New breast cancer treatments recommended for subsidy on the PBS

The recommendation of three breast cancer drugs for subsidy on the Pharmaceutical Benefits Scheme (PBS) is a significant step forward for all Australians affected by breast cancer.

The three breast cancer drugs recommended on Friday 21 April for listing on the PBS by the Pharmaceutical Benefits Advisory Committee (PBAC) at its March 2023 meeting are:  

• Keytruda (pembrolizumab) for metastatic triple negative breast cancer
• Enhertu (trastuzumab deruxtecan) for metastatic HER2-positive breast cancer 
• Verzenio (abemaciclib) for HR-positive/ HER2-negative early breast cancer

Metastatic breast cancer

Keytruda (pembrolizumab), is a type of immunotherapy. It has been shown to improve median overall survival for people with metastatic triple negative breast cancer (TNBC), whose tumours express higher levels of the PD-L1 protein, by more than six months.

TNBC is typically more aggressive, has fewer treatment options, and disproportionately affects younger women. Around 15 per cent of breast cancers are triple negative. 

Enhertu (trastuzumab deruxtecan) an antibody-drug conjugate, has been shown to improve median progression-free survival for people with human epidermal growth factor receptor 2 (HER2) positive metastatic breast cancer by more than 10 months.

Around 15 to 20 per cent of breast cancers are HER2-positive. 

(Note that access was extended to people living with HER2-low metastatic breast cancer in August 2024) 

BCNA’s Director Policy, Advocacy and Support Services Vicki Durston said these recommendations for listing on the PBS are significant news for those living with treatable but not curable metastatic breast cancer.  

‘People living with metastatic breast cancer often face significant out of pocket costs for these drugs prior to them being subsided – and many cannot afford them at all,’ Ms Durston said.  

‘For some time, cancer control agencies have been calling for new treatment options to treat triple negative breast cancer, which is often aggressive. Access to Keytruda represents an important new treatment option.’   

‘Enhertu is a new emerging type of drug that is innovative and is specifically tailored for those with HER2-positive metastatic breast cancer.’  

Ms Durston said it is imperative people with metastatic breast cancer, a growing group with significant unmet needs, have access to new and innovative therapies.  

BCNA has long been calling for improvements to the collection and reporting of metastatic data as well as advocating for improved services to ensure this group is not invisible.    

‘We know that these drugs offer hope to those living with metastatic breast cancer,’ Ms Durston said.  

Early breast cancer

Verzenio (abemaciclib) is a CDK (cyclin-dependent kinase) inhibitor for people with hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-), lymph node positive, invasive, resected early breast cancer whose cancer is at high risk of recurrence.  

Verzenio has been shown to increase invasive disease-free survival when combined with endocrine therapy, compared with endocrine therapy alone.   

In addition to these clinical benefits, BCNA also recognises the psychosocial role of treatments for breast cancer that is at high risk of recurrence in reducing fear of recurrence (FoR).  

FoR is experienced by many with breast cancer and is characterised by anxiety, fear, and stress regarding the risk of cancer recurring post treatment.  

BCNA celebrates these three positive recommendations and will now work with the pharmaceutical companies and government to ensure these drugs are made accessible on the PBS as soon as possible.   

‘What these decisions mean is that regardless of how much you earn or where you live you will have access to these innovative new drugs that are tailored for different breast cancer sub-types that can save and prolong lives’ says Ms Durston.  

Drugs not recommended for subsidy

BCNA was disappointed to learn that two drugs were not recommended for subsidy on the PBS by the PBAC at their March 2023 meeting: 

• Keytruda (pembrolizumab) for early triple negative breast cancer
• Lynparza (olaparib) for HER2-negative BRCA-positive early breast cancer.

BCNA notes that both Keytruda and Lynparza have been offered early re-entry pathways for reconsideration by the PBAC and will work with the pharmaceutical companies to ensure resubmission as soon as possible.

For any questions about any of the drugs mentioned in this article, BCNA recommends speaking with your medical oncologist or treating team.