In a study presented at ESMO 2014, Dr Felipe Ades Moraes from Institut Jules Bordet in Brussels, Belgium and colleagues found that patients in Eastern Europe had less access to the HER2 positive breast cancer targeted drug trastuzumab than their counterparts in Western Europe and the USA; differences they say can be linked to discrepancies in cancer survival.  

Trastuzumab is used to treat breast cancer in patients with HER-2 positive tumours, which account for around 20% of breast cancers.

The drug was first approved for use by the US Food and Drug Administration in 1998.

“The development of trastuzumab is considered to be one of the greatest improvements in breast cancer treatment in recent years,” Ades Moraes said.

“But we found that there were significant differences in trastuzumab procurement between countries in Western Europe, the USA and Eastern Europe and that these differences could be partially related to discrepancies in cancer survival between these regions.”

The researchers had previously shown that there were differences in health expenditure among the European Union countries and that these differences were related to discrepancies in cancer survival.

“The more spent, the fewer patients died after a cancer diagnosis,” Ades Moraes says.

Now the researchers say they have shown that differences in the uptake of innovative and life-saving drugs may be one of the explanations for why these discrepancies exist.

Using national registry data, the researchers estimated the number of new cases of HER2-positive breast cancer patients per year in 24 countries, including 14 in Western Europe and 9 in Eastern Europe.

They then estimated the number of likely trastuzumab treatments per year using trastuzumab procurement data for each country.

Tracking how many possible patients could have been treated with the supply of trastuzumab within individual countries between 2001 and 2013, the researchers found that Eastern European countries acquired insufficient trastuzumab to treat all the patients who would benefit from it.

“Trastuzumab procurement levels only increased in Eastern Europe after 2005 when the drug received extended approval for use after surgery, to increase the cure rate of breast cancer, while Western Europe and the USA had a faster uptake, seen since the drug’s first approval in the metastatic setting (2000 and 1998, respectively) and acquired sufficient amounts of the drug to treat virtually all patients,” Ades Moraes said.

"Advances in all areas of healthcare, ranging from screening to surgery and radiotherapy, endocrine treatment, and chemotherapy, have all contributed to the decreasing breast cancer mortality trend in the USA and Europe,” the researchers say.

“Our demonstration of the higher trastuzumab uptake in countries with higher breast cancer survival strengthens the notion that the uptake of life-saving drugs is one of the many important factors in improving cancer survival."  

“As cancer treatment and cancer drugs become more complex and more expensive, a close relationship between health authorities and doctors can dramatically improve patient care and cancer survival by determining priorities in health budget allocation,” Ades Moraes says.

Source: ESMO