PBAC recommendations sure to run foul of specialists and breast cancer support groups

Australians with HER2 positive breast cancer are facing a real possibility that they will be significantly more disadvantaged in 2009 regarding their breast cancer treatment.

Currently, patients are allowed to be treated with Trastuzumab (Herceptin) alone for metastatic breast cancer and they are allowed to have Herceptin treatment in combination with hormonal therapies.

The PBAC has made some recommendations to the Minister for Health "to make the Herceptin program more cost effective".

The recommended restrictions will include:

• Not allowing Herceptin to be used alone in patients with HER2 positive metastatic breast cancer.
• Not allowing Herceptin to be used with Aromatase inhibitors.
• To not allow the use of Herceptin for metastatic breast cancer except with only Docetaxel or Paclitaxel chemotherapy.

The real impact of this is that there are large numbers of patients nationally who can get extremely long durations of relapse free survival with the use of Herceptin alone and these recommendations would compel these patients to undergo treatment with often toxic chemotherapy with all the side effects and reductions and quality of life that that entails. As these drugs have a cumulative effect on the bone marrow, they have only a finite number of doses that can be given before treatment needs to be stopped and if the recommendations of the PBA are to be carried through by the Minister, the patients would then have to cease their lifesaving Herceptin treatment too. 

These recommendations fly in the face of the current available evidence which shows that Trastuzumab (Herceptin) is highly effective when given with a variety of chemotherapy agents, not just Taxanes but including Capecitabine and Vinorelbine. New data just published at the San Antonio Breast Cancer Symposium, December 2008, showed significant benefit when this drug was used with certain hormonal therapies, namely the Aromatase inhibitors. 

None of these treatments would be allowed if the PBAC recommendations are upheld by the Minister of Health.  

This Virtual Cancer Centre editorial commentary is being released now to invite discussion and commentary from breast cancer groups and oncologists.

These minutes have not yet been made available to the general public.

(Dr Andrew Dean, January 2009.)