4 New Lung Cancer Medicines Added to Reimbursement Coverage

Amendments to the Social Security Institution’s Health Implementation Communiqué, published in the Official Gazette dated 10.05.2018 and entering into force, brought 4 new targeted lung cancer medicines into reimbursement coverage and updated coverage for 1 medicine:

Crizotinib (Marketed as Xalkori)

• Anaplastic lymphoma kinase (ALK) or ROS-1-positive, advanced non-small-cell lung cancer (NSCLC) is covered when patients receive it as first-line monotherapy until progression (disease worsening), with costs reimbursed by the Institution.
• It is also reimbursed until progression in patients with confirmed ALK fusion positivity who previously received chemotherapy and subsequently progressed, for metastatic non-small-cell lung cancer in second-line treatment.
• Crizotinib was already available in Türkiye but could only be used through a special off-label application. It is now directly reimbursed when prescribed by medical oncology specialists based on a medical board report valid for up to 6 months and involving at least one medical oncologist.
• Other medicines used for ALK positivity include alectinib or ceritinib . If patients progress after these treatments, sequential or combined crizotinib use is not reimbursed.

Osimertinib (Tagrisso)

• For patients with epidermal growth factor receptor (EGFR) mutation-positive lung cancer who have progressed during or after previous tyrosine kinase inhibitor treatment and whose EGFR T790M mutation positivity is confirmed by a post-progression biopsy, reimbursement is provided until progression for adults with locally advanced or metastatic non-small-cell lung cancer unsuitable for chemoradiotherapy and surgery.
• With this approval, osimertinib was reimbursed in Türkiye for the first time.

Gefitinib (Iressa)

• Reimbursement is provided until progression for metastatic nonsquamous non-small-cell lung cancer positive for an EGFR exon 19 deletion and/or exon 21 mutation.
• With this approval, gefitinib was reimbursed in Türkiye for the first time.
• Erlotinib, gefitinib , and medicines containing afatinib are not reimbursed if used sequentially or together.

Ceritinib (Zykadia)

• For patients with ALK-positive advanced non-small-cell lung cancer in first-line treatment, it is reimbursed as monotherapy (single-drug treatment) until progression.
• For patients with ALK-positive metastatic non-small-cell lung cancer (NSCLC) who previously received crizotinib and subsequently progressed, in second-line treatment it is reimbursed until progression.
• These approvals brought ceritinib into reimbursement coverage in Türkiye for the first time.
• For patients who progress after ceritinib, sequential or combined crizotinib or alectinib use is not reimbursed.

Alectinib (Alecensa)

• For patients with ALK-positive advanced non-small-cell lung cancer in first-line treatment, it is reimbursed as monotherapy until progression.
• For patients with ALK-positive metastatic non-small-cell lung cancer who previously received crizotinib and subsequently progressed, in second-line treatment it is reimbursed until progression.
• These approvals brought alectinib into reimbursement coverage in Türkiye for the first time.
• Alectinib treatment followed by progression does not permit reimbursement of sequential or combined crizotinib or ceritinib.

Note: For reimbursement of these targeted medicines in the specified situations, the relevant genetic alterations, such as ALK fusion or EGFR positivity, must be confirmed by genetic testsperformed in an accredited laboratory.

Related Topic

Advances in Lung Cancer Treatment—2017 and 2018