Adjuvant trastuzumab in early HER2-positive breast cancer: Journeying towards the optimal duration of therapy in South Africa

S Afr Med J. 2020 Mar 30;110(4):271-273. doi: 10.7196/SAMJ.2020.v110i4.14621.

Abstract

Trastuzumab was added to the South African Essential Medicines List (EML) in 2017 for the adjuvant management of human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. However, access has remained inconsistent, as some provinces continue to regard trastuzumab as unaffordable within the contexts of their respective oncology budgets. The intention of providing access to trastuzumab through its inclusion on the EML, therefore, has not been met. The National EML Committee (NEMLC) recently reviewed newly published peer-reviewed information investigating the impact of a shorter trastuzumab treatment period on both clinical efficacy and safety. On account of this review, and with a view to improving access while reducing cost and toxicity, the NEMLC has revised the duration of trastuzumab therapy, i.e. from 12 months to 6 months in the adjuvant management of early HER2-positive breast cancer. This article explores and reports on the data used to make this policy amendment.

MeSH terms

  • Antineoplastic Agents, Immunological / economics
  • Antineoplastic Agents, Immunological / therapeutic use*
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / metabolism
  • Breast Neoplasms / pathology
  • Budgets
  • Cardiotoxicity / etiology
  • Chemotherapy, Adjuvant
  • Drugs, Essential*
  • Duration of Therapy*
  • Female
  • Health Policy*
  • Health Services Accessibility
  • Humans
  • Mastectomy*
  • Mastectomy, Segmental
  • Neoplasm Staging
  • Policy Making*
  • Receptor, ErbB-2 / metabolism
  • South Africa
  • Trastuzumab / economics
  • Trastuzumab / therapeutic use*

Substances

  • Antineoplastic Agents, Immunological
  • Drugs, Essential
  • ERBB2 protein, human
  • Receptor, ErbB-2
  • Trastuzumab