of patients, in recent years, China has continuously negotiated access and updated the national medical insurance catalogue, so that more and more high-quality innovative drugs are included in the medical insurance catalogue. Before 2002 1 new year's day, the national drug list of basic medical insurance, industrial injury insurance and maternity insurance (2020) was officially announced and will be officially implemented on March1this year. There are 2800 kinds of drugs in the catalogue, including western medicine 1426 kinds and Chinese patent medicine 1374 kinds. There are still 892 kinds of decoction pieces not adjusted. In this medical insurance catalogue adjustment, * * * negotiated drugs 162, drugs 1 19, the negotiation success rate was 73.46%, and the average price of drugs successfully negotiated decreased by 50.64%. In the field of cancer, more than 50 kinds of anti-tumor drugs are included in medical insurance, among which 7 kinds of targeted drugs and 2 kinds of immune drugs are related to lung cancer patients.