Women who feared losing vital cancer treatment offered new hope

Breast cancer patients offered PBS repreive after removal of lifesaving drug Zoladex In short: Women with breast cancer who feared losing access to a critical drug Zoladex have been offered a lifeline. The federal government's PBS advisory group has recommended listing an equivalent medication, triptorelin. What's next? The government said it was committed to listing all medications recommended by PBAC. Women with breast cancer left contemplating drastic surgery because of uncertainty over a critical drug have been offered a lifeline, with an equivalent medication on track to be subsidised. The move is set to provide a long-term treatment solution to breast cancer and endometriosis patients who have grappled with uncertainty in recent months over access to the drug Zoladex. As revealed by the ABC in June, AstraZeneca, the maker of the goserelin 3.6mg implant known as Zoladex, said it would pull the drug from both the PBS and private market in November. An urgently convened out-of-session meeting of the Pharmaceutical Benefits Advisory Committee (PBAC) recommended the PBS listing for an equivalent medication, triptorelin, be expanded so it could be used for a number of women's health conditions. A health department spokesperson said the federal government was committed to listing all medications recommended by PBAC. "The government lists medicines on the PBS at the earliest opportunity once recommended by PBAC, and all relevant listing requirements have been met by the pharmaceutical company," they said. In June, AstraZeneca said the Australian price for the product, sold as Zoladex, was too low, "making it unsustainable to supply the medicine on the PBS". The drug company initially offered a temporary access program, however later bowed to widespread pressure from advocates and patients, announcing it would provide the medication for free to eligible patients without other suitable treatment pathways. Breast Cancer Network Australia (BCNA) Director of Policy and Advocacy Vicki Durston said having an alternative medication like triptorelin on the PBS — rather than a separate access program run by a pharmaceutical company motivated by profits — was crucial. "I think what [AstraZeneca's access program] presented is so much uncertainty," she said. "We want to ensure… that we don't see a two-tiered model where pharmaceutical companies are running programs that sit outside those regulatory structures. "And we need to ensure that [women] are protected and that there are safeguards to ensure that this doesn't happen again." CEO of advocacy group So Brave Rachelle Panitz said the last couple of months had been incredibly challenging for breast cancer patients across the country. "There's a lot of anxiety and concern around, can I actually access my medicine? So I think this is a really great next step, certainly for long-term surety of access," she said. "This will be really, really good news for a lot of patients … they will never have to worry about access to medicines and that's what we've all been hoping for." Uncertainty led Katie to remove her ovaries Zoladex, delivered monthly as a pellet injected under the skin, stops a patient's ovaries from producing oestrogen, a hormone which promotes the growth of many forms of breast cancer and can fuel endometriosis. The ovarian suppression can also help preserve fertility for women with breast cancer undergoing treatment. The ABC spoke to several women last month, who said they were contemplating removing their ovaries because they were scared they would die without the medication. Katie Thorpe, 35, has metastatic breast cancer and had been on Zoladex since 2018, before discovering it would be removed from the Australian market. "I woke up to the headline in the ABC one morning and it was an absolute shock. That was the first I'd heard of that announcement," she said. "That uncertainty and the confusion about the communication and availability really weighed on my mind." Ms Thorpe, who is a consumer advocate for BCNA, had already been considering removing her ovaries, but said when AstraZeneca announced it would pull Zoladex from the Australian market, it "cemented" the decision. "It's a key part of keeping my cancer from progressing any further in my body … it was literally part of what was keeping me alive," she said. "At the time we did not have an alternative. It was going to be pulled from the market or have your ovaries removed." She had the surgery, known as an oophorectomy, at the end of June. "I just didn't want to take that risk, I wanted to take my health into my own hands and that was really what pushed me to have that surgery." New medication and Zoladex 'like for like': clinician Associate professor of medicine and senior oncologist Nicholas Wilcken said the recommendation that triptorelin be placed on the PBS for breast cancer patients was "a relief." He said the medication was equivalent to Zoladex and had also been used for a long time across the world. "I would say it's like for like," he said. "If you think about what these drugs do, their aim is to turn the ovaries off temporarily and so you can measure hormone levels and determine whether, you know, each drug is doing that appropriately and sufficiently. And the answer is that they both are." The federal government has recently been in several protracted, high-profile stand-offs with major pharmaceutical companies, over the way the PBS operates. A spokesperson said the health department acknowledged AstraZeneca's move to remove Zoladex 3.6mg from the PBS had created distress for patients. "We recognise that uncertainty about access to a medicine can be deeply concerning for patients and clinicians, particularly where people are considering significant treatment decisions in response." Ms Thorpe said the federal government listing the alternative drug on the PBS would spare other women from the pain and uncertainty she had experienced. "I know that my case is pretty extreme, but that was the reality for a lot of women who were told that their treating teams were uncertain about whether there would be treatment available and an oophorectomy or removal of ovaries would be their only option, so this is a huge relief," she said. "I think in the future as well, we just need better communication. This caused so much frenzy and uncertainty within the community and definitely could have been handled a lot better … but having this pathway and this way forward is certainly going to offer a lot of hope." BCNA has encouraged women who are still uncertain about their treatment to reach out to them or talk to their clinician.