Phar­mac urged to fund life-ex­tend­ing drug

Breast Can­cer Foun­da­tion says ev­i­dence now ex­ists to jus­tify ac­cess to pre­vi­ously excluded pa­tients

Weekend Herald - - News - Anna Leask

Phar­mac is be­ing urged to change its fund­ing cri­te­ria for a life-ex­tend­ing drug for women with in­cur­able breast can­cer.

A study has shown the drug Per­jeta — avail­able only to Kiwi women who had not had chemo­ther­apy — could have sig­nif­i­cant ben­e­fits for many more pa­tients.

Women di­ag­nosed with ad­vanced (also known as in­cur­able or metastatic) breast can­cer have a 22 per cent chance of liv­ing longer than five years.

The drug Per­jeta could lengthen their life by 15 months or more — time they say they des­per­ately want.

The drug was in­tro­duced in New Zealand in Jan­uary last year af­ter it was ap­proved by Med­safe.

How­ever, Phar­mac ruled only women who have not re­ceived Her­ceptin or chemo­ther­apy treat­ment pre­vi­ously were el­i­gi­ble for full fund­ing.

That meant about 160 women were excluded from the treat­ment un­less they paid for it them­selves — at a cost of at least $130,000 per pa­tient.

The is­sue hit head­lines last month af­ter Auck­land de­tec­tive Sarah Cato, 35, ap­pealed for help to fund the drug so she could have more time with her wife, Keely, and 10-year-old daugh­ter, Emma.

She has now raised $111,000 af­ter shar­ing her story in the Her­ald and is still fundrais­ing to cover the on­go­ing cost of the treat­ment. Phar­mac di­rec­tor of op­er­a­tions Lisa Wil­liams said Per­jeta was only reg­is­tered by Med­safe for use in pa­tients who had not re­ceived prior treat­ment with Her­ceptin or chemo­ther­apy.

In Fe­bru­ary 2017 af­ter pleas from ad­vo­cacy groups in­clud­ing the NZ Breast Can­cer Foun­da­tion and Breast Can­cer Aotearoa Coali­tion, it sought “ex­pert clin­i­cal ad­vice” from its Phar­ma­col­ogy and Ther­a­peu­tics Ad­vi­sory Com­mit­tee on whether other pa­tients could use the drug.

“PTAC de­ferred mak­ing a rec­om­men­da­tion, not­ing that the avail­able ev­i­dence wasn’t strong enough, or of a high enough qual­ity, to sup­port the use of per­tuzumab [trade name Per­jeta] for peo­ple who had al­ready had treat­ment,” said Wil­liams.

But NZBCF chief ex­ec­u­tive Evan­gelia Hen­der­son said a new trial pre­sented at the Amer­i­can So­ci­ety for Clin­i­cal On­col­ogy con­fer­ence in Chicago last week showed the com­bi­na­tion of Her­ceptin and Per­jeta con­sid­er­ably length­ened the life of some pa­tients.

The Pherexa trial showed half of pa­tients who added Per­jeta to their ex­ist­ing Her­ceptin treat­ment for metastatic HER2+ breast can­cer sur­vived more than three years, com­pared with an av­er­age sur­vival of just two years four months for those con­tin­u­ing on Her­ceptin alone.

Hen­der­son said in light of the trial re­sults, the NZBCF was pre­par­ing a writ­ten sub­mis­sion to Phar­mac, in­cor­po­rat­ing the Pherexa trial re­sults.

Wil­liams said when the PTAC re­viewed Per­jeta in 2017 it took into ac­count data from the Pherexa trial, pre­sented to ASCO the year be­fore.

The full trial re­sults were only pub­lished this month. “Phar­mac is al­ways open to re­view­ing new pub­lished ev­i­dence and re­assess­ing fund­ing cri­te­ria,” Wil­liams said.

“We would seek ex­pert clin­i­cal ad­vice from our Can­cer Treat­ments Sub­com­mit­tee to un­der­stand whether the ev­i­dence is ro­bust, of good qual­ity and sup­ported the use of per­tuzumab in pre­vi­ously treated HER2-pos­i­tive metastatic breast can­cer pa­tients.”

Hen­der­son said the de­ci­sion to “ex­clude” the 160 women di­ag­nosed be­fore Per­jeta was in­tro­duced in New Zealand was “un­fair”.

“It’s time to put right this dread­fully un­just sit­u­a­tion, which left 160 pa­tients who might ben­e­fit from Per­jeta out in the cold, purely be­cause they had the mis­for­tune to be di­ag­nosed with ter­mi­nal can­cer be­fore Jan­uary 2017,” Hen­der­son said.

“Eigh­teen months ago Phar­mac put off its de­ci­sion, say­ing it wanted more ev­i­dence.

“To­day, that ev­i­dence ex­ists, and we say it’s time to of­fer Per­jeta to all

pa­tients who might ben­e­fit.”

Hen­der­son said of the 160 women blocked from Per­jeta, some had passed away and oth­ers had tried to raise money to pay for the drug them­selves.

“When you have ter­mi­nal can­cer, the ex­tended sur­vival some peo­ple have achieved with this new drug means ev­ery­thing to pa­tients and their fam­i­lies,” she said.

“We’re ask­ing Phar­mac to con­sider ex­tend­ing Per­jeta to the re­main­ing pa­tients as mat­ter of ur­gency, be­fore more lives are lost.”

To find out more about breast can­cer in­clud­ing what to look for and how to self-check, go to breast­cancer.org.nz or breast­cancer­foun­da­tion.org.nz

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