KEY POINTS:
A drug credited with saving lives is facing unacceptable delays for public funding, say a cancer specialist.
Mabthera, one of a new generation of smart drugs like Herceptin that targets specific characteristics of cancer cells, is already funded for an aggressive form of lymphoma.
But the application for
it to be used for follicular lymphoma, which makes up about a third of the 770 lymphoma cases in New Zealand, has languished among drug agency Pharmac's decision-making processes, said Auckland oncologist Peter Browett.
"It's quite frustrating both as a clinician and someone trying to advocate for treatments for your patients," said Dr Browett, who is also medical director of the Leukaemia & Blood Foundation.
It is currently only publicly funded for late-stage follicular lymphoma, when patients have not improved with conventional chemotherapy.
An application last year to have it as standard treatment - as in Australia - was considered in February by Pharmac's clinical advisory committee, which recommended its use but gave it a "low to medium" priority.
It also recommended that the application be referred to the Cancer Treatments Subcommittee for advice regarding appropriate dosage combinations.
But the group has not met since the end of 2006, said Dr Browett, "the reason being there weren't enough items to put a full agenda together".
"Well, give me a break - you can either have a teleconference or get people together for a couple of hours to discuss them. To not meet because there weren't other items to put on the agenda is somewhat unusual.
"Without wanting to be cynical, one wonders if this is - if patients or media ask questions - so they can say it's part of the careful review that needs to happen."
But Pharmac medical director Peter Moodie denied stalling. He said it would be reviewed by the cancer subcommittee in December.
Dr Moodie said cancer drugs are funded out of the district health boards' budget, not Pharmac's.
"We have to be able to convince the district health boards that this is good expenditure of their money because if they spend it on those drugs, it means that they are going to have to not fund something else."
Dr Moodie said the health boards had already been convinced to fund three high-priority cancer drugs this year, and drugs with a higher priority had to be dealt with first.
"We've just got to do things at the times we can. To suggest that we've actually been delaying things unreasonably is just not true."
Randomised trials in England, Germany and North America have found patients receiving Mabthera in combination with chemotherapy had higher remission rates than those on chemotherapy alone.
Dr Browett said while the data will continue to "mature", indications were that 10 per cent more patients who received the drug in addition to chemotherapy were still alive three years later, compared with those who received chemotherapy alone.
"This is one of the first treatments in follicular lymphoma that's clearly shown an improvement in survival."
The private sector does not have the resources to administer the drug, which needs to be delivered through an intravenous drip concurrent with chemotherapy, he said.
The other problem is cost. Dr Browett estimates a single course of the drug alone costs between $50,000 and $60,000.
American specialist Myron Czuczman, who developed the drug, admitted a solution was difficult.
"I think it's up to the governing bodies to come along and work with the haematologists and the physicians," said Dr Czuczman, "not just with people who are the administrators, in determining what is best for patients."
