Tislelizumab (Tevimbra)

Key Messages

• Canada’s Drug Agency (CDA-AMC) recommends that Tevimbra be reimbursed by public drug plans, in combination with gemcitabine and platinum chemotherapy, for the first-line treatment of adult patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) if certain conditions are met.
• Evidence from 1 clinical trial showed that Tevimbra, in combination with gemcitabine-cisplatin in the first-line setting, improved progression-free survival (PFS) and overall survival (OS) compared with gemcitabine-cisplatin alone in patients with recurrent or metastatic NPC. The pan-Canadian Oncology Drug Review Expert Review Committee (pERC) determined that adding Tevimbra to gemcitabine plus platinum chemotherapy provides acceptable clinical value compared with gemcitabine plus platinum chemotherapy alone for the first-line treatment of recurrent or metastatic NPC. pERC also determined that Tevimbra in combination with gemcitabine and platinum chemotherapy addresses the need identified by both patients and clinicians for a more effective first-line therapy to delay disease progression and extend survival. These determinations were enough for pERC to recommend that Tevimbra be reimbursed. Given that Tevimbra is expected to be used as an add-on to gemcitabine plus platinum chemotherapy, acceptable clinical value reflects its added benefit over gemcitabine plus platinum chemotherapy alone.
• Tevimbra in combination with gemcitabine plus platinum chemotherapy should only be covered for adults with recurrent or metastatic NPC that cannot be treated with surgery or curative radiation and who have not received any previous systemic treatment for the condition. Patients should have good performance status and should not have active or uncontrolled cancer in the brain or significant autoimmune disease.
• Tevimbra in combination with gemcitabine plus platinum chemotherapy should only be reimbursed if the patient is under the care of a clinician who has expertise in managing NPC and side effects of immunotherapy and the cost of Tevimbra is reduced. Treatment should be discontinued if the patient experiences disease progression or unacceptable side effects.
• Important organizational implications must be addressed for health systems to be able to adopt Tevimbra.