Proposal to widen access to zoledronic acid for early breast cancer
We propose to widen funded access to zoledronic acid (injection 4 mg per 5 ml, vial) to include adjuvant use in postmenopausal women with early breast cancer.
Consultation on this proposal closes at 5 pm on Tuesday, 14 November 2017 and feedback can be emailed to alexander.rodgers@pharmac.govt.nz.
What would the effect be?
Certain patients with early breast cancer would be eligible for a funded course of zoledronic acid. This treatment has been shown to reduce the risk of bone metastases and improve survival rates in post-menopausal early breast cancer patients.
The treatment requires an infusion once every six months for a maximum of two years.
Who we think will be interested
Oncologists, doctors in general practice, patients who have or may develop early breast cancer, pharmacists, and organisations with an interest in cancer treatment.About zoledronic acid
Zoledronic acid is a bisphosphonate, a class of medicines which reduce bone turnover. Bisphosphonates are used to treat osteoporosis and to prevent or treat bone metastases.
Zoledronic acid is currently listed on the Pharmaceutical Schedule in two forms; this proposal relates to the 4 mg per 5 ml vial form. Two brands of this form are funded, Zoledronic acid Mylan, and Zometa.Why we’re proposing this
PHARMAC received an application to widen access to zoledronic acid for postmenopausal women with early breast cancer from the New Zealand Breast Cancer Special Interest Group. The application has been reviewed by the Pharmacology and Therapeutics Advisory Committee (PTAC) as well as by PTAC’s Cancer Subcommittee, CaTSoP.
PTAC and CaTSoP considered there is evidence of a modest but significant effect from treatment with bisphosphonates, in terms of reduced risk of disease recurrence and improved survival, although only in post-menopausal women. While the currently published evidence is from trials using multiple regimens and various bisphosphonates, the majority of published evidence was for use of zoledronic acid.
For more information on the history of the proposal and to read the minutes of these clinical reviews, please go to: https://www.pharmac.govt.nz/ApplicationTracker?ProposalId=1328 [link no longer available]
Details about our proposal
If approved, the Special Authority for zoledronic acid (Zoledronic acid Mylan and Zometa) inj 4 mg per 5 ml, vial would be amended to include adjuvant use in postmenopausal women with early breast cancer from 1 January 2018 as follows (additions in bold):
Special Authority for Subsidy
Initial application — (bone metastases) only from an oncologist, haematologist or palliative care specialist. Approvals valid without further renewal unless notified for applications meeting the following criteria:
Any of the following:
- Patient has hypercalcaemia of malignancy; or
- Both:
- 2.1. Patient has bone metastases or involvement; and
- 2.2. Patient has severe bone pain resistant to standard first-line treatments; or
- Both:
- 3.1. Patient has bone metastases or involvement; and
- 3.2. Patient is at risk of skeletal-related events pathological fracture, spinal cord compression, radiation to bone or surgery to bone).
Initial application — (early breast cancer) only from an oncologist. Approvals valid for 2 years for applications meeting the following criteria:
All of the following:
- Treatment to be used as adjuvant therapy for early breast cancer; and
- Patient has been amenorrhoeic for 12 months or greater with endocrine levels consistent with a post-menopausal state; and
- Treatment to be administered at a minimum interval of 6-monthly for a maximum of 2 years.
The hospital restrictions for zoledronic acid (Zoledronic acid Mylan and Zometa) inj 4 mg per 5 ml, vial would be amended in the same way.
To provide feedback
Send us an email: alexander.rodgers@pharmac.govt.nz by 5 pm Tuesday 14 November 2017.
All feedback received before the closing date will be considered by PHARMAC’s Board (or its delegate) prior to making a decision on this proposal.
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