7-minute cancer shot launched in India: New immunotherapy injection could change lung cancer treatment but comes at a cost
Fifty-seven year-old smoker Jai Singh (name changed) walked into the cancer clinic of Medanta hospital at Gurugram with a diagnosis of lung cancer last December. It had already spread to his brain, liver and bones. While he had started radiotherapy (this uses X-rays, gamma rays or protons to kill cancer cells and shrink tumours), he was afraid of taking chemotherapy (this uses powerful drugs to destroy cancer cells). That’s when his doctors put him on immunotherapy, which has now become easy to administer with injectables.
“He had heard of the side-effects of chemotherapy from other patients. Fortunately, his PD-L1 levels were found to be high at 75 per cent. This means the patient has a high expression of this protein, indicating that three-quarters of the tested cancer cells are actively using it as a cloak to hide from your immune system. The high percentage meant he was a ripe candidate for immunotherapy. Normally, it is an infusion. We recommended the newly-launched subcutaneous or under the skin injection atezolizumab,” said Dr Sajjan Rajpurohit, head of medical oncology at the hospital.
Pharmaceutical giant Roche has just launched the subcutaneous version of its cancer immunotherapy drug atezolizumab — with the brand name Tecentriq — in the Indian market. Dr Rajpurohit said the ease of administering the immunotherapy with an injection, which reduces the time that patients have to spend in the hospital, along with fewer infusion-related side-effects have meant better compliance to the treatment among his patients.
Who is the immunotherapy shot meant for?
The treatment is meant for those with non-small cell lung cancer, which accounts for a majority of the over 81,000 lung cancer cases diagnosed each year in India. However, the therapy is not meant for all patients with this type of cancer. It is an immunotherapy drug that specifically targets PD-L1 receptors, so only those who have these receptors on most of the cancer cells qualify for this treatment. Nearly half of the patients with non-small cell lung cancer are eligible for the treatment.
How does it help the patients?
The drug, in both IV and subcutaneous versions, has been shown to increase overall survival and progression-free survival and reduce the risk of death in lung cancer patients.
Importantly, the subcutaneous version of the drug can be administered by trained nursing staff in hospital outpatient departments through an injection in the thigh in just seven minutes. The drug, so far, was administered as an intravenous infusion.
This is also beneficial for hospitals, considering at least five patients can receive the subcutaneous injection in the time it takes for one patient to get the IV infusion. Global studies have also shown that four of five patients preferred the subcutaneous version over the IV version, according to the company.
How much does the drug cost?
The cost, however, remains very high — Rs 3.7 lakh per dose with most patients needing around six doses. That’s why the company is running a patient assistance programme called Blue Tree to lower the cost of treatment and make it more accessible to patients.
The drug has also been included under the Central Government Health Scheme. “The bio-equivalent dose needed for the subcutaneous version is higher — 1,800 mg against 1,200 mg for the intravenous versions — so there is a difference of around Rs 25,000 to Rs 30,000 between the two. Yet, the cost almost comes out to be the same considering the hospitalisation charges etc that they can avoid,” said Dr Rajpurohit.
How does the drug work?
Atezolizumab helps control cancer by taking away a cancer cell’s ability to hide from the immune system, allowing immune cells to find and attack it. Normally, immune cells called T cells patrol the body and destroy abnormal cells, but many cancer cells protect themselves by displaying a protein called PD-L1 on their surface. This protein binds to receptors on T cells and sends a false signal that tells the immune system not to attack, allowing the cancer to grow unchecked. Atezolizumab works by attaching to the PD-L1 protein and blocking this interaction. Once this “off signal” is blocked, the T cells can recognize the cancer cells as harmful and become active again. These reactivated immune cells then attack and destroy the cancer cells.