Treatments that can save lives - and may remain outside the health basket

The Oncology Association submitted today (Tuesday) to the Ministry of Health the ranking of preferred drugs and treatments for the coming year. At the top of the list: treatment for bladder cancer that showed an improvement of about 16% in overall survival after two years. Also high on the list is immunotherapy for stomach cancer, which, according to experts, has been a global standard for years.

The Oncology Association prioritizes treatments for early stages of cancer ahead of the 2027 health basket discussions and warns of a growing gap between treatments available in the public framework in Israel and the options available to patients with private insurance. In the recommendation document submitted to the Ministry of Health, experts warn that the gap may deepen inequality between cancer patients based on their economic status and also affect their chances of recovery and survival.

The document was written by the chair of the Oncology Association, Prof. Ravit Geva, and the chair of the National Council for the Prevention, Diagnosis, and Treatment of Malignant Diseases, Prof. Ido Wolf, alongside the association's subcommittee. According to them, the principle guiding the oncologists was to give high priority to treatments in early stages of the disease, where there is a possibility to increase the rate of patients who will be cured. However, several treatments for metastatic disease also reached the top of the list, especially in cases where experts believe there is a significant gap between Israel and the accepted standard of care in the world.

At the top of the list: treatment for bladder cancer

After two decades without a breakthrough in the field, a combination of the immunotherapy treatment Keytruda and an antibody-drug conjugate (ADC) called Padcev was submitted for the 2027 basket for the treatment of muscle-invasive bladder cancer. In a study that examined the efficacy of the combination before and after surgery among patients found eligible for the common chemotherapy cisplatin, a 35% reduction in the risk of mortality and an improvement in overall survival (OS) were recorded; a 47% reduction in the risk of disease progression or recurrence and an extension of time without disease progression (EFS); and a complete pathological response in 55.8% of patients, compared to 32.5% in the control arm.

Among patients not eligible for cisplatin, the following results were recorded: a 60% reduction in the risk of disease progression, recurrence, or death; a 50% reduction in the risk of mortality and an improvement in overall survival (OS); and a complete pathological response in 57.1% of patients, compared to only 8.6% in the surgery-only group.

Oncologists on stomach cancer: Israel has a significant gap from the world

One of the sharpest messages in the document concerns the treatment of stomach cancer. The association ranked the immunotherapy submissions for the disease as a group in third place. Experts recommend including the treatment for suitable patients according to CPS scores and HER2 characteristics, and emphasize that immunotherapy improves overall survival and has already been approved globally for the treatment of stomach cancer for about five years.

According to the data presented by the association, one in eight to nine patients receiving immunotherapy is expected to survive two to three years, compared to an average survival of less than a year with chemotherapy alone. The association estimates this involves about 100 patients.

The experts even use exceptionally sharp phrasing, stating that "the State of Israel is in a significant strategic gap in the treatment of stomach cancer." According to them, the treatments are already publicly funded in other countries, and their non-inclusion in Israel harms not only patients but also the ability to attract clinical trials in the field.

From breast cancer to treatment that may prevent surgery and radiation

In fourth place is Enhertu (trastuzumab deruxtecan), as an adjuvant treatment for patients with HER2-positive breast cancer who have residual invasive disease after pre-surgical treatment and are at high risk of recurrence. The document notes that this is a very high-risk population, and that the study recorded an absolute reduction of 8.7 percentage points in the risk of recurrence after three years, as well as a decrease in the risk of brain metastases. The estimate is for about 59 patients.

In fifth place is Kisqali (ribociclib), for patients with early breast cancer, hormone receptor-positive and HER2-negative, who are at high risk of recurrence even without lymph node involvement. According to the association, after four years of follow-up, a gain of about 6 percentage points was recorded in reducing the risk of recurrence, and it is estimated that about 143 patients may be suitable for the treatment.

One of the most prominent treatments on the list is ranked sixth: Jemperli (dostarlimab) for patients with locally advanced rectal cancer of the dMMR/MSI-H type. The association defines it as a "curative and revolutionary treatment" because it may eliminate the need for surgery and radiation — treatments that can involve permanent damage, including a stoma or damage to the sphincters. It is estimated that about 20 patients may be suitable for the indication.

Further down the list, Keytruda was ranked as an adjuvant treatment for NSCLC lung cancer, Tecentriq for adjuvant treatment of colon cancer in a group with a defined biological characteristic, as well as treatments for patients with metastatic prostate cancer sensitive to hormonal therapy.

Also ranked was treatment with Zungartinib — an innovative and breakthrough oral treatment for patients with advanced lung cancer with a HER2 mutation, including proven efficacy even in complex cases with brain metastases. The treatment provides an effective response to a patient population that until now had almost no effective treatment options available.

The association also emphasized that a lower ranking does not indicate that the treatment is not essential. In fact, the experts' position is that all the first 20 indications in the ranking deserve to be included in the health basket. According to them, the very need to place them against each other stems from resource limitations, not from a significant gap in their medical importance.

In the background, there is also a warning against creating "two health systems" for cancer patients. The association notes that the accelerated development of new oncological drugs leads to an improvement in life expectancy and quality, but at the same time increases the gap between what is funded in the public basket and what can be obtained through private insurance. Experts fear that this means a patient with financial means will get access to advanced treatment, while another patient with the same disease may not receive it.

"Behind every line in the list are patients for whom the treatment may be very significant and sometimes change the course of their disease," wrote the heads of the association. They added that their hearts are with patients for whom effective treatment may remain outside the basket due to budget constraints, and expressed hope that resources will be found to allow the inclusion of as many indications as possible this year.

It should be noted that as of now, the budget intended for the health basket is 650 million shekels, as it was last year. Estimates are that there will be no budget cut this year either, but there will also be no increase, against the backdrop of the election atmosphere.