Patient access to premium-priced targeted cancer treatments in Brazil and Mexico is improving, creating an opportunity for developers and marketers of epidermal growth factor receptor (EGFR) inhibitors, says a new report.

In Brazil, the Health Secretariat is developing measures to facilitate public patient access to the most commonly-requested targeted agents, and a number of private insurers which have traditionally often failed to cover oral antineoplastic agents are starting to change their policies to include them, says the study, from Decision Resources.

In Mexico, the inclusion of targeted therapies in national formularies has increased in recent years, and the public Seguro Popular programme, which covers a vast proportion of Mexico's population, is set to expand its oncology coverage to include colorectal cancer in addition to breast cancer, which is already covered, the report notes.

As a result, new drugs that offer clear clinical advantages are well-positioned for market access, and efforts by marketers to ensure that oncologists and payers are aware of the benefits offered by their drugs are expected to bear dividends, it says.

The majority of Mexican oncologists surveyed for the study say that the number of patients for whom they can prescribe EFGR inhibitors is limited by the hospital reimbursement budget, and that in the social security sector, which covers around 45% of the population, healthcare programmes frequently run out of funds to pay for targeted agents. This leads to patients being denied treatment with EGFR inhibitors. 

"In practice, oncologists in many Mexican cancer centres pre-empt budget shortages by prioritising cheaper chemotherapeutic agents," says Decision Resources analyst Niamh Buckley. Furthermore, Mexican payers believe that prescribing of regimens incorporating two targeted agents, such as Roche/Genentech/Chugai's Herceptin (trastuzumab) and GlaxoSmithKline's Tykerb (lapatinib), will be severely constrained in the country, adds Dr Buckley.

The study also finds that, in Brazil, non-hospital-administered EFGR inhibitors are not currently widely reimbursed by private health care, which covers about a quarter of the population.

Surveyed oncologists from both Brazil and Mexico say they consider EGFR inhibition to be a more important therapeutic option for non-small-cell lung cancer and colorectal cancer than for breast cancer. Decision Resources comments that this perception is likely based on the availability of several other effective treatment options for breast cancer, and also to the fact that just one-fifth of breast cancer patients are eligible for HER2-targeted therapy.

Among the oncologists in Brazil and Mexico surveyed for the report, virtually all said that they prescribe Herceptin and ImClone Systems/Merck Serono/Bristol-Myers Squibb's Erbitux (cetuximab) to their cancer patients, while relatively few prescribe Amgen's Vectibix (panitumumab). Additionally, fewer oncologists in Mexico than in Brazil prescribe Tykerb or Genentech/OSI Pharmaceuticals/Roche/Chugai's Tarceva (erlotinib).

Decision Resources has also looked at how cancer patients in Brazil and Mexico can access premium-priced angiogenesis inhibitors such as Roche/Genentech/Chugai's Avastin (bevacizumab), Pfizer's Sutent (sunitinib) and Bayer/Onyx's Nexavar (sorafenib).

None of these drugs are included in the national programmes for free or discounted medicines sponsored by the Brazilian government, but steady demand for them is ensured by the fact that most public hospitals include angiogenesis inhibitors in their treatment guidelines. Due to budget restraints, hospitals operated by the national healthcare programme do not generally have these drugs in stock, but they direct patients to the state Health Secretariat with a request to release the drug, it says.

"If the patient's need is great and the drug required is labeled for that indication then, generally, in both Brazil and Mexico, treatment is ultimately accessed as the patient has a legal right to that treatment. However, most public-sector patients in Brazil must actually instigate legal action before they are granted access to angiogenesis inhibitors," says Decision Resources analyst Dr Andreia Ribeiro.

In Mexico, Avastin, Suten and Nexavar are included in the institutional formularies of the Social Security programmes providing coverage largely to employed and retired people and, when the drugs are in stock, patients have 100% coverage for treatment with them. The report finds that, in practice and despite formulary listing, access to angiogenesis inhibitors is limited in Social Security hospitals because of budget restrictions, but in some cases clinicians can prescribe angiogenesis inhibitors for indications that are off-label in Mexico - such as as Avastin for glioblastoma multiform - if the doctor can support the drug's prescription with documented evidence of the likely benefit to the patient.