New Zealand's pharmaceutical management agency Pharmac has announced public funding for Tecentriq (atezolizumab) in combination with bevacizumab for patients with hepatocellular carcinoma (HCC), the most common form of liver cancer. The funding, which began today, marks a significant advancement in treatment options for the approximately 70 New Zealanders diagnosed with HCC annually.
This combination therapy, which has been the standard of care in many countries for years, is the first immunotherapy regimen approved for this patient population in New Zealand.
Mechanism of Action and Clinical Benefits
Dr. Kerryn Symons, Country Medical Director at Roche New Zealand, explained the dual mechanism of the treatment: "Atezolizumab is an immunotherapy that activates the patient's own immune system to fight off the cancer, while bevacizumab cuts off the blood-supply to the tumor, which slows down tumor growth."
Clinical studies have demonstrated impressive efficacy, with a 34 percent reduction in the risk of death compared to previous treatments. "Half of patients are surviving more than 18 months, which is a significant improvement on the previous treatments," noted Dr. Symons.
The approval aligns New Zealand with international standards of care. The same combination received European Commission approval as a first-line treatment for adults with advanced or inoperable HCC, based on the phase 3 IMbrave 150 study. This study showed improved overall survival compared to sorafenib, which had been one of the standard treatments for previously untreated liver cancer.
Clinical Perspective
Hepatologist and Professor of Medicine at the University of Auckland, Ed Gane, emphasized the importance of this development: "Patients require this treatment combination when the HCC is unable to be removed by surgery or has spread to other parts of the body. Clinical trial results have shown that this treatment combination helped patients to live for longer than other medicine."
The treatment is particularly significant as liver cancer is one of the few cancers where mortality rates are increasing. In the UK, for example, the incidence of HCC is projected to rise by 38% to 15 cases per 100,000 people by 2035.
Risk Factors and Health Disparities
Chronic liver disease is the primary cause of HCC and often goes undetected. Sarah Davey, Chief Executive of the Hepatitis Foundation of New Zealand, highlighted the role of viral hepatitis: "More than 94,000 New Zealanders are living with chronic viral hepatitis B, of whom more than 200 will die each year from liver cancer. Every death is preventable by earlier diagnosis and follow-up."
Hepatitis B is responsible for almost half of HCC cases, while Hepatitis C accounts for approximately one-third. Other risk factors include obesity and diabetes, which contribute to chronic liver disease.
The burden of HCC disproportionately affects certain populations in New Zealand. "Māori and Pacific people have a higher prevalence of Hepatitis B and C, obesity, and diabetes, which are all underlying risk factors for chronic liver disease," Davey explained. "Māori patients have a lower survival rate, with 31 percent of Māori patients more likely to die of liver cancer than non-Māori due to lower rates of diagnosis and management of the underlying liver disease."
Global Context
This funding decision in New Zealand follows similar approvals in other countries. In the UK, the National Institute for Health and Care Excellence (NICE) recently approved NHS funding for the Tecentriq and Avastin combination, noting that patients receiving the dual regimen "live longer and have longer before their disease progresses than people who have sorafenib."
The Tecentriq/Avastin combination has become a crucial component of Roche's immuno-oncology portfolio. In addition to HCC, it has been approved to treat non-squamous non-small cell lung cancer (NSCLC). While Tecentriq sales rose 64% to approximately $2.2 billion in the first nine months of last year, Avastin has begun to face biosimilar competition.
Prevention and Early Detection
With 90 percent of chronic liver disease cases being preventable, healthcare professionals emphasize the importance of early detection and management of risk factors. The funding of this advanced treatment option represents a positive step forward, but addressing the underlying causes and improving early diagnosis remain critical challenges in reducing the impact of liver cancer in New Zealand and globally.
