Herceptin in Norfolk
Herceptin in Norfolk I’m not Her+ but i though some of you might be interested in the following extract of an article in my local paper.
“About one in five women with breast cancer will be sensitive to Herceptin. We will test every breast cancer patient for it and if they are sensitive to it and it needs prescribing, then we will prescribe it.
Primary care trusts in Norfolk - despite their financial predicament and multi-million pound deficits - have previously financed the drug for a small number of women in the advanced stages of breast cancer. Making it widely available to women in the early stages after surgery signals a forward-thinking approach to breast cancer treatment from the PCTs for women in the county.
Agreed criteria have been laid down for women with early breast cancer to make them eligible for the drug.
They must test positive for the HER-2 receptor, though only around 20pc of women with breast cancer will test positive, consequently, Herceptin will not work for the majority.
Patients’ tumour size must be 10mm or more and they must also have completed both surgical treatment and chemotherapy (chemotherapy generally takes up to six months after diagnosis to complete) and Herceptin must be started within six months of chemotherapy.
And because Herceptin has side effects, including weakening of the heart, patients need a heart scan which shows that the heart is functioning normally.
Despite only 20pc of women benefiting, the results for that group have been significant.
Mr Pain said: “I think the results from Herceptin are probably the most significant and impressive from any single drug for breast cancer. And I think for those one in five women this is a great leap forward and those tested will be offered the drug if deemed appropriate.
“We have already been using Herceptin for some time for patients with advanced disease but the evidence shows it can be of use in early stages post-op.
Herceptin is still not licensed to be used to treat early stages of the disease and NICE (National Institute of Health and Clinical Excellence) has not issued formal guidance to PCTS on prescribing it, though some PCTs such as those in Norfolk are happy for it to be prescribed.
Manufacturer Roche claims research shows the drug halves the risk of the HER-2 form of cancer returning.
There have been a number of high profile court cases where women have been refused Herceptin treatment by PCTs and even challenged that decision in the High Court.
Recently mother-of-three Ann Marie Rogers took Swindon PCT to the High Court after it refused treatment but the judge ruled in the authority’s favour saying it had not acted unlawfully in refusing treatment.
Surgeons at the N&N are delighted that PCTs, working with the Norfolk and Waveney Cancer Network, have given the go-ahead for the N&N, which treats breast cancer patients from across the county.
Mr Pain added: “I think it gives the reassuring message that the whole management of breast cancer has come on in leaps and bounds and continues to do so.
“It is good news for patients at the N&N, they could not get better treatment than they are getting here.
“The survival rates from breast cancer are improving all the time although it is becoming more common but fewer and fewer people are dying from this disease and that situation will improve further.
A spokesperson for PCTs in Norfolk said for patients who fulfil the criteria for Herceptin their specialist will discuss the pros and cons of their individual case.
She said: “For some women the risk of side effects will outweigh the possible benefit of having Herceptin so it may still not be in their interests for them to have Herceptin. If their specialist recommends that they should have Herceptin then the relevant PCT will pay for Herceptin.
“There will also be some women who may have to stop Herceptin before the course is finished because they develop serious side effects.
Kelley
Wow! What a positive attitude from Norfolk PCTs! I wonder if there will be a property boom in East Anglia as a result…
wouldnt it be lovely to read such a frank account like this from more areas in the country, rather than hearing excuses (which dont stand up to criticism anyway) from areas which dont want to fund.
I feel sure as time goes on there will not be a choice for them to make on this, and other drugs. You cant stop progress or we would all still be using our neighbours as midwives! Cancer is such a big issue that to try and ignore the new drugs coming thru is absolutely BATTY.
Now where can I hide this soapbox…
Steph x (who lives under a sensible PCT)
— And what a change for a newspaper (local at that) to get their reporting right - at least it looks as it if has been correctly reported. I had the misfortune recently to rant at a local newspaper about my views on herceptin and it being withheld from early stage breast cancer patients - re costing etc. In my case if was starting again today with diagnosis and progressed to herceptin the NHS would have saved itself a fortune. Unfortunately local newspaper junior reporter thought my rant was headline stuff and they even dropped the front page item to splash mine across half the page with the headline “MY WONDER DRUG” - was I mortified!!! Never trust the papers - there were no inaccuracies - but it was not the point I was making - I thought quite strongly.
Does anyone know what the general guideline is for how long to give herceptin in early stage? I have heard anything from 3mths to a year. How does this sit alongside advanced stage bc being on it permanently I wonder?
Dawnhc
Which newspaper… …was it in, please Kelley?
I finished my Chemo on October 12th 2005, still waiting for my HER2 test result (after requesting it from my Oncologist, Dr Harnett) and I don’t see him again until April 19th.
Thanks
Granmum
Granmum Hi,
It was in todays Eastern Daily News other wise known as EDP . The website is www.edp24.co.uk which, i think, has the article in full.
Kelley
Thanks Kelley Just found it and printed it out.
Granmum
Hi DawnHC Right now the recommended period for herceptin is one year. This is because most of the trials used it for one year for early breast cancer. There is, however, one trial that only gave herceptin together with taxotere for nine weeks before 3 rounds of FEC, with really good published results and no heart trouble. Unfortunately it was much smaller than the other trials, so more research is needed to see whether it really is as good as the treatments in the bigger studies. The herceptin only during taxotere regime is possibly a good option where the risks of heart problems are high, since the women who received herceptin + taxotere before FEC actually had slightly fewer heart problems than the control group.
As far as cost effectiveness goes, I figured once that giving a year of herceptin to everyone with a 70% chance of recurrence or higher probably saved money, if herceptin is as effective as the trials indicate. Cost effectiveness, however, is based on how many years of quality-adjusted life are gained and the cost-effectiveness cutoff is about £30,000 per year of normal life. A Begian heath economist estimated that a year of herceptin, as used in the herceptin carboplatin taxotere trial, would be cost effective for women in their mid-fifties and younger with stage III cancer, but he wasn’t taking into account the costs of care for secondaries, which are quite high.
On the other hand, the herceptin-only during chemo method is about a third of the cost and therefore should make it cost effective for many more people. I wish this would be considered rather than denying herceptin to women outright.