1. Chemotherapy
2. Hormonal
3. Other Targeted Treatments - Herceptin and Tykerb
4. BCAC response to National Medicines Strategy Consultation, 13 April 2007

Chemotherapy
Chemotherapy is a ‘systemic’ therapy, affecting the whole body through the bloodstream. The aim of systemic treatments is to eliminate any cancer cells that may have spread to other parts of the body from the site of the original cancer.  Cancer cells divide rapidly and chemotherapy drugs interfere with this process. However, cancer cells are not the only dividing cells in the body so chemotherapy can affect other rapidly dividing cells too e.g. in the blood and hair. Side effects are closely monitored and can often be treated to improve wellbeing.    Chemotherapy is usually given as a combination of drugs rather than one single agent. This is because cancer tumors are made up of many different kinds of cells that may have different vulnerabilities to ‘attack.’


Hormonal Treatments
Hormonal therapy is effective against breast cancer that is hormone-receptor-positive. Hormonal therapy blocks the hormone oestrogen from stimulating the growth of breast cancer cells.

Tamoxifen has been the standard treatment for women with hormone-receptor-positive breast cancer. Now, results of several worldwide clinical trials show that new hormonal treatments, the aromatase inhibitors Arimidex (anastrozole), Aromasin (exemestane), and Femara (letrozole) work better than tamoxifen in post-menopausal women with hormone-receptor-positive breast cancer. Aromatase inhibitors are now considered the standard of care for post-menopausal women with hormone-receptor-positive breast cancer while tamoxifen remains the standard choice for pre-menopausal women.

Tamoxifen is fully funded in New Zealand. The aromatase inhibitor exemestane (Aromasin) is funded by PHARMAC (from August 1st 2007). However, exemestane is the first and only of the aromatase inhibitors that PHARMAC has fully funded without the need for a Special Authority approval. The other two are provided free of charge to patients thanks to partial subsidies from Novartis (Femara) & AstraZeneca (Arimidex).

Other Targeted Treatments - Herceptin and Tykerb
Herceptin
Herceptin (trastuzumab) is a treatment designed to specifically target breast cancers that make too much of the HER2/neu gene or HER2 protein, known as HER2-positive breast cancer. It is administered intravenously into the bloodstream once every one to three weeks. Herceptin contains an immune system–like antibody that blocks the HER2 protein in cancer cells and this helps stop the growth of HER2-positive cancer cells. About 20- 25% of breast cancers are HER2-positive. HER2-positive breast cancers tend to be more aggressive than HER2-negative breast cancers.

Herceptin has been funded in New Zealand for advanced HER2 positive breast cancers for some time. From July 1st 2007, PHARMAC funded Herceptin for HER2 positive early stage breast cancer for a 9 week treatment regime with taxane chemotherapy. New Zealand is the only country in the world to do this. 25 of the 30 OECD countries (as of February 2008) fund 52 weeks - the proven regime - for their women. Of the remaining five countries, New Zealand funds for 9 weeks and Turkey, Korea, Poland and Hungary currently do not fund Herceptin for 52 weeks.

Since 1998, Herceptin (trastuzumab) has been used to successfully treat HER2 positive breast cancers that have spread beyond the breast and the lymph nodes under the arm to other organs within the body (advanced or metastatic breast cancer). However, in the majority of patients with advanced HER2 positive breast cancer, the disease will eventually progress despite Herceptin treatment. In some cases, the cancer will spread to the brain probably because Herceptin and other chemotherapy regimens cannot adequately cross the blood-brain barrier. These problems highlight the need for new drug treatments.

For more information please visit our special Herceptin page.

Tykerb® (lapatanib)
Tykerb, also known as lapatinib, is a new oral therapy that targets the HER2 protein. Clinical trials have shown that patients with metastatic HER2 positive breast cancer whose disease has progressed despite Herceptin may respond to lapatinib. This represents a new and effective way of treating advanced HER2 positive breast cancer. Lapatinib can enter the central nervous system (i.e. cross the blood brain barrier) and, when partnered with the chemotherapy treatment capecitabine (Xeloda), is proving to be successful in delaying the progression of advanced disease, almost doubling the time before tumour progression and fewer women are relapsing with brain metastases. The potential role of lapatinib in early stage HER2 positive breast cancer will not be known for several years. Two clinical trials testing the effectiveness of lapatinib in early HER2 positive breast cancer are scheduled to begin in New Zealand in 2007.

In Australia, lapatanib will be listed on the Pharmaceutical Benefit Scheme (PBS) from May 1 2008. Lyn Swinburne, breast cancer survivor and CEO of Breast Cancer Network Australia, commented that this announcement is a wonderful outcome for many women who have been waiting a long time for this process to be finalised.

“The government’s decision to list Tykerb on the PBS removes the worry of a significant financial strain for women who are eligible for this treatment option,” Mrs Swinburne said.

For more information, please read our Tykerb Fact Sheet

Further Herceptin Information:
Herceptin Information page May 2008
Herceptin: a Promising Advance in the Treatment of
Early-stage HER2-positive Breast Cancer September 2007
Herceptin - How Can I Help?
Herceptin FAQs September 2007
Herceptin in Early Breast Cancer - ADIS Fact Sheet September 2007
Submission to Pharmac on Herceptin Funding 12 April 2007
Letter to New Zealanders 18 October 2006
Response to 60 Minutes Programme, TV3 16 October 2006
View 60 Minutes breast cancer documentary
Submission to Health Select Committee re Herceptin Petition 5 April 2006
Herceptin Will Save Lives The Press 9 August 2006
Anne Hayden Submission on Herceptin Petitition 5 April 2006

Herceptin Press Releases:
PHARMAC continues to disappoint May 5 2008
High Court Forces PHARMAC to Listen April 8 2008
Herceptin Petition sends strong message August 23 2007
9 weeks Herceptin only a partial subsidy July 1 2007
Pharmac decision on Herceptin 'unintelligent and reckless' May 3 2007
It's all about the Money with Pharmac March 20 2007
Pharmac's 9 Week Trial Offer 'Cheap and Unethical' 15 February 2007
No more excuses from Pharmac on Herceptin funding 7 January 2007
PHARMAC Budget Underspending a Crying Shame 12 November 2006
Cruel Pharmac Decision for Breast Cancer Awareness Month 16 October 2006
Australian Funding for Herceptin Wins Praise 22 August 2006
Herceptin Affordable and Safe 16 August 2006
Breast Cancer Patients Fight on for Herceptin Access 30 July 2006
PHARMAC Deals Cruel Blow 28 July 2006
Herceptin Heroes Dismayed by Pharmac Herceptin Decision 28 July 2006
Herceptin Support from Parliament’s Health Select Committee 15 June 2006
BCAC Challenges PHARMAC with Updated Herceptin Trial Data 6 June 2006
Cancer Experts, Patients and Advocates Plead ‘Fund Herceptin Now! 7 April 2006
Breast Cancer Consumer Advocacy Group Dismayed by PTAC Decision 16 February 2006
NZ Women With Early Stage Her2 Positive Breast Cancer Face Terrible Choice 3 February 2006