The use of Herceptin before surgery in women with HER2-positive early breast cancer (Neo-adjuvant Herceptin)
Herceptin (trastuzumab) is a targeted treatment for women who have HER2-positive breast cancer. It works by targeting the HER2 receptors on the tumour, leaving healthy cells untouched.
Herceptin was listed on the Pharmaceutical Benefits Scheme (PBS) for women with HER2-positive early breast cancer in October 2006. The PBS rules for Herceptin state that it can only be used after breast cancer surgery, and must be given initially with chemotherapy. The treatment period is a maximum of 12 months.
For some women with large HER2-positive tumours, the recommended treatment often includes some chemotherapy and Herceptin prior to surgery, in an endeavour to shrink the tumour before surgery. This is known as neo-adjuvant treatment, i.e. treatment before surgery.
As the current PBS rulings restrict the use of Herceptin to after surgery, women requiring neo-adjuvant Herceptin are unable to access it through the PBS at the subsidised-rate.
BCNA strongly believes that women requiring Herceptin before surgery should be able to access it at the subsidised cost through the PBS. This is also the view of the Medical Oncology Group of Australia, the key industry organisation for Australian medical oncologists.
This arrangement should impose no additional cost on the PBS, and through it the Australian Government and taxpayers, as women receiving neo-adjuvant Herceptin would still receive a maximum of 12 months treatment. Some of this treatment would be before surgery and the remainder after surgery.
- Women for whom neo-adjuvant Herceptin is the recommended treatment should be able to access Herceptin through the PBS.
- Women’s entitlement to neo-adjuvant Herceptin should come from their 12 month total entitlement to PBS-subsidised Herceptin.
- The Therapeutic Goods Administration should fast-track the application by pharmaceutical company Roche Australia to approve the use of Herceptin as neo-adjuvant treatment.
- The Pharmaceutical Benefits Advisory Committee should fast-track changes to the PBS rulings for Herceptin to allow women to have neo-adjuvant treatment as part of their 12 months treatment of Herceptin.
- The Australian Government should immediately accept any recommendation from the PBAC to change the PBS listing for Herceptin to allow its use as a neo-adjuvant treatment in women with HER2-positive early breast cancer.
