Blockbuster anticancer drug series 4 - Avastin

The first anti-VEGF targeted formulation, which solves cancerous species with high treatment limitations

The biosimilar challenge begins with a combination of immuno-cancer drugs and targeted anti-cancer drugs

"By blocking blood vessels generated to proliferate cancer, cancer is starved to death.There is a drug that realizes the theory of a professor at Harvard University in the U.S., who caused a "sensation" in the 1970s.

 

Avastin, a Vascal Endothermic Growth Factor (VEGF) inhibitor, which is also considered a good partner for immuno-cancer drugs.

 

It's the first anti-VEGF event to surpass 100 billion won.

 

Avastin was launched when Genentech in the United States was interested in angiogenesis research and discovered VEGF and genes.

 

Avastin has greatly succeeded along with new antibody drugs such as Rituxan and Herceptin.

 

After Avastin's approval, Roche completely acquired Genentec.

 

Avastin received a lot of expectations and concerns at once.

 

Avastin, which started as a treatment for colorectal cancer, had indications for various carcinomas such as breast cancer, lung cancer, and kidney cancer.

 

In particular, Avastin significantly increased the treatment effect in carcinoma.

 

However, side effects such as high blood pressure, blood clots, and heart failure caused by excessive inhibition of angiogenesis have become controversial.

 

Indications for breast cancer have been withdrawn in the United States due to ambiguous effects against toxicity.

 

Controversy also arose in unauthorized indications.

 

Wet macular degeneration, which causes blindness, is also caused by excessive proliferation of new blood vessels under the retina.

 

Avastin preference was much higher because of the low cost.

 

Avastin was widely used in the treatment of macular degeneration.

 

In Korea, Avastin has expanded its indications relatively smoothly to breast cancer, non-small cell lung cancer, kidney cancer, glioblastoma, ovarian cancer, and cervical cancer since it was approved as a treatment for colorectal cancer in 2005.

 

It was used as a primary treatment in all indications other than glioblastoma and became essential for chemotherapy.

 

With the first registration in 2014, Avastin surpassed 100 billion won in sales for the first time in 2018, 13 years after approval based on IQVIA.

 

Last year, it posted 118 billion won in sales.

 

This is the third-highest selling figure in the entire drug market in Korea.

 

Will Avastin find a new opportunity? Avastin is a good drug to use with other anticancer drugs due to its mechanical nature.

 

It is used with conventional chemotherapy in all indications other than glioblastoma.

 

Targeted anticancer drugs have obtained primary treatment indications for EGFR-positive non-small cell lung cancer with good effects with Tarceva, an EGFR target treatment.

 

It is also used in primary maintenance therapy for ovarian cancer in combination with the PARP inhibitor Lynparza.

 

Roche received primary treatment indications for liver cancer and non-small cell lung cancer through combination therapy with its anti-PD-L1 immuno-cancer drug Tecentriq and Avastin.

 

Keytruda and Opdivo are also exploring the possibility of being used in combination with Avastin in various carcinomas.

 

It is expected that anti-VEGF drugs will compensate for the limitations of cancer immunotherapy alone.

 

Some clinical trials have failed, but combination of cancer immunotherapy and Avastin is still a good strategy.

 

Avastin is widely used.

 

Big Pharma such as Amgen, Pfizer, and Beringer Ingelheim are participating overseas, and two biosimilars have been released in Korea this year.

 

They are Onbevzi of Samsung Bioepis and Zirabev of Pfizer.

 

Onbevzi, the first simulator sold by Boryeong Pharmaceutical, has been paid since this month, and is in the midst of preparing for prescriptions at general hospitals.

 

However, Zirabev is more advantageous in indications.

 

Onbevzi, did not receive some indications for ovarian cancer related to the patent for use.

 

Celltrion and Prestige Biopharma are also developing biosimilar products, so competitive drugs are expected to increase further.

 

When competition begins in earnest, Avastin sales, which amount to 120 billion won, are expected to be inevitable.

 

Avastin sales have already declined as biosimilars have already entered the largest European and U.S.

 

markets.

 

Global sales fell 25% year-on-year last year.

 

In the case of Korea, drug prices have been continuously lowered since Avastin was registered, and the actual difference between the original and biosimilars is expected to be insignificant as only 5% of the patient's burden is applied.

 

The results may vary depending on the non-reimbursed item.

 

In particular, there are biosimilars that are cheaper than Avastin in off-label diseases such as macular degeneration.

 

Sales of expired patents are usually falling, but Avastin has new opportunities.

 

It is an expansion of benefits in combination with Tecentriq.

 

In the primary treatment of liver cancer, combined therapy passed the HIRA's Cancer Drugs Benefit Application Committee in February.

 

In particular, it is more difficult to replace biosimilars with combination therapy with immuno-cancer drugs.

 

The primary benefit for liver cancer is currently in the presumption stage for more than six months.

 

The key is how quickly Roche Korea and the government will be able to reach an agreement over Avastin drug prices, which are burdensome at high prices.