Disadvantages of effective ADC anticancer drugs

Millions of won per administration

One cycle of non-reimbursed Trodelvy is close to 10 million won, and Enhertu is 7 million won

ADC, effective even in carcinomas with poor treatment outcomes

It has been shown that patient accessibility to antibody-drug conjugates (ADCs) introduced in Korea has been significantly reduced due to high non-reimbursed drug prices.

 

The price of non-reimbursed Trodelvy, which was approved in Korea last May, is about 1.6 million won per vial.

 

Converted into one cycle (21 days, 2 administrations), the cost is approximately 9.3 million won, which is close to 10 million won.

 

Enhertu’s non-reimbursed drug price is also high.

 

The non-reimbursed price of Enhertu, which requires three vials per cycle for an average patient is about 7 million won.

 

If you participate in the Patient Assistant Program (PAP) run by the company, the price drops to the high 5 million won range, but it is still a burden for the patient.

 

ADC has recently emerged as a hot keyword in the anticancer drug market.

 

Newly introduced ADC anticancer drugs in Korea, such as Daiichi Sankyo Enhertu and Gilead Trodelvy, are effective against a variety of cancer types, not just one cancer type.

 

Enhertu, which was approved in Korea last year as a treatment for human epidermal growth factor receptor type 2 (HER2) positive breast and stomach cancer, showed superior results compared to existing treatments in clinical data such as PFS and OS.

 

Enhertu is also showing effectiveness in clinical trials targeting patients with HER2-low-expressing breast cancer, non-small cell lung cancer, colon cancer, ovarian cancer, and biliary tract cancer.

 

Trodelvy, which targets TROP-2 protein, is also seeking to secure various indications.

 

Currently, it has been approved as a treatment for triple-negative breast cancer in Korea, but its efficacy and safety are also being checked for HR+/HER2- breast cancer and non-small cell lung cancer.

 

Accordingly, various domestic companies are also taking on the challenge of ADC development.

 

This is because, if development is successful, there is a high possibility of securing various indications.

 

Currently, not only traditional pharmaceutical companies such as Samjin Pharmaceutical, Anguk Pharmaceutical, and Chong Kun Dang, but also bio companies such as Celltrion, Samsung BioLogics, Lotte BioLogics, and LegoChem Bio have declared their participation in the ADC market.

 

ADCs have the advantage of securing excellent therapeutic effects and a variety of indications, but the high drug price is an obstacle to prescription.

 

As a result, some patients are giving up treatment.

 

This is because patient copayment occurs even with actual cost insurance.

 

In particular, the longer the treatment period for Enhertu and Trodelvy, which showed an advantage in PFS compared to existing treatments, the greater the burden on patients.

 

Professor Kyeong-Hwa Park of the Department of Oncology at Korea University Anam Hospital (Chairman of the Korean Cancer Society) said, “ADCs are effective even in cancer types that have had poor treatment results so far, so there are many patients who want to use them, but the non-reimbursed drug price is an obstacle,” adding, “It has a large impact on the family economy.” In addition to ADCs, there are also situations where a general anticancer drug is switched.

 

“Even patients with actual cost insurance face a significant burden as they incur a 20% copayment per month,” the professor said.

 

However, he explained that there is a reason why ADC non-reimbursed drug prices are high.

 

Unlike existing anticancer drugs, ADC's manufacturing process is different from general chemical principles.

 

Professor Park said, “ADC has a high manufacturing cost because it involves a process of generating antibodies and linking the payload.

 

In the case of Kadcyla, a first-generation ADC, it is known that 10 molecules of Herceptin must be reacted to obtain one molecule.

 

“It is understandable that non-reimbursed drug prices are high,” he said, adding, “I sympathize with the positions of both the government, which wants to reduce health insurance finances, and the company, which must protect development costs, but I hope that an agreement will be reached as soon as possible and the reimbursement will be passed.” He continued, “I hope that in the future, not only overseas pharmaceutical companies but also domestically will succeed in developing ADCs and contribute to stabilizing health insurance finances by lowering drug prices.”