[Desk View] Is all anticancer adjuvant therapy on a losing streak?

Anticancer drugs are on a losing streak in their quest for insurance reimbursement in the adjuvant therapy category. Reimbursement is deemed necessary, but meeting the agreement is not easy.

The concept of continued medication administration as 'prophylaxis' is not new. In the field of chronic disorders, medicines have been used as part of a 'management' regimen rather than as a treatment. For example, anticoagulants have been designed as a prophylaxis.

The issue emerged as prophylaxis field expanded to include high-cost, cutting-edge anticancer drugs. Various new anticancer drugs are securing peri-operative prophylaxis indications and being researched. Adjuvant therapies for numerous numbers of cutting-edge new drugs, including immune checkpoint anticancer agents, targeted anticancer drugs, and antibody-drug conjugates (ADC), are now one of the expanding indications. We are seeing flood of indications.  

The subject of adjuvant therapy raises concerns. The cost issue is one of them. While it is well known, recurrence of cancer is terrifying even after remission. Although

However, prescribing anticancer drugs as adjuvant therapy and applying insurance reimbursement is posing a burden on the Health Ministry. In fact, there have been only a few cases in Korea where adjuvant therapies have received reimbursement expansion.

CDK4/6 inhibitors, for instance. Both Eli Lilly’s 'Verzenio (abemaciclib)' and Novartis's 'Kisqali (ribociclib)' have obtained indications in Korea for adjuvant therapy in early-stage breast cancer.

Verzenio has been at the forefront of the reimbursement challenge, yet the result has been three rejections by the Cancer Disease Review Committee (CDRC). Verzenio struggled to even get on the CDRC list from its very first attempt. After a long six-month wait following the initial submission, it was finally tabled in May 2023, only to result in "failure to establish reimbursement criteria." Five months later, Lilly resubmitted the application to the Health Insurance Review and Assessment Service (HIRA) in October. While it was considered at the CDRC in March and July of last year, the outcome remained unchanged.

Recently, the company reapplied for Kisqali. As it awaits its turn on the CDRC agenda, attention is focused on whether it can achieve a different result.

What remains clear is that the benefits of adjuvant therapy are garnering significant attention from the academic community. Adjuvant therapies are already appearing in the guidelines of leading global societies, often receiving high recommendation grades.

It is time for full consideration. We must meticulously weigh the necessity of oncology adjuvant therapies for each medication and prioritize practical benefits over vague "financial burdens." Administering treatment only after a patient has relapsed may actually prove to be less cost-effective. Recurrence and metastasis are fatal factors that increase cancer mortality rates. Since there is no single correct answer, the pros and cons must be carefully balanced. We cannot neglect the growing list of adjuvant therapies.