There has been no new medicine in 40 years, and it is difficult to survive for half a year after relapse! "The worst of evils" Small cell lung cancer 1 treatment is covered by health insurance: 300 people can be saved every year
“The worst of evils” small cell lung cancer is prone to relapse and survival is less than 5 months after treatment
Cancer is the first among the top ten causes of death in Taiwan. Among the top ten cancers, “lung cancer” ranks first. According to the pathological classification and prognosis of survival status, “the worst of the worst” small cell lung cancer is highly malignant, has a rapid disease progression, and has a 5-year survival rate. The average is less than 10%. Because small cell lung cancer has neuroendocrine characteristics, it often grows very fast and is prone to develop drug resistance after treatment. Once it relapses, the average survival period is less than 5 months. There has been no treatment breakthrough for decades. , regarded by clinicians as “the worst of the worst”.
Dr. Yang Zhengda, chairman of the Taiwan Lung Cancer Society, said in an interview that small cell lung cancer is highly related to smoking, and the proportion of all lung cancers has gradually dropped from 10-15% in the past to 6-8% today. However, the overall number of people still shows a slight increase. There are about 1,000-1,100 people every year. In terms of symptoms, small cell lung cancer is usually located in the center of the lungs. Patients often have respiratory symptoms such as difficulty swallowing, or hoarseness due to tumor compression of nerves. Many also seek medical treatment for bone pain after metastasis.
“Small cell lung cancer is still the most malignant lung cancer with the highest mortality rate. Although chemotherapy is effective in the early stage, drug resistance will soon appear!” Dr. Yang Zhengda pointed out that chemotherapy drugs for small cell lung cancer have been used for more than 40 years. It shows that there has been no breakthrough development in drug research and development for small cell lung cancer in recent decades. It was not until the combined use of PD-L1 immune checkpoint inhibitors and chemotherapy that significant survival prolongation effects were seen, reversing the treatment dilemma of small cell lung cancer.
Small cell lung cancer doubles in size in one month! Immunotherapy breaks through treatment dilemma
“Even if it is assessed that it is suitable for surgical treatment, small cell lung cancer can easily continue to appear after surgery. What is even more frightening is that small cell lung cancer grows extremely fast and can even double in size in a month!”
Dr. Lai Junliang, chairman of the Taiwan Society of Clinical Oncology, pointed out that the treatment of small cell lung cancer is mainly based on traditional chemotherapy and supplemented by radiation therapy. However, once drug resistance occurs, there will be no available drugs. Small cell lung cancer can be divided into “limited stage” and “spread stage” based on the disease process. The average survival in the limited stage is about 16.92 months, while in the spread stage is only about 8.71 months. It is worth noting that most patients are already in the spread stage when diagnosed. , the proportion that can be operated on is not high.
Dr. Lai Junliang said that PD-L1 immunosuppressants break the dilemma that traditional chemotherapy cannot prolong the survival of small cell lung cancer. By combining immunosuppressants with chemotherapy drugs, the five-year survival rate can be increased from 5.31% to 12%, which brings new opportunities for the treatment of small cell lung cancer. Come a new dawn. The latest NCCN small cell lung cancer treatment guidelines in the United States indicate that new PD-L1 immunosuppressants combined with chemotherapy can reduce the risk of death by 30% and help extend overall survival by more than one year.
However, it has been clinically found that patients with small cell lung cancer may experience side effects such as rash, hepatitis, hypothyroidism, hyperthyroidism, injection adverse reactions, intestinal inflammation, and upper renal insufficiency during immunotherapy. Dr. Lai Junliang suggested that most side effects of immunotherapy are “preventable and controllable.” As long as regular monitoring remains within the safe range, if small cell lung cancer is confirmed, patients should actively discuss the most appropriate treatment strategies with their doctors.
The annual self-expense is 1.45 million! Immunosuppressants combined with chemotherapy for small cell lung cancer receive health insurance benefits
Although immunosuppressants combined with chemotherapy have brought hope in the treatment of small cell lung cancer, immunotherapy is expensive at its own expense. However, considering the drug’s immediate availability and reducing the burden on patients, Taiwan’s health insurance has combined the use of immunosuppressants for small cell lung cancer in December 2023. Chemotherapy is included in health insurance benefits, and it is expected that approximately 300 patients will benefit every year.
Dr. Yang Zhengda pointed out that the current benefit is for first-line treatment of metastatic small cell lung cancer, patients who have not received chemotherapy and have no brain or spinal metastasis, and whose physical condition, including liver and kidney function, should meet the standards. Since most patients with small cell lung cancer are middle-aged and elderly men with a history of heavy smoking, most of them are blue-collar salaried people with fragile social and economic capabilities, and it is difficult to afford out-of-pocket expenses of more than one million yuan. Fortunately, with the help of health insurance benefits, the survival of patients with small cell lung cancer can be prolonged and the financial burden on patients and families can be significantly reduced.
Pang Yiming, deputy director of the Central Health Insurance Administration of the Ministry of Health and Welfare, said that immunosuppressants are precision treatments and cost nearly 1.45 million a year. However, in order to provide clinicians with the best treatment weapons and help more patients get good treatment, in addition to paying small For major diseases such as cell lung cancer, policies such as parallel review and temporary payment will continue to be promoted in the future to accelerate the review and pricing of precision treatment drugs. As the pathological classification of cancer becomes more detailed, the National Health Insurance Department will also use actuarial resources to promote drug payment that is more in line with the overall benefits of society and benefit the greatest number of Taiwanese people.
