Pharmac breast cancer cost-saving proposal welcome but ignores patients facing “dead-end”

Breast Cancer Foundation NZ is urging Pharmac to widen access to an already-funded treatment for Kiwi women with advanced breast cancer, as the drug-buying agency today opens consultation on a drug switch proposal.

Pharmac is considering replacing Herceptin (the brand name for the drug trastuzumab) with another company’s version called Herzuma, now that Herceptin’s patent has expired. Breast Cancer Foundation NZ welcomes this move as a cost-saving measure that is safe and effective, but the charity is disappointed Pharmac’s clinical advisors have recommended against providing it to certain patients who have run out of options.

Trastuzumab is a targeted therapy used to treat the HER2-positive subtype of breast cancer. It’s currently funded in New Zealand for both early and advanced breast cancer (ABC) – where cancer has spread beyond the breast and become incurable. But if an ABC patient’s cancer grows or spreads while on trastruzumab, it’s no longer funded for them, which goes against international best practice.

Adele Gautier, the Foundation’s research and strategic programmes manager, says this decision could hurt hundreds of Kiwi women who need this drug: “Overseas, it’s common practice for ABC patients to reuse a previous treatment after their cancer worsens. In New Zealand, we already allow this with cheaper treatments like chemotherapy and hormone therapies, so we should be able to with trastuzumab too. Our breast cancer specialists want this, and research shows it works – just last week, a study published in the Nature journal showed trastuzumab prolonged the life of patients for years after their condition worsened.

“Kiwis with ABC have lower survival rates and fewer treatment options than patients in other countries, so we should be doing all that we can to change this. Refusing to allow more flexible prescribing of proven treatments for patients with no other option points to inadequate funding which means Kiwis can’t get the drugs we already have, let alone the latest medicines. We are urging Pharmac to reconsider this restriction and we encourage affected Kiwis to have their say too.”

In 2019, the world’s leading authority on ABC, the Portuguese oncologist Dr Fatima Cardoso, criticised Pharmac’s restriction on Herceptin, saying: “There is a dead-end for patients who need anti-HER2 therapy….And this is the reason for such an appalling survival for HER-positive advanced breast cancer patients in New Zealand.”

Last October, a group of New Zealand breast cancer specialists recommended this use of Herceptin when it ratified the 2nd New Zealand Consensus Guidelines for Advanced Breast Cancer (ABC-NZ2) – a framework setting out best practice treatment of ABC in Aotearoa.

According to Pharmac, around 300 Kiwi women are currently receiving trastuzumab for advanced HER2-positive breast cancer. This subtype is more aggressive and has poorer outcomes – the median survival is 18 months compared to 27 months for the most common sub-type.

Breast Cancer Foundation NZ continues to call for reform to Pharmac’s outdated funding model to keep pace with the demands of modern medicine and improving standards of care.

To have your say on Pharmac's proposal, click here. Pharmac is accepting feedback until 30 June.