A new round of medical insurance negotiations came to an end, the National Medical Security Bureau and the Ministry of Human Resources and Social Security announced the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalogue (2021)", and the new version of the medical insurance drug catalogue was officially implemented on January 1, 2022.
In this catalog, in the field of targeted therapy for lung cancer, we were surprised to find that the domestic generation of targeted drugs exitinib was successfully shortlisted for postoperative adjuvant therapy for lung cancer, while the third generation of osimertinib failed to succeed, the reasons for which are unknown. For a long time, many netizens are looking forward to oscitinib to enter the postoperative auxiliary treatment medical insurance, after all, the cost of more than 5,000 per month is not low. This time, many more are going to be disappointed.
A generation of targeted drugs ektinib is China's first independent research and development of small molecule targeted drugs, after the listing in 2011, 10 years in clinical applications. The study of exetinib for postoperative lung cancer patients is a phase III EVIDENCE study led by Professor Zhou Caicun of our hospital.
In the phase II-IIIA patients enrolled in the study, non-small cell lung cancer patients who had achieved R0 resection, 322 enrolled patients were directly randomized to the extinib group or the adjuvant chemotherapy group (vinorelbine/pemetrexed + cisplatin) after surgery, and the treatment time of exetinib was 2 years, and the postoperative chemotherapy was 4 cycles. The results showed that exetinib was used as a postoperative adjuvant therapy in patients with non-small cell lung cancer with EGFR mutations, and the efficacy and safety were significantly better than that of standard adjuvant chemotherapy. The intermediate disease-free survival DFS in the extinib group reached 46.95 months, which was significantly better than the 22.11 months of adjuvant chemotherapy in the control group, and the 3-year DFS rate in the extinib group was 63.9%, which was also significantly better than the 32.5% in the standard chemotherapy group.
From the above studies, if there is an EGFR mutation in patients with lung cancer surgery, the efficacy of targeted therapy is significantly better than that of chemotherapy. Not only exetinib, but also gefitinib and osimertinib have large samples of multicenter clinical studies in postoperative adjuvant targeted therapy, especially oscitinib, the most famous is the ADAURA study, which is blinded in advance due to the overwhelming efficacy advantage, and the results are published 2 years in advance.
Based on the research results, the NCCN Guidelines 2021 editions V1, V2 and V3, three consecutive editions of the recommendation for adjuvant therapy of osimtinib are updated, of which the latest V3 edition removes the "consideration" of the V1 and V2 editions of "consideration" of the use of osimtinib adjuvant therapy twice, and officially recommends "oscitinib adjuvant therapy IB-IIIB stage EGFR mutation positive and previously used adjuvant chemotherapy or is not suitable for adjuvant platinum-containing dual-drug chemotherapy."
Although the Chinese version of the guidelines has also been updated, recommending osimertinib for postoperative patients with lung cancer with stage IB-IIIA EGFR mutations, however, the medical insurance catalogue has not yet been included, which means that postoperative patients with osiminib can not be reimbursed. However, the domestic ektinib effect is also good, if the economic situation is indeed not good, you can choose exetinib, not only the original price is low, the cost after reimbursement is almost affordable for everyone.