‘Reimbursing Revlimid as maintenance therapy beneficial’

Will contribute greatly to improving overall survival in patients

Hyeon-Seok Eom, Professor of Hemato-Oncology at the National Cancer Center

“Reimbursement as first-line or second-line greatly affects prescription pattern”

“non-reimbursed areas still exist... coverage needs to be extended”

Professor Hyeon-Seok Eom

The multiple myeloma treatment ‘Revlimid’ has finally been listed for reimbursement after 4 long years of await as maintenance therapy, starting from the new year of 2023.

 

Reimbursement of Revlimid as maintenance therapy had undergone various twists and turns in Korea.

 

Since 2019, BMS Korea had actively sought to list the drug for reimbursement, but was unable to make progress.

 

The agenda has been deliberated by the Cancer Disease Drug Committee during meetings that were held in September 2019, June 2020, then again in September last year.

 

The last meeting gained attention due to its deliberation of the CAR-T therapy ‘Kymriah (tisagenlecleucel),’ but to no avail for Revlimid.

 

After passing CDDC deliberations in June last year, Revlimid’s reimbursement was finally extended to cover its use as maintenance therapy after 4 years.

 

That a drug can prevent or delay the recurrence of cancer is an extraordinary concept that all cancer survivors would opt for.

 

Revlimid has presented such an option for the first time in the field of multiple myeloma, a type of blood cancer that has a recurrence rate of 70-80%.

 

Dailpharm met with Hyeon-Seok Eom, Professor of Hemato-Oncology at the National Cancer Center to seek insight into the significance and value brought by Revlimid's reimbursement as maintenance therapy.

 

-It took a long time for Revlimid to receive the reimbursement extensions.

 

How do you believe the reimbursement extension will affect the field? When considering how research on Revlimid’s use as maintenance therapy started in the mid-2000s, quite some time had been taken for its reimbursement approval.

 

After the 5-year, and 10-year study data were published, I remember demand started to rise for the reimbursement of the drug as maintenance therapy around 2015.

 

Even patients recognized the need and filed petitions to the National Assembly.

 

Despite such efforts, it took quite some time for Revlimid to receive reimbursement as maintenance therapy.

 

Patients were unable to use the drug as maintenance therapy or had to pay the full non-insured price for such use.

 

In fact, from the late 2000s to early 2010s, this difference in treatment options led to a difference in the 5-year survival rate of multiple myeloma patients in Korea and the U.S.

 

This is an example of how access to drugs directly affected the survival rate of patients.

 

In the same context, patients in Korea will enjoy an improvement in their survival rate with the reimbursement extension.

 

Improvement in the patient's quality of life and survival rate is of the greatest significance in terms of treatment as well.

 

-The reimbursement approval of RVd (lenalidomide+bortezomib+ dexamethasone) therapy last year has greatly changed the prescription pattern of HCPs in Korea.

 

The reimbursement of the maintenance therapy will also bring much change in the prescription environment.

 

I believe the reimbursement of Revlimid as maintenance therapy will change how HCPs progress with treatment in the first line as well as the second line for multiple myeloma.

 

For example, a patient’s overall survival may improve further if he or she uses Revlimid as maintenance therapy after VRd (bortezomib+lenalidomide+dexamethasone) therapy.

 

This is why many studies abroad investigated the use of Revlimid as maintenance therapy following VRd therapy.

 

In this aspect, the reimbursement approval of Revlimid has great significance.

 

-Ultimately, how well the disease can be cared for in the front line (as first-line therapy) seems to be key in managing multiple myeloma as well. That’s true.

 

Despite the increasing diversity of treatment options available in the field, it is still most important to see a good prognosis in the earlier stages.

 

Considering how about 30% of patients die while transitioning from first-line treatment to second-line treatment and the prognosis of patients generally worsens with later lines of treatment, it is very important to increase the time to recurrence and survival rate of patients by treating patients well in the earlier stages.

 

Therefore, it is most important to improve the prevention of recurrence, PFS, and OS with first-line treatment after considering various treatment options.

 

Many HCPs abroad use many drugs in the first line to prolong the treatment period as much as possible.

 

-What improvements do you wish for in treating multiple myeloma?

 

The reimbursement of Revlimid as maintenance therapy has improved the front-line treatment environment, therefore, we now need to focus on improving the second-line treatment environment.

 

We need to use more diverse options to treat multiple myeloma in the second line as well.

 

The survival period of the patients is greatly reduced when patients go through further lines of treatment.

 

The PFS is only a few months, and even the OS does not exceed 1 year in later lines of treatment, so it is important to use drugs well in the earlier stages.

 

Also, good drugs remain unreimbursed in Korea.

 

It is a pity that these effective drugs cannot be used earlier due to environmental issues like lack of reimbursement and are therefore used in the later stages of treatment.

 

As in the United States, we should allow the use of effective drugs in earlier lines of treatment, and discretion should be given to the doctors for the combined use of drugs with reimbursement.

 

- Are there any drugs you are looking forward to in the field of multiple myeloma in the future? With treatments continuing to evolve, I expect new treatment methods like CAR-T therapies would also eventually be introduced to the field.

 

Development of such treatments will significantly improve the OS and quality of life of patients in the earlier lines of treatment, in the first- or second-line.

 

Currently, patients with multiple myeloma generally recieve chemotherapy and autologous hematopoietic stem cell transplantation.

 

However, some patients may experience side effects such as hair loss due to strong drugs and the process itself is also cumbersome as it requires weekly hospitalization.

 

I hope that positive changes would come to foster a better treatment environment for patients in the future.