Specialists to advise nine weeks of Herceptin

Cancer specialists will advise Pharmac on giving Herceptin to some breast cancer patients for just nine weeks, instead of the more established year-long treatment.

"I think it's a possible path ahead," an Auckland specialist, Associate Professor Vernon Harvey, said yesterday.

On Monday, Pharmac confirmed its July decision not to extend state funding of the expensive cancer medication to women with a certain type of early-stage breast cancer.

It said the spending would not be justified, given the medicine's effectiveness compared with some other drugs.

Herceptin is already funded by taxpayers for women in the terminal phase of the type of breast cancer that over-expresses a protein called HER2. This very aggressive disease accounts for about a quarter of all cases.

Each year in New Zealand around 2400 new cases of breast cancer are diagnosed and 600 women die from the disease.

Pharmac's decision, supported by district health boards, has devastated women with HER2 breast cancer and their advocates, who describe it as "particularly cruel", coming as it does in Breast Cancer Awareness Month.

They say New Zealand is now one of the few Western nations not funding Herceptin for early breast cancer. Around 20 NZ women are paying for Herceptin treatment themselves, at an average price of about $100,000, including private clinic costs.

Pharmac, although refusing to extend funding, left the door ajar by asking its cancer treatments subcommittee meeting next week to further consider results from a trial based in Finland in which some women were given Herceptin for nine weeks.

This regimen, if considered suitable, would represent a huge saving on the cost of Herceptin for early cancer, which Pharmac puts at $20 million to $25 million per year.

Professor Harvey, a member of the sub-committee, said the Finland-based trial was relatively small, involving about 200 patients given Herceptin at the same time as chemotherapy instead of afterwards.

"It came up with the same result as the much bigger trial, namely it cut the recurrence rate by about half. The only question about it is: because it was a relatively small number of patients, how reliable that is.

"It's a question of do you go with something that you know is absolutely reliable but costs a lot, or something which you know is much less reliable but is much cheaper.

"We know that, with a year of therapy, the results of that are very reliable because of the 12,000 patients involved. Here we are talking about one trial that involved 200 patients and therefore, although it came up with the same result, the result is less reliable because small changes could make a difference to the outcome."

The ideal would be to compare the Finnish method with the standard therapy.