News in brief: Preventive DNA screening for cancers to be piloted; Prescription costs eased with PBS Safety Net changes; Study supports adjuvant pertuzumab in HER2+, node-positive EBC

Preventive DNA screening for cancers to be piloted

A pilot study will take Australia one step closer to offering preventive DNA screening for inherited cancers via the public health care system, its developers say.

The DNA Screen pilot study will offer preventive DNA screening for hereditary breast and ovarian cancer (HBOC), Lynch syndrome and familial hypercholesterolaemia to 10,000 Australians aged 18–40 years, according to an article in the MJA this week

Recruitment for the study, designed by the DNA Screen Investigator Group and funded by the Medical Research Future Fund Genomics Health Futures Mission, will start in mid 2022.

About 2% of participants are expected to have high risk screening results and will be provided with genetic counselling and referrals to relevant state-based clinical services in the public health care system for risk management, and for cascade testing of first degree blood relatives.

Prescription costs eased with PBS Safety Net changes

Patients with chronic diseases will have the financial burden for medication costs eased by an announcement of the lowering of PBS safety net thresholds in the 2022 Budget.

From July 1 the threshold for access for general patients will be lowered by the equivalent of two scripts, from $1,542.10 to $1,457.10, a saving of up to $85. This means that after the equivalent of about 34 full-priced general co-payments, general patients pay only the concessional co-payment of $6.80 per PBS script for the balance of the year.

For concession card holders the threshold will be reduced by the equivalent of 12 scripts from $326.40 to $244.80, a saving of up to $81.60. When concession card holders reach the safety net threshold, after 36 full-priced concessional scripts, they will receive PBS medicines at no charge for the balance of the year.

The measure is costing $525.3 million over four years from 2022–23.

Study supports adjuvant pertuzumab in HER2+, node-positive EBC

Clinicians can have renewed confidence in adjuvant pertuzumab’s efficacy in HER2+ early breast cancer patients, particularly, node-positive (N+) ones, researchers suggest.

A fresh look at the 4,804-patient APHINITY trial showed HER2+ patients on adjuvant pertuzumab plus trastuzumab and chemotherapy had absolute six-year invasive disease-free survival (IDFS) gains of 2.8% ± 0.9% versus placebo, trastuzumab and chemotherapy.

HER2+, N2+ patients benefited well over the node-negative (N-) cohort, averaging six-year IDFS gains of 4.5% ± 1.2 and 0.1 ± 1.1, respectively.

However the largest gains were seen in patients with intermediate clinical composite risk, (5.3 ± 1.9 overall; 6.9 ± 2.3 N+; 4.0 ± 3.0 N−), highest TILs percentage (6.3 ± 1.7 overall; 7.4 ± 2.4 N+; 3.2 ± 1.7 N−), and intermediate HER2 copy number (2.8 ± 1.9 overall; 7.4 ± 2.5 N+; −1.3 ± 1.9 N−), the authors wrote in the European Journal of Cancer.

Although they “could not identify a pattern of treatment effects that could reliably exclude the benefit of adding pertuzumab for any subpopulation of patients with N+ disease”, the authors noted that N- patients on trastuzumab and chemotherapy “have relatively good outcomes . . . which are not further improved by the addition of adjuvant pertuzumab”.

“These results support current clinical practice regarding the use of adjuvant pertuzumab for early HER2+, N+ breast cancer,” they concluded.

The APHINITY trial was sponsored and funded by pertuzumab manufacturer Roche though no specific additional funding was used for this analysis, the authors say.  

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