Cancer Drugs & Diagnostics Added To W.H.O’s 2019 Essential List

"Around the world, more than 150 countries use WHO's essential medicines list to guide decisions about which medicines represent the best value for money, based on evidence and health impact. The inclusion in this list of some of the newest and most advanced cancer drugs is a strong statement that everyone deserves access to these lifesaving medicines, not just those who can afford them," said WHO Director-General Tedros Adhanom Ghebreyesus, PhD in a statement.

The EML included several higher priced products including targeted therapies for lung cancer, and immunotherapies with checkpoint inhibitors for melanoma, among others.

Essential medicines was defined as being those that satisfy the priority healthcare needs of the population; drugs are selected with regard to evidence regarding safety and efficacy, disease burden, and comparative cost effectiveness. 

Started in 1977 the Model List of Essential Medicines is updated every 2 years for general medicines, with cancer specific updates being more sporadic, with the most substantial reviews of cancer medicines being in 1984, 1994, and in 1999; the latest were conducted in 2015 when 16 oncologic therapeutics were added. 

The ESMO Magnitude of Clinical Benefit Scale was used as a screening tool to identify cancer treatments, it recommended candidates for inclusion have a score on the ESMO-MCBS of A or B in the curative setting and 4 or 5 in the non curative setting. 

The following new cancer drugs were recommended by the committee to be added to the EML:

• Nivolumab for frontline monotherapy for patients with unresectable and metastatic melanoma; Pembrolizumab is listed as a therapeutically equivalent alternative. This is the first time that therapies for metastatic melanoma have been listed.
• Bortezomib, lenalidomide, thalidomide, and melphalan are indicated for patients with newly diagnosed multiple myeloma in both nontransplant and transplant eligible/available settings; these are the first drugs for multiple myeloma to be listed.
• Erlotinib is indicated for frontline treatment of EGFRmutation–positive advanced non–small cell lung cancer with afatinib and gefitinib listed as therapeutically equivalent alternatives.
• Abiraterone is indicated for patients with metastatic castration-resistant prostate cancer. (Enzalutamide was not listed.)
• Arsenic (oral and IV formulations) is listed for patients with acute promyelocytic leukemia; arsenic is also listed on the EML for children's medicines EMLc.
• Pegaspargase is recommended for the treatment of patients with acute lymphoblastic leukemia.

Indications for several therapies currently on the EML were recommended to be extended to include cervical cancer and multiple myeloma; 10 medicines currently on the EML were recommended to have their indications extended to the EMLc; and indications were extended for 11 agents already included on the EMLc.