Jill Anzarut – a thorn to government, a champion to breast-cancer activists – is to start Herceptin on Friday for a half-centimetre tumour that was once deemed too small to treat.
The 35-year-old Toronto mother would have begun it Thursday, when Cancer Care Ontario began funding it, except it was her son Benjamin’s fifth birthday and there was a family celebration planned.
“It’s a big day all around, and now we’ll forever remember Ben’s birthday is a big celebration for cancer patients as well,” Ms. Anzarut said in a telephone interview.
Ontario moved Thursday to fund the costly breast-cancer drug – a potentially life-saving drug – for small tumours, two months after The Globe and Mail first documented her case in a story that went viral.
Breast-cancer activists organized a powerful e-mail campaign, with thousands urged to send letters to Ontario Health Minister Deb Matthews. Health-policy makers said there was only so much money, and the province said it wasn’t about to have policy dictated by a newspaper story.
Not all oncologists were of the same view: On June 11, 2010, a member of the 25-person breast-cancer disease site group that advises government suggested the province consider funding Herceptin for women at higher risk of recurrence with smaller tumours.
“I think it’s time for us to re-examine this situation and see if people at high enough risk should be able to qualify for Herceptin,” wrote an oncologist who was not identified.
At the end of that meeting, the committee endorsed Herceptin only for those with HER-2 positive tumours greater than 1 cm. However, the members had little choice, as they require a high level of medical evidence to recommend guideline changes.
“Because of the lack of evidence,” wrote Maureen Trudeau, co-chairperson of the breast-cancer disease site group in an e-mail, “there was no mechanism until now to obtain the funding for trastuzumab (Herceptin) – all the members of the breast disease site group are in agreement.”
The drug has turned one of the most aggressive forms of the disease into the most treatable, though at a high cost: about $40,000 for a course of treatment, which consists of intravenous medication provided every three weeks for one year. Under the new program, the bill for an estimated 120 additional Ontario cancer patients would come to about $4.8-million annually.
Under Ontario’s New Evidence Building Program for Cancer Drugs, patients with any size HER-2 positive tumour undergoing chemotherapy will be eligible for Herceptin so long as they have adequate heart function, according to Carol Sawka, Cancer Care Ontario's vice-president of clinical programs and quality initiatives.
Ontario now joins British Columbia, Alberta and Saskatchewan in funding the drug for smaller tumours. Quebec, Manitoba, New Brunswick, Nova Scotia and Newfoundland also fund it on a case-by-case basis.
According to Diane McArthur, executive officer of the Ontario Public Drug Programs, patients with tumours smaller than 1 cm would be followed under the program and evidence on effectiveness collected for two to three years. She said she will ask the pharmaceutical manufacturer Roche Canada to offset some of the costs of data gathering.
“The drug company certainly has an obligation, I think a moral responsibility to help contribute towards this further evidence collection,” Ms. McArthur said.
A Roche Canada spokeswoman declined comment.
The program is intended to fund cancer drugs for medical grey-zone cases: patients who do not fit clinical practice guidelines, but where there is growing medical evidence suggesting a drug may be of benefit.
Other promising cancer drugs are also expected to be publicly funded but under close patient study. If evidence reveals the drugs are not as effective as initially thought, they will no longer be covered, according to Ms. McArthur.
Ontario Ombudsman Andrè Marin suspended his investigation into the matter – though he hasn’t closed the file entirely – saying he is “very optimistic that it’s the end of it.”
As for Ms. Anzarut, her advice for cancer patients is to be your own best advocate, do your research and realize you are part of a community that will help. She also used social media – Twitter – to inform people about what she was going through, spawning support.
“Because of my situation, I was a younger woman, I felt I had an obligation to inform other people that breast cancer hits young,” said Ms. Anzarut, who has undergone breast-conserving surgery and is in the midst of chemotherapy. “I was quite vocal, I wanted other people to know.”