Good news / bad news – Pharmac’s new drug deal a bitter pill for 160 long-suffering patients

Pharmac’s decision to fund pertuzumab (trade name Perjeta) from January 2017 for New Zealanders with advanced (metastatic) HER2+ breast cancer will be good news for patients diagnosed from the New Year onwards, but is a bitter pill for the 160 Kiwis who have been deprived of this significantly life-extending drug so far and now appear to be shut out of the new agreement.

Right now, most NZ patients with advanced HER2+ breast cancer (a terminal disease) are prescribed Herceptin. The new drug, Perjeta, is taken with Herceptin, but Pharmac has decided existing Herceptin patients can’t have it: Perjeta is Pharmac-approved only as a first treatment for advanced cancer starting simultaneously with Herceptin – patients can’t already be taking Herceptin.

Herceptin-plus-Perjeta is acknowledged in all international guidelines as the standard of care for advanced HER2+ breast cancer, so Pharmac’s decision condemns patients who’ve been on sub-optimal treatment to continuing with that sub-optimal approach. The decision overlooks the fact that the original Perjeta trial proved so successful in extending the patient lives that “control group” patients who were taking Herceptin-only ended up being offered Perjeta as well. It also ignores the fact that in Australia, many patients already on Herceptin for advanced breast cancer were offered access to Perjeta when it was funded there 18 months ago. Pharmac has left the door open to further discussion next year, but as things stand, terminal patients who’ve been fighting for more time will see newer patients getting access to a drug they can’t have.
“This is a heartless decision by Pharmac – we urged them to fund Perjeta for all patients currently being treated with Herceptin for metastatic breast cancer,” said Evangelia Henderson, chief executive of the NZ Breast Cancer Foundation. “Yes, there’s debate about the statistical evidence for this group, but it’s an argument that will never be resolved, as the original trial didn’t set out to measure the effectiveness of Perjeta for people already on Herceptin.

“As we see it, we have to take our evidence from the trial that did happen – which was so successful, it was deemed essential to offer Perjeta to the patients on Herceptin-only. We call on Pharmac to make Perjeta available to people already battling this advanced disease here, to help those 160 New Zealanders have what could be a significantly longer time with their families.”