October 21, 2013
Two new drugs, Perjeta and Kadcyla, have been approved by Medsafe for treatment of advanced (metastatic) HER2+ breast cancer in NZ. Neither is available through the public health system –Pharmac funding is not yet approved. The NZBCF will be pursuing this with the Ministry of Health.
In the meantime, women can pay privately for Perjeta and Kadcyla, and drug company Roche has introduced access programmes to make the drugs more affordable.
About Perjeta and Kadcyla
Perjeta and Kadcyla are targeted treatments – they target only the cells that have too much of the HER2 protein. Perjeta (pertuzumab) is used in conjunction with Herceptin and docetaxel (chemotherapy), for patients with HER2-positive metastatic breast cancer who have not received previous anti-HER2 therapy or chemotherapy for their metastatic disease.
Kadcyla (referred to in studies as T-DM1) is for patients who have either received prior treatment for their metastatic disease or developed disease recurrence during or within six months of completing treatment for early breast cancer.
Both drugs have impressive research studies – CLEOPATRA for Perjeta and EMILIA for Kadcyla – showing significant improvements in progression free survival, and a decrease in deaths. The risk of death in the Perjeta trial was reduced by 34%. The median overall survival has not yet been reached, as more than half the patients in the CLEOPATRA trial continue to survive.
About the access programmes for NZ women
Roche NZ is offering access programmes that cap the total cost of each drug. While these medicines are not cheap, the caps give certainty about total spend. The cost will typically be spread over about 18 months for Perjeta and 12 months for Kadcyla. Around half of patients will respond well enough to the treatments to reach the capping point – after that, they pay no more for the drug but continue treatment paying only the clinic and doctor costs for receiving their treatment. Treatment would discontinue when the patient’s disease progressed. Patients taking Perjeta whose disease progresses may move on to Kadcyla. Roche’s bridging programme means those women won’t face a big bill for Kadcyla.
It seems likely that some New Zealand women will consider the benefits offered by the new drugs to justify the cost. Women should consider “shopping around” for Perjeta and Kadcyla, as prices may vary depending on mark-ups charged at different clinics. In many areas, it will be possible for women to have most of their treatment in the public system, but go private just for their Perjeta and Kadcyla treatment. One notable exception appears to be Auckland – the NZBCF will be in discussion with the ADHB. Women with private health insurance should talk to their insurer to find out if they’re covered for at least part of the cost of treatment with Kadcyla and Perjeta.
Next steps for women with metastatic HER2+ breast cancer:
1. Talk to your oncologist about whether Perjeta or Kadcyla might be suitable treatments for you
2. Obtain pricing from your oncologist – then shop around!
3. Ask your private insurer what they’ll cover (policies change over time, so don’t assume you know the answer)
4. For further information visit www.roche.co.nz or phone the NZBCF breastcare nurse advice line 0800 BC NURSE (0800 22 68773)