Issue With Ethics Of Restricting Leukaemia Drug
24 July 2002
Doctors Take Issue With Ethics Of Restricting Leukaemia Drug
Pharmac Board meets this week to make a decision
New Zealand's top specialists are concerned that it may be unethical not to offer patients with chronic myeloid leukaemia the new leukaemia drug Glivec given the results from recent clinical trials which included New Zealand patients. The Pharmac Board is meeting in Wellington this week (eds: Thursday, 25 July) to discuss funding of Glivec. During its consultation process, Pharmac indicated that it would only fund treatment for people with advanced disease, but the Haematology Society of New Zealand and Australia says Glivec is least effective in this group.
In effect, Pharmac is deciding the fate of up to 90 New Zealanders lives, say the country's 20 haematologists, all members of the New Zealand branch of the Haematology Society. The Society wants Glivec funded for eligible patients with either early or advanced disease.
"Glivec should be available for use in patients in New Zealand who have failed the current standard treatment, interferon," says Dr Peter Browett, New Zealand president of the Society. "This only equates to about 90 patients a year, so, we are not talking about vast numbers of patients who will consume Pharmac's budget - but we are talking about giving these patients a second chance at life.
"We can say that because we are talking about the most successful drug yet developed to fight cancer. "As a doctor, when a patient is not responding to interferon, we currently face an ethical dilemma. Should we keep treating them with interferon when you know there's something much better?"
Haematologists have expressed concerns over statements by Pharmac that Glivec is yet to be proven in early chronic myeloid leukaemia.
"Results from the latest major Phase III trial show that 84 per cent of patients with early disease who were on Glivec achieved a major cytogenetic response, that is, a significant disappearance of cancer cells. A complete cytogenetic response - the complete disappearance of cancer cells - was achieved in 69 per cent. This compared with 30 per cent and 11.5 per cent respectively for the patients with early disease on interferon combination therapy," says Dr Browett.
"Results of this kind for a cancer therapy are unprecedented.
"Instead we should be looking to the examples of the United States and most parts of Europe where Glivec has now become the standard of care for patients with this rare form of leukaemia," said Dr Browett.
Dr Browett and his team have overseen the New Zealand arm of the Phase II and Phase III international trials of Glivec. Dr Browett is an independent investigator.