Blue Jackie: Estimates Debate — In Committee 
Blue Jackie: Estimates Debate — In Committee 
[Volume:648;Page:17650] 
Dr JACKIE BLUE (National) 
: 
 I say to the Minister that National has an idea and a policy that we would be really happy for him to copy. It is to free up money so that women can get 12 months’ supply of Herceptin. We would be very happy for the Minister to take that up right now for women; they need it. This is a critically important issue for women and their families. 
When I was speaking as a new MP this issue came to the forefront and began with such hope and such excitement. The results of large international trials were coming through and they were showing that breast cancer recurrence rates—that is coming back in the bones the brain or the liver—were reduced. Let us face it. When cancer comes back in those organs there is a very poor outlook and it is not surprising that the studies were also showing that there were improved survival rates. Medsafe moved really quickly and New Zealand was the first country in the world to register 12 months of Herceptin usage. A few months prior to that in December the pharmaceutical company had made an application for funding for 12 months’ supply—a decision that Pharmac turned down outright without consultation. That was the basis of the April decision by the High Court to direct Pharmac to re-consult and to review its decision. 
Since 2006 we have had to sit back and watch 33 other countries one by one fund 12 months’ supply of Herceptin. I go back to 2006. The issue bounced around the various Pharmac committees but it was clear over 2006 that Pharmac had become very interested in a very small Finnish trial that gave women only 9 weeks of Herceptin. The results were interesting—yes they were interesting—but they were not statistically significant. But Pharmac did not seem to be bothered by that at all. In fact Pharmac seemed to become quite fixated about the idea of 9 weeks of Herceptin so from July last year women were funded to have 9 weeks’ supply only. 
I have not met one cancer specialist yet who is of the opinion that 9 weeks is the standard of care and has the evidence to back it up. Pharmac even made an application to Medsafe for the 9-week regime but Medsafe turned it down because it lacked the clinical evidence. It also agreed with the cancer specialists but did not have the clinical evidence backing it at all. So to give the 9-week Herceptin regime some legitimacy Pharmac decided to give women a clinical trial whereby half the women would get 9 weeks of Herceptin and the other half would get 12 months. It proposed that women would enter the international short-or-long-duration trial. But it does not seem as though that trial is going to get off the ground. It needs 3000 women. Pharmac started recruiting in January this year but until May this year— 
Jill Pettis 
: Jackie say it like it is. National cannot both give tax cuts and supply Herceptin for 9 months. 
Dr JACKIE BLUE 
: I am telling the member how it is. Only 39 women have been recruited internationally and the preliminary result presuming the researchers can get 3000 women—they want 600 from New Zealand—will not be available for another 7 years. This is really important. Women with aggressive HER2 breast cancer do not have 7 years to wait for these results to come through. They do not have the luxury of waiting for 7 years to see whether the 9 weeks is a goer. 
None the less we have the situation that from 1 July women are getting only 9 weeks of treatment. It is an unproven course there is no trial and I do not think there will be a trial in my opinion. Here and now women with HER2-positive breast cancer are being advised by their specialists that 12 months is the best standard of care internationally. Specialists have told me that they feel they have a moral duty to tell women all the facts. The facts are that 9 weeks is not proven and 12 months is the better option. We can see what is happening. Women have been told the truth and the fortunate few who have had the resources the community support or the house to mortgage are doing that to raise money desperately. They want to live and they want to see their children grow up. A fortunate few can do it but hundreds and hundreds of others do not have the community support do not have the house to mortgage and do not have the resources to do it. 
This is the most vulnerable time in these women’s lives. Can members imagine being diagnosed with the most aggressive form of breast cancer and being told that 12 months of treatment is the better course but they can be given only 9 weeks? They want to live—boy do they want to live. Make no mistake these women who have a suboptimal treatment of Herceptin face an uncertain future. They do not know whether the 9 weeks will be a goer. There is no proof that it will be. They want the best insurance and the best insurance is 12 months of Herceptin. 
Pharmac reviewed this decision yesterday. We understand that a decision is coming out next week. Pharmac called for submissions and there have been over 300. I read the submission from the New Zealand breast cancer special interest group which represents the majority of breast cancer specialists in New Zealand and it overwhelmingly backed a 12 months’ supply of Herceptin.