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Focus> Offbeat HK> Content
Friday, October 25, 2019, 11:45
New cancer treatment can save lives, at a cost
By Chen Zimo
Friday, October 25, 2019, 11:45 By Chen Zimo

Immunotherapy is effective but remains very expensive, and the government needs to act to lower costs and make new drugs available, medical experts say. Chen Zimo reports.

Yau Chung-cheung, clinical associate professor at the University of Hong Kong’s Department of Medicine. (PHOTO PROVIDED TO CHINA DAILY)

It was lung cancer — and a former Hong Kong civil servant, only in his 40s, knew he had only six months to live. The cancer had spread to his brain, liver, and other vital organs. His cancer was stage 4 — the most advanced stage, metastatic cancer — by the time he was transferred to Queen Mary Hospital, the teaching hospital of  the University of Hong Kong, after years of treatment in other hospitals.

After he was evaluated, doctors advised him to try a new treatment — immunotherapy.

New drugs and treatments are available almost every two months. But they have to wait for months to get approval for local registration by the government

Samuel Mak Ka-yan, convener of the Cancer Strategy Concern Group

Under immunotherapy, the patient’s immune system is brought into focus to fight cancer with the body’s natural defenses, said Yau Chung-cheung, clinical associate professor at the University of Hong Kong’s Department of Medicine. Yau was one of the doctors on the medical team that treated the former civil servant.

Cancer cells elude attacks from the body’s natural defenses by sending out signals that disguise the cells as normal, and as a result, the body’s immune system can’t identify the cancer cells. Immunotherapy uses drugs to unmask cancer cells and help the immune system identify and attack them.

Medications are injected into the patient intravenously to stimulate the immune system. Immunotherapy can be given as a stand-alone treatment, or in combination with other types of cancer treatments, such as surgery, chemotherapy, electrotherapy, or target therapy.

The biggest drawback is that the treatment is costly — from HK$30,000 (US$3,800) to HK$40,000 a month, Yau said.

The civil servant overcame his death sentence. After two years of immunotherapy and chemotherapy, he was declared cancer-free. It was arguably one of the most successful “cures” in Hong Kong.

Left: Activation of T cells requires that the T-cell receptor binds to structures on other immune cells recognized as ”non-self”. A protein functioning as a T-cell accelerator is also required for T cell activation. CTLA- 4 functions as a brake on T cells that inhibits the function of the accelerator. Right: Antibodies (green) against CTLA-4 block the function of the brake leading to activation of T cells and attack on cancer cells. (PHOTO PROVIDED TO CHINA DAILY)

Research helps extend survival

Examples of successful treatments continue to multiply, as research brings new medications and even better treatments into the medical arena.

Queen Mary Hospital initiated research into immunotherapy in 2012. It was one of the earliest in the Asia-Pacific region to enter the field.

The treatment became widely known after former US president Jimmy Carter said in 2015 that he had been cured of melanoma by using immunotherapy.

The 2018 Nobel Prize in Physiology or Medicine was awarded jointly to two scientists, James P. Allison and Tasuku Honjo, for their discovery of immunotherapy by stimulating the immune system to attack tumor cells.

Therapies based on the prize-winning discovery have proved effective in extending the survival of patients with liver cancer in clinical studies at the HKU medical school and Queen Mary Hospital, Yau said.

Left: PD-1 is another T-cell brake that inhibits T-cell activation. Right: Antibodies against PD-1 inhibit the function of the brake leading to activation of T cells and highly efficient attack on cancer cells. (PHOTO PROVIDED TO CHINA DAILY)

During its seven years of research, Queen Mary Hospital has taken the lead in immunotherapy for the treatment of liver cancer. More than 120 patients with liver cancer participated in the immunotherapy study project. Eight were declared “cured” — showing no signs of cancer for years — while in more than half the cases, the cancer is reportedly under control.

The treatment is not readily accessible. Every year, more than 1,800 cases of liver cancer are diagnosed in Hong Kong. The associated mortality rate is 10.8 percent, according to the Hong Kong Anti-Cancer Society.

Three immunotherapy drugs, for treating four types of cancers, are listed as self-financed on the Hospital Authority Drug Formulary. The drugs are used in the treatment of skin cancer, renal cell cancer, lung cancer, and neck cancer.

Nivolumab, one of the listed drugs, has been covered by the Community Care Fund Medical Assistance Program since August 2018, and a subsidy to purchase the drug is offered to patients meeting specified criteria. Usually, the drug needs to be taken every two weeks during the course of treatment, and each two-week dosage costs up to HK$40,000.

The high and recurring costs of the remaining drugs, however, have to be borne by patients themselves, or with the help of private health insurance companies.

(SOURCE: THE NOBEL ASSEMBLY AT KAROLINSKA INSTITUTET)

To speed up efforts vital for patients

Drugs that are not on the HA Drug Formulary may also be obtained by local patients, since Hong Kong places few restrictions on the use of immunotherapy drugs, said Cheung Foon-yiu, a specialist in clinical oncology for the Hong Kong Integrated Oncology Center.

Oncologists may order drugs from foreign manufacturers as required, as long as the medications are approved by the US Food and Drug Administration, he added.

Once a drug is registered in Hong Kong, or included in the HA Drug Formulary, it becomes widely available and is much less expensive than if it were purchased on the “gray market”.

With the increasing availability of new drugs, current prices of immunotherapy drugs are already now 30 to 50 percent lower than they were in 2015, Cheung said.

Social groups are calling on the government to speed up efforts to promote immunotherapy treatment, as it may be the last hope for patients with terminal cancer.

Cheung Foon-yiu, a specialist in clinical oncology for the Hong Kong Integrated Oncology Center. (PHOTO PROVIDED TO CHINA DAILY)

Samuel Mak Ka-yan, convener of the Cancer Strategy Concern Group, said public policy lags far behind the medical technology used to treat cancer. 

“New drugs and treatments are available almost every two months. But they have to wait for months to get approval for local registration by the government,” Mak said.

The problem is that cancer patients cannot wait, he added.

Cancer patients may progress from stage 1 to stage 2 cancer in just a month. At that point, chemotherapy may be required. The earlier that advanced treatment begins, the greater the chance of survival.

Mak recommends that the government follow the example of many countries and put drugs used to treat cancer on the “fast track” to approval. In the United Kingdom, new cancer treatments may become available within a matter of weeks, through the fast-track pathway of the UK’s National Health Service.

Contact the writer at mollychen@chinadailyhk.com


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