As she drives home, Nisha (name changed) briefly answers the phone to say she will call back. We are to talk on breast cancer. For the 50-year-old, life had virtually ground to a halt when she found a lump on her breast. Multiple tests confirmed her worst fears. “It was an aggressive type of cancer,” she says, and a surgery and chemotherapy later her family was advised to get her onto a clinical study involving a breakthrough breast cancer drug called Trastuzumab.

Nisha’s family, being affluent, would have gone to any length to give her the latest treatment, even flying her out of the country. But having gone through the journey of diagnosis and treatment, she says, a transparent system is required to ensure that good medicine reaches the many women unable to access it.

In fact, the breast cancer example pretty much tells the complicated story around cancer drugs.

More ammunition October marks breast cancer month. And Roche (the company that sells Trastuzumab as brand Herceptin) introduced two more medicines, Kadcyla and Perjeta – giving doctors more ammunition to treat breast cancer. While the basket of breast cancer drugs is reason to cheer, challenges remain in getting these Next-Gen drugs across to more people given the cost of therapy, say cancer specialists.

Despite the bigger basket of breast cancer medicines, challenges remain in getting these next-gen drugs to more people, given the cost of therapy, say cancer specialists.

These drugs are good, efficacious and they expand the options available to a patient whose disease has progressed despite treatment with Herceptin, says Ashish Bakshi, a medical oncologist. “But every other day we see patients who have to sell their property to afford treatment,” he says.

Herceptin revolutionised the treatment for women with the aggressive HER2-positive sub-type of breast cancer. And Kadcyla comes in when Herceptin has failed, which means the patient’s family has already spent a sizeable sum on treatment, the doctor points out. Hospital sources indicate, Kadcyla (usually taken in six cycles) costs about Rs 1.5 to 2 lakh for 100/160 mg vial, while Perjeta is pegged at about Rs 2.5 lakh per 420 mg vial.

Without getting into specifics, Roche said it had adopted an India-specific pricing on these drugs. “We recognise that one of the key hurdles in access to optimal standard of care treatment for cancer patients is availability of funds,” it said, adding that its patient support programme, The Blue Tree, aimed to support patients from diagnosis to treatment completion.

“In most cases, the maximum retail price does not reflect the final cost of treatment to the patient. The cost of therapy the patient pays is significantly lower because of the patient access initiative…where the patient only has to pay for limited cycles, after which the drug is free for as long as they need it,” Roche said.

Campaigns are presently on in the United Kingdom to bring in less expensive versions of Kadcyla. India too had seen a similar campaign, but on Herceptin – with pro-health groups calling for less expensive versions and intervention from the government.

In fact, Herceptin’s journey in India is a study of the difficult terrain to be navigated to get good medicines to patients. It’s been over two years since Roche stopped pursuing its patent on this drug. Herceptin then cost about Rs 6-8 lakh for 12 injections, insiders said. Roche partnered with Emcure to bring a less expensive version of the drug here.

But Herceptin continues to be an emotive subject, as Roche is now locked in a legal bout with Biocon and Mylan who sell generically similar versions of Trastuzumab.

Without leaving it to the companies, the government needs to take more responsibility in making these medicines affordable through health insurance, common procurement and subsidies, say experts.

Science & humanity With 20 per cent of all breast cancer cases estimated to be HER2-positive, Bakshi says the new drugs don’t just keep the disease under control but improve the quality of life and survival as well.

There are two sides to the story, as companies seek returns on their research investment and patients, the medicine. There is science and there’s humanity, says Bakshi, succinctly defining the challenge whose solution continues to elude.

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