HER2-negative metastatic breast cancer is a common yet incurable disease that has spread from the breast to other parts of a person’s body. It’s an aggressive cancer that usually affects the breast plus a patient's bone, lungs, liver and brain. Even when breast cancer spreads into other parts of the body, it’s still considered breast cancer.
Treatment for HER2-negative MBC is typically hormone therapy. Palliative care is also recommended to help the patient feel comfortable during treatment. The goal of palliative care is to help reduce the symptoms and side effects of treatment by supporting the patient physically, mentally and socially.
A revolutionary chemotherapy drug
Chemotherapy or targeted therapy can be used in combination as well. These forms of therapy are used to slow, stop and eventually stop the cancer growth. One new chemotherapy oral medication called Ibrance (palbociclib) has been fast-tracked by the FDA for use in the United States.
In clinical trails, Ibrance was proven to delay disease progression by 24 months. In patients taking Ibrance with hormone therapy, tumor shrinkage was 42.1 percent, compared to 34.7 percent in the placebo group, taking hormone therapy alone. The drug has been hailed as one of the biggest breakthroughs in the past twenty years according to Dr. Nicholas Turner, team leader in molecular oncology at The Institute of Cancer Research (ICR).
There are negative side effects of taking Ibrance. They include: nausea, vomiting, tiredness, loss of appetite, weakness, hair loss, and tingling in extremities. However, when a patient is diagnosed with an incurable cancer, like HER2-negative MBC, most side effects are tolerable if they can gain years on their lives.
Gail was diagnosed with human epidermal receptor 2 (HER2)-negative metastatic breast cancer (MBC) in February of 2014. Her oncologist started her on letrozole (Femara) only. Just eight months later, the cancer spread from her breast and sacrum to her ribs and spine. After the cancer spread in October 2015, she began Ibrance along with Femara.
Gail said she couldn’t believe the scans—they were getting better and better each month with the addition of Ibrance. In June 2017, her scan revealed no ‘hot spots.’ She is now in remission from her HER2 Negative MBC. Side effects are unpleasant but not unbearable; Gail is so thankful to Pfizer Oncology for bringing this drug to the United States.
She says her cancer has not progressed in the last year because of Ibrance. Gail is very grateful and feels extremely lucky that she can afford the medication. However, she is saddened to think that there are so many people with MBC who cannot afford the treatment to live.
Not everyone can afford Ibrance
In the U.S., Pfizer’s Ibrance costs an average of $10,000 per month. However, most U.S. insurances cover part of the medication, making it more affordable. And for those living in the U.S. who cannot afford Ibrance, or who lack medical insurance, Pfizer offers a patient assistance program to help ease the burden financially. Unfortunately, Ibrance isn’t affordable worldwide.
Mary is a HER2-negative MBC patient, living in New Zealand, but getting treatment in another country. The medication is too expensive in New Zealand so she travels to Malaysia for treatment. Ibrance costs Mary $7,500 every three months getting it through Malaysia, compared to New Zealand, where the drug would cost $15,000 for a three-month period.
With three children, Mary is not sure how much longer she can afford the miracle medication. She says in the past year her tumors have not grown. Ibrance helped reduce her fatigue, which was constantly unbearable before starting the drug. Mary is now on a mission to get funding in New Zealand. She’s urging New Zealand’s Pharmac to fund the drug.
Pharmac’s director, Sarah Fitt, said they have been actively engaging with Pfizer to give them a funding application for New Zealand. The funding application would allow the medication to be prescribed and covered though insurances in the county. This would make Ibrance more affordable for Mary and others with HER2-negative MBC in New Zealand.
Ibrance in the United Kingdom
In England, there are about 45,000 new breast cancer diagnoses each year. Of those 45,000, 5,500 women would be eligible for treatment with Ibrance. However, the National Health Service (NHS) along with National Institute for Health and Care Excellence (Nice) have an issue with the price of Ibrance versus the benefit. The NHS provides health insurance to those in the UK, normally at no cost. Initially, the NHS did not approve coverage of the medication.
After much debate, letters from cancer patients and grueling negotiation between Pfizer UK, NICE, and the NHS, Ibrance has finally been approved. The reason the medication has been in limbo is likely due to its high cost, about $80,000 for a full course for one patient. However, after negotiations Pfizer has been able to provide Ibrance to the NHS at a discounted rate.
Pfizer UK had previously bypassed the NHS by supplying five months of free Ibrance to those women who need it in the UK. Fiona Hazell, Director of Policy and Engagement at Breast Cancer Now, says Pfizer’s generosity has been an unexpected lifeline for thousands of women living with HER2-negative MBC in the UK. Fiona goes on to say that Ibrance offers patients with incurable MBC significant extra time before their cancer progresses, time that is truly invaluable to patients and their families.
Now that the NHS has worked out a deal with Pfizer, many women are going to be eligible for treatment with Ibrance. Professor Carole Longson, director of health evaluation at NICE, said their committee heard testimonies from patients and experts praising Ibrance for delaying progression of MBC. Some patients even said they have been able to continue with normal daily activities, like working, whereas before they were unable to work.
Funding in New Zealand
Mary has become an advocate for Ibrance in New Zealand. She hopes that the approval in the UK will allow for more positive results and statistics. And those statistics can be used to pressure Pharmac to hasten their negotiations with Pfizer.