Herceptin Will Save Lives by Libby Burgess

Herceptin will save women's lives and the debate comes down to the value placed on those lives, writes LIBBY BURGESS.

Imagine this: you are a 40-year-old woman. Twelve weeks ago, you were diagnosed with early-stage breast cancer. Since then your breast has been surgically removed, you have started chemotherapy that has made your hair fall out and driven you into early menopause, you're nauseated and exhausted. Next you will receive radiotherapy, five days a week for five weeks. You have been told that you have only a 30 or 40 per cent chance of being alive in 10 years.

Your oncologist tells you your breast cancer is HER-2 positive. This is associated with a higher chance of breast-cancer recurrence and poorer long-term survival. You are then told that there is a new drug available that may significantly reduce your risk of recurrence and death from breast cancer but it is not funded in the public health system. However, if you are able to pay for the drug, it can be delivered in the private sector.

The drug costs around $70,000 but you may pay more than $120,000 depending on your weight and your doctor's fees. Your doctor strongly recommends Herceptin if you can afford it because the early clinical trial results are so compelling. Even if you have private health insurance, it is unlikely that your insurance will cover the costs.

You read in the newspaper that the Herceptin data is "just hype" and that the improvement in disease-free survival at two years shown in trials is only 8%. Your oncologist tells you that Herceptin will reduce your risk of relapse by 36% to 52% after three years and give you an overall survival advantage (so far up to 18% after four years in a large United States trial). You hear about cardiotoxicity but your oncologist tells you that there is only a 0.6% chance of this, and any effects are highly reversible and minor compared to the benefits of fighting your aggressive cancer. Pharmac says the figures just "don't stack up" for Herceptin at present and they need more information.

If you lived in Slovenia, France, Italy, Canada, Ireland, the Netherlands, Switzerland or Sweden your government would fund your treatment. If you lived in Australia or the United Kingdom, you should be able to access treatment in the near future.

You know that you have an aggressive form of early breast cancer which is potentially curable with combined treatment including surgery, chemotherapy, hormonal therapy and radiation therapy. Adding Herceptin will further increase your chances of cure. The use of Herceptin in women with advanced breast cancer which has spread to other parts of the body has made a huge impact and women are now living longer.

There is no doubt that this drug is effective. To date, essentially all anti-cancer drugs that are effective in advanced disease are as effective, if not more so, in early disease. Likewise, early benefits shown in clinical trials have almost invariably translated into long-term survival benefits.

Is Herceptin worth the high cost? There are obvious benefits to society in treating someone at an early stage to prevent the return of cancer, not least the money saved by not having to treat them as they die from advanced disease. Economic analyses in other countries have shown that providing subsidised Herceptin is cost-effective in terms of gain in quality and length of life for their women.

The early results for Herceptin from large-scale, well-conducted trials in early breast cancer are significant and unprecedented.

The early results for Herceptin from large-scale, well-conducted trials in early breast cancer are significant and unprecedented. Four trials of over 10,000 women with at least two years follow-up have shown a 36% to 52% reduction in the rates of relapse of breast cancer and an overall survival advantage, up to an 18% increase in disease-free survival after four years. Breast cancer is a common disease and very small statistical survival differences can translate into very large numbers of women benefiting.

In the international HERA trial, involving over 5000 women including 31 New Zealanders, the benefits of Herceptin in preventing recurrence were so great after one year that it was considered unethical to continue without offering Herceptin to the women who had originally received placebo only.

The major issue does not appear to be whether Herceptin works. Everybody agrees that it does. The question for New Zealand is – will the number of lives saved justify the cost? New Zealand spends only $190 per person per year on pharmaceuticals compared to Australia's $420 per person. Why?

The early data suggests that Herceptin could save between 50 and 100 New Zealand lives per year. Are these women's lives not worth saving?

Health should not be a contest, prioritising one disease sufferer over another. Surely a government with a significant surplus must invest in the obvious economic and social benefits of enabling women to recover from cancer and continue to contribute to our society for many years to come.

* Libby Burgess chairs the Breast Cancer Advocacy Coalition, an umbrella organisation representing 12 different New Zealand breast-cancer groups. This piece was written with input from two clinical oncologists specialising in breast cancer.