“You should light the candle at my wedding. That’s my wish. So, don’t worry about the drug cost, take the medicine, and get well soon.”

Baek Geum-seon, a 63-year-old woman who met Korea Biomedical Review 10 days before her daughter’s wedding, said she was happy she could make her daughter’s wish come true. 

Baek is taking Tagrisso (osimertinib), AstraZeneca’s targeted therapy for lung cancer. 

When she was diagnosed with lung cancer in May 2022, she was suffering from unbearable back pain. Her thighs and hips hurt so much that she thought, “I’m going to die in this condition.” She couldn’t eat or sleep. She was in the worst condition, unable to even go to the bathroom by herself, but after taking Tagrisso for three months, Baek was able to do light housework, take a walk, and go to the local mart without a wheelchair. Baek was happy saying that she found her normal daily life again.

‘Why did I get lung cancer?’

Baek is a stage-4 lung cancer patient with tumors spread to the head, chest, abdomen, and legs. She didn’t cough or have trouble breathing, so she couldn't believe the doctor who said she had stage 4 lung cancer.

Since the end of April last year, her back hurt and she found it difficult to walk. She thought it might be a herniated disc or arthritis, which is common in people in their 60s. She went to a joint specialist and went through all the tests, such as X-rays, CT, and MRI scans. The doctor said it was only a disc herniation. She never thought her bones ached because of cancer. She was in so much pain that she couldn't eat, and she lost 35kg. 

In May, she took another MRI at a local hospital and the doctor told her to go to a bigger hospital. 

But when cancer cells were found in her lungs, she was diagnosed with lung cancer. The tumor was 1 cm, not large, but it was stage 4, meaning that the cancer already spread to the head and legs. She has never smoked, and she didn’t cough, but she had stage 4 lung cancer. The moment she heard it, she burst into tears.

Baek was hospitalized at Yonsei Cancer Center. Detailed tests showed that she had a mutation related to lung cancer. 

Professor Kim Hye-ryun of the Department of Oncology prescribed her Tagrisso, and Baek has been taking it for nine months so far. 

Tagrisso is the world's first third-generation EGFR mutation-positive non-small cell lung cancer (NSCLC) targeted therapy approved as first-line treatment for locally advanced or metastatic NSCLC patients with EGFR exon 19 deletion or exon 21 (L858R) substitution mutation. 

Among the third-generation EGFR tyrosine kinase inhibitors (TKIs) developed to date, Tagrisso is the only drug that demonstrated a median overall survival (mOS) of more than three years in the first-line treatment in the progressive stage of NSCLC and is being established as a standard treatment in the U.S. and Europe.

Among EGFR-positive NSCLC patients, 20 percent have brain metastasis at the time of diagnosis. Those with brain metastasis have difficulties in daily life because of headaches, vomiting, cognitive problems, language issues, and gait dysfunction.

Existing first- and second-generation treatments have low blood-brain barrier permeability, so the effect on brain metastasis is significantly reduced and side effects are severe. 

On the other hand, Tagrisso shows the same level of treatment effect in brain metastasis patients as in patients without brain metastases. This has also been proven through large-scale global clinical trials and real-world analyses.

‘I would have died early if not for Tagrisso’

Baek said she could feel the effect of Tagrisso more than anyone else. 

“After taking it for three months, I could feel that I was getting better. Before, I used to cry a lot because of severe pain and thought about death a lot. But now, back pain is gone and I don’t have to take painkillers,” she said.

No hip pain or leg pain. She could go on a trip with her family. 

“If I hadn’t used Tagrisso, I would have died early. Now, my quality of life has improved so much that I could go shopping and have a chat at a cafe.”

Because her health status improved after using Tagrisso, she visits Yonsei Cancer Center every three months. 

“Every time I visit professor Kim, she says the tumor has shrunk. I think the tumor in my body is shrinking little by little with Tagrisso,” she said.

Of course, Baek experiences side effects. They are not serious but she had stomatitis and cramps in her legs. Her hair fell out but it is growing again. When she thinks of the past when she had severe pain in the back and hips, the “side effects are nothing,” she said. 

3-month Tagrisso costs $15,380 

However, Baek’s joy of living did not last long because she had to face another pain -- the expensive price of Tagrisso. The drug costs 6 million won ($4,614) per four weeks, and nearly 20 million won per 12 weeks. 

“Once, my attending doctor asked me if the drug expenses were burdensome. I asked her if I could stop it because it costs too much but she said I must continue the treatment,” Baek said. 

Her husband and children told her that they would even sell their house to pay for the drug.

“If Tagrisso is not covered by health insurance soon, I will have to sell my house,” she said. 

Baek said she was grateful to see her son and daughter running around to pay for their mother's medicine, and she was determined to overcome the disease.

Still, when she heard of patients in the lung cancer community giving up treatment due to money issues, she got worried, too. 

“My heart broke when I saw a 65-year-old patient’s posting saying ‘I don’t have money for the drug anymore. I’ve lived this long, so I should give up.’ When any family member gets sick, the whole family becomes anxious. Not every patient can get Tagrisso, but if some patients can benefit from it due to mutations, I feel like submitting a petition to allow reimbursement (for Tagrisso),” Baek said. 

‘I hope President Yoon keeps his promise on health insurance’

On Feb. 6, a petition on the National Assembly’s national petition board requested the reimbursement for Tagrisso as the first-line therapy for NSCLC.

The petition garnered the consent of 50,000 people and was referred to the National Assembly’s Health and Welfare Committee, a standing committee. 

Recalling President Yoon Suk Yeol’s pledge during the last presidential election that he would no let people die simply because of lack of money, Baek said Tagrisso was a good example to keep that pledge.  

At 9:00 every morning, Baek's cell phone rings an alarm that tells her it's time to take Tagrisso. This is because she does not want to forget to take Tagrisso even for a single day.

If Tagrisso wins reimbursement as the first-line therapy for NSCLC and she gets to receive treatment without financial burden, she wants to go to “a college for housewives.” With a new life comes meaningful work, she said. 

This story was originally published in Korean in Korea Healthlog, a sister paper of Korea Biomedical Review. -- Ed.