The Bureau of National Health Insurance (BNHI) announced that the targeted therapy drug bevacizumab, administered to "adult patients experiencing recurrent glioblastoma multiforme (GBM) after receiving standard radiotherapy and chemotherapy in combination with temozolomide," will be included in the NHI benefit package starting May 1, 2012.
Bevacizumab (trade name Avastin), is an anti-angiogenic monoclonal antibody (mAb) that fights against vascular endothelial growth factor (VEGF) and can slow tumor growth.Last June, bevacizumab and other chemotherapy drugs were listed as reimbursed first-line drugs for the treatment of metastatic colorectal cancer (mCRC). This year, the use of bevacizumab for patients experiencing recurrent malignant glioblastoma after unsuccessful first-line treatment will be further incorporated into the scope of benefits.
Patients with brain tumors account for 0.75% of all cancer patients and most brain tumor patients are between the age of 45 and 65. Of all types of primary brain tumors, GBM is the most fatal. GBM patients account for 43% of all brain tumor cases.If a tumor were to damage any part of the brain that controls motor functions, feelings, or language, the patient may develop symptoms such as partial flaccid paralysis or paralysis, dysesthesia, sensory deficit, loss of speech, and visual field defects.So far, standard treatment for this type of brain tumor includes surgery and external beam radiotherapy in combination with the chemotherapy drug temozolomide. If the patient’s condition deteriorates or reoccurs after treatment, there is no other effective medicine or treatment available.
Despite the limited number of patients with this type of cancer, each one deserves the best treatment available. While not all patients will undergo surgery, the long journey to combat cancer – both during and after treatment – is challenging for the patient, the patient’s family, and the medical team.
The price for a bottle of bevacizumab under NHI is NT$9,211. In the case of a 60-kg patient who is prescribed 6 bottles every two weeks until his condition worsens, the inclusion of this targeted therapy drug into the NHI benefit package can save the patient NT$480,000 after an average of 4 months. It is expected that, in five years, a total of 60 to 150 patients will benefit from this new policy and there will be a NT$30 million to NT$70 million increase in NHI pharmaceutical product expenses.
Bevacizumab is not a chemotherapy drug, but it is not without side effects.Common side effects include nose bleed (50%), hypertension (8-34%), baldness (6-32%), abdominal pain (50-61%), headache (30-50%), upper respiratory tract infection (40-47%), thrombosis (13-26%), proteinuria (4-36%), etc.