Achi news desk-
A new cancer treatment recently approved in Canada promises to cut treatment time down to a few minutes, but experts disagree on whether it’s best for patients.
One fears that it will unnecessarily use a higher dose of an existing drug and that it is likely to be cheaper than the current method of intravenous administration.
In contrast, another oncologist says it is a welcome development that can significantly reduce the time for cancer treatment.
New cancer treatment in Canada
Health Canada approved the sale of Tecentriq SC last month, a prescription medicine that treats patients with lung, liver and breast cancer in a new subcutaneous formulation of the already approved drug atezolizumab.
Atezolizumab is currently used in intravenous form as Tecentriq IV to treat various tumors. The new subcutaneous type of cancer immunotherapy treatment injects the drug under the skin rather than intravenously into the veins.
Mississauga, Ont.-based pharmaceutical company Roche Canada said. in a news release last week that the subcutaneous injection Tecentriq helps strengthen the immune system’s ability to fight cancerous cells. The company told CTVNews.ca that this is the first skin cancer immunotherapy injection for several types of cancer in Canada.
This treatment is approved in more than 30 countries. The Swiss pharmaceutical giant F. Hoffmann-La Roche Ltd. is the parent company of Roche Canada.
New immunotherapy is considered to save time
As well as boosting the immune system, another potential benefit for patients is the flexibility this new treatment offers.
Roche Canada said the Tecentriq subcutaneous injection must be administered by a qualified healthcare professional, but this could be done outside of a hospital, at another facility or even at a patient’s home.
Sharlene Gill, president of the Canadian Society of Medical Oncologists, said in a video interview with CTVNews.ca that the subcutaneous formulation would reduce the time to treat patients who normally receive long-term immunotherapy.
A subcutaneous injection could be given under the skin more quickly, as in about 15 minutes compared to about an hour through an IV, he explained.
“I’m not sure I’d call it a game changer, but I’d say this is really important to people in terms of: it might not be a new medicine, but it’s a better way to provide highly effective medicine. medicine,” said Gill, who is also a professor of medicine in the department of medical oncology at the University of British Columbia in Vancouver.
“Probably where it can be done and how quickly it can be done are the two big benefits… For patients living with cancer, time is their most valuable commodity.”
It could also free up the system to provide treatment to more patients in hospital and provide fairer access to cancer care for patients who may not live in a big city or near a chemotherapy unit, he added.
‘It doesn’t change results’
While Gill talks about the benefits for patients, Bishal Gyawali, a medical oncologist and professor of oncology at Queen’s University in Kingston, Ont., said he has some concerns.
He said he does not believe Tecentriq SC is significantly different from what is already available as it uses the same drug, atezolizumab, which currently exists in intravenous form. Gyawali is co-founder of an organization made up of medical professionals and patient advocates called Common Sense Oncology, which aims to promote a more patient-centered approach to oncology.
For some cancers, other immunotherapy drugs have better quality evidence and are preferred over atezolizumab, he added.
“This (subcutaneous treatment) doesn’t change outcomes, because it’s just a matter of convenience — intravenous injection versus subcutaneous injection,” Gyawali said in a video interview with CTVNews.ca. “In terms of effectiveness, it’s the same as an intravenous drug.”
Gyawali said he feels that taking atezolizumab intravenously is not a big burden, as the drug is given once every four weeks. He said the evidence suggested that an intravenous injection could even be given every eight weeks with the same effect.
‘What is the price of comfort?’
Based on how atezolizumab has been tested in one clinical trial, Gyawali says Tecentriq SC will be sold and used at a higher dose of 1,875 milligrams. That’s equivalent to the IV dose of 1,200 mg in terms of achieving a drug concentration in the blood, Gyawali said. However, he believes that the 1,200 mg dose every three weeks is more than what is needed for “optimal effectiveness.”
The study concluded that intravenous and subcutaneous treatments were equally effective. Its results were published in the Annals of Oncology in August 2023. F. Hoffmann-La Roche Ltd., the parent company of Roche Canada, funded the trial.
Gyawali said it was a “missed opportunity” as the trial tested the higher dose despite evidence that a lower dose may be just as effective.
He said the IV dose is already higher than what patients need.
“There is no doubt about it but the industry is testing or recommending a higher dose than what is needed and not testing a lower dose simply because with a higher dose they can make more money,” said Gyawali.
What’s more, he said, he expects the new subcutaneous injection to cost “significantly more” than the intravenous version in part because he believes it will be marketed as a convenience proposition.
“How much more are we prepared to pay for a subcutaneous injection versus the same drug in the intravenous form that patients can get once a month?” he said. “What is the price of comfort, so to speak?”
In addition, he said he feared that a higher dose of atezolizumab or any immunotherapy, regardless of formulation, could lead to more side effects, drug waste and higher costs. He described a problem with what he said were unnecessarily high doses involving other immunotherapy drugs such as pembrolizumab and nivolumab, as well.
A photo shows the logo of Swiss pharmaceutical giant Roche at its headquarters in Basel on February 17, 2015. AFP PHOTO / SEBASTIEN BOZON (Photo by SEBASTIEN BOZON / AFP) (Photo by SEBASTIEN BOZON / AFP via Getty Images)
Laura Pagnotta, spokeswoman for Roche Canada, did not directly respond to CTVNews.ca about Gyawali’s accusations that the company was motivated primarily by profit over the best interests of patients in testing higher doses that the oncologist believes are unnecessary for the treatment.
Instead, he said in an email to CTVNews.ca that Health Canada’s approval “indicates safe and effective use of the treatment, based on solid data.”
As for concerns about the potential side effects of higher doses, Pagnotta said the clinical study found no serious safety concerns.
“The safety profile of the Tecentriq SC formulation is consistent with that of Tecentriq IV and the rate of adverse events (side effects) was similar in clinical trials,” Pagnotta said in an email. “No infusion-related reactions occurred in the study of Tecentriq SC and injection site reactions were mild in nature, did not affect administration, and mostly resolved without additional treatment.”
Calling it an “important first step,” Pagnotta said the company can now have conversations with the pan-Canadian Pharmaceutical Alliance and the federal, provincial and territorial agencies to discuss “the price, the value of the innovation, and the data to support both. .”
“We have a solid package to submit for review and we look forward to the discussion and to bringing this treatment to patients as soon as possible,” he wrote. “With a treatment like subcutaneous Tecentriq, we hope to not only ease the treatment burden for patients, but also save some of the healthcare system costs associated with more labor-intensive and time-intensive treatments and formulations so that the those resources. back to overall cancer study, prevention, and system-wide disease control.”
Although the new procedure reduces the complexity of administering the drugs, Gill said it still had to be done by qualified professionals, and patients had to be monitored for side effects.
“I believe these types of developments are making incremental improvements in the patient experience of their cancer journey and how they experience cancer,” said Gill.
CTVNews.ca reached out to Health Canada for comment, but did not receive a response in time for publication.
