Lynparza for Fallopian Tube Cancer: Costs and Treatment Options

Q: Lynparza for Fallopian Tube Cancer: Costs and Treatment Options

Hello： <br>1. <br>First, to answer the most important question, these new targeted therapies (Olaparib, Rucaparib, Niraparib), as well as the older targeted drug Avastin, are currently not covered by health insurance in Taiwan. <br>The chances of them being covered in the future

Ovarian cancer and Lynparza (olaparib) issues?

1) Can patients with fallopian tube cancer use Lynparza (olaparib) out-of-pocket? What is the approximate cost range? What are the criteria for insurance coverage?
2) For a patient with stage III fallopian tube cancer who has relapsed once and is now suspected of relapsing again with a detected BRCA gene mutation, could you provide some current novel treatment options for us to consider discussing with our primary physician? For example, what are the options for immunotherapy? Are there choices like dendritic cell therapy (DC) or CAR-T therapy? Which one is better? What are the approximate out-of-pocket costs? How can insurance provide coverage? Additionally, are there any targeted therapies that have shown better efficacy for this condition? What are the insurance coverage criteria for those? What are the approximate out-of-pocket costs? Besides cellular immunotherapy and targeted therapy, are there any other treatment methods currently available in the U.S.
and Japan?
P.S.
We are not abandoning traditional chemotherapy or standard treatments; we just want to know if there are additional therapies within our financial means that can be used in conjunction with traditional treatments (of course, with the consent of our primary physician).
I apologize for the confusion and incompleteness of the information found online, as the medical field is quite specialized and difficult to understand, so I am reaching out to a professional like you!

PAC, 20~29 year old female. Ask Date: 2020/02/12

Dr. Chen Yunfang reply Oncology

Hello:
1.
First, to answer the most important question, these new targeted therapies (Olaparib, Rucaparib, Niraparib), as well as the older targeted drug Avastin, are currently not covered by health insurance in Taiwan.
The chances of them being covered in the future are also low (at least the research results in recent years have not been impressive!).
Among these BACA mutation inhibitors, Olaparib was the first to market and has the largest market share.
Even for Olaparib, the out-of-pocket cost is about NT$10,000 per day.
The result of taking it is a delay in cancer progression by about four months, but ultimately, the survival time for those who take it and those who do not is the same.
This is the main reason why health insurance will not cover it; funds need to be spent wisely, and these drugs are all increasingly expensive!
2.
Next, regarding immunotherapy drugs, these medications are also not covered by health insurance (such as Keytruda, Nivolumab, etc.).
The reasoning is likely the same: the efficacy is unclear, and it is not worth spending large amounts of money on coverage.
The out-of-pocket costs for these drugs vary from over NT$100,000 to more than NT$200,000 per month, depending on which pharmaceutical company’s drug is chosen.
3.
Finally, for CAR-T therapy, health insurance currently only allows three hospitals in Taiwan to perform it (Taipei Veterans General Hospital, China Medical University Hospital, and Kaohsiung Medical University Hospital), and it is also entirely out-of-pocket.
The pricing is even less transparent (not publicly regulated).
Patients need to privately inquire with the treating physicians.
According to what I’ve heard from my patients' families, for pancreatic cancer treatment at China Medical University Hospital, an initial deposit of NT$300,000 is required, and after extracting cells and culturing them for a month, the treatment is arranged.
However, if the patient's condition is poor, they may not be suitable for the treatment, and ultimately, if the patient passes away, the hospital refunds NT$150,000.
If the entire process is completed over several months, the total cost can be around NT$1.5 million.
There is a lot of new information about cancer treatment available online every day, but much of it is promotional content.
While efficacy is often discussed, the out-of-pocket costs are rarely mentioned.
It is advisable to have a thorough discussion with your primary physician about treatment options and avoid spending money on treatments with no clear efficacy.

Reply Date: 2020/02/12

More Info

When considering treatment options for fallopian tube cancer, particularly with the use of Lynparza (olaparib), there are several important factors to discuss, including costs, insurance coverage, and alternative treatment options.

1. Lynparza (Olaparib) Usage and Costs: For patients with fallopian tube cancer, Lynparza is an option, especially for those with a BRCA mutation. However, it is important to note that as of now, Lynparza is not covered by health insurance in many regions, including Taiwan. The cost of Lynparza can be substantial, typically around NT$10,000 per day. This translates to approximately NT$300,000 per month if taken continuously. The lack of insurance coverage is primarily due to the cost-effectiveness analysis, which indicates that while Lynparza may extend progression-free survival, it does not significantly increase overall survival compared to standard treatments. Therefore, patients often have to bear the financial burden themselves.

2. Treatment Options for Recurrent Stage III Fallopian Tube Cancer: For patients who have experienced a recurrence of stage III fallopian tube cancer and have a BRCA mutation, there are several treatment avenues to explore. These include:
- Immunotherapy: This is an emerging field in cancer treatment. Options such as immune checkpoint inhibitors (e.g., Pembrolizumab, Nivolumab) are being studied, but they are not yet standard for fallopian tube cancer. The costs for these therapies can range from NT$100,000 to NT$200,000 per month, and they are also not typically covered by insurance due to uncertain efficacy in this specific cancer type.

- Cellular Therapies: Options like dendritic cell (DC) therapy and CAR-T cell therapy are being explored. However, CAR-T therapy is primarily used for hematological malignancies and is not yet a standard treatment for solid tumors like fallopian tube cancer. The costs for CAR-T therapy can be exorbitant, often exceeding NT$1,500,000 for the entire treatment process, and it is also not covered by health insurance.

- Targeted Therapy: Besides Lynparza, other targeted therapies such as Niraparib and Rucaparib may be considered, but similar to Lynparza, they are not covered by insurance and can be quite expensive.

3. Other Treatment Modalities: In addition to the aforementioned therapies, traditional chemotherapy remains a cornerstone of treatment for fallopian tube cancer. Combining traditional chemotherapy with newer agents may be a viable strategy, and it is essential to discuss this with the treating oncologist.
4. Consultation with Healthcare Providers: Given the complexity of treatment options and the financial implications, it is crucial to have open discussions with healthcare providers. They can provide insights into the most appropriate treatment plans based on the patient's specific circumstances, including the potential benefits and risks of each option.

5. Research and Clinical Trials: Patients may also consider participating in clinical trials, which can provide access to cutting-edge therapies that are not yet widely available. These trials often cover the costs of treatment and can be a valuable resource for patients seeking innovative options.

In summary, while Lynparza and other targeted therapies present promising options for treating fallopian tube cancer, the financial implications and lack of insurance coverage pose significant challenges. It is essential for patients to engage in thorough discussions with their healthcare providers to explore all available treatment options, including traditional chemotherapy, immunotherapy, and participation in clinical trials, while considering their financial situation and overall treatment goals.

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