Breast cancer

What’s in the Budget for oncology – and what’s missing

The PBS listing of sacituzumab govitecan (Trodelvy) for the treatment of breast cancer is one of several highlights in the 2022 Budget for oncology.

But the Budget has also been a disappointment for cancer specialists, with the omission of funding for key programs such as lung cancer screening.

The listing of Trodelvy on the PBS from 1 May will provide subsidised access to the $80,000 treatment for about 580 adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (mTNBC) who have received at least two prior systemic therapies, including at least one prior therapy for locally advanced or metastatic disease.

According to manufacturer Gilead, Trodelvy is made up of three components: a monoclonal antibody, sacituzumab govitecan, that recognises and attaches to Trop-2 expressing cancer cells, SN-38, a chemotherapy intended to kill cancer cells, and a proprietary hydrolysable linker that connects the antibody to SN-38 and breaks down the release of the chemotherapy inside the cancer cells and adjacent tumour cells through a bystander effect.

In a statement, the company noted that in the ASCENT trial, the median overall survival of patients with metastatic TNBC treated with Trodelvy was 11.8 months compared to 6.9 months with  chemotherapy.

Professor Fran Boyle,  medical oncologist at the Mater Hospital Sydney, welcomed the listing as an important new treatment option for what was unique and challenging breast cancer subtype, particularly in those with metastatic disease.

“Triple negative cells don’t have the most common receptor proteins expressed in breast cancer, so hormone therapy or treatments that target HER2 aren’t suitable,” she said.

“ Now, with this novel antibody-drug conjugate approach, we can leverage Trop-2, which is expressed in most breast cancers and deliver an anticancer agent directly to the cancer cells to help stop the growth and spread of the cancer.”

Several other cancer-related items were funded in the 2002 Budget, many of which have been previously announced. These include:

  • $375.6 million to establish a Western Australian Comprehensive Cancer Centre,
  • $40.7 million to increase the availability of testing and screening services for a range of cancers to catch up on COVID-19 related delays,
  • $32.6 million for PET for initial ages of patients diagnosed with rare and uncommon cancers,
  • $28m to establish Genomics Australia,
  • $10.6 million to amend the current MRI of the breast item for patients at high risk of developing breast cancer, raising the age limit from 50 to 60.

However the 2022 Budget dashed hopes for respiratory physicians who noted there was no funding from federal government to support its promise of introducing a national lung cancer screening program.

Lung Foundation Australia expressed “extreme disappointment” that the government was not funding a screening program that was backed by evidence showing it would prevent 12,000 lung cancer deaths over 10 years.

“There is undeniable evidence for this screening program that has already had initial investment into scoping, but this lack of funding means progress will stall, and thousands of lives will be lost as a result” said CEO Mark Brooke.

“Over the last three years a significant amount of work has gone into assessing suitability of a lung cancer screening program, which was ultimately recommended by Cancer Australia, and even an investment of $6.9m in the previous budget,” he said.

As well as saving lives and reducing the financial burden to the health system associated with lung cancer, a screening program was also supported by the Australian community, said Mr Brooke, citing figures showing 82% in support of government funding for a national program.

“Lung Foundation Australia strongly believes that a national screening program is a crucial first step in improving survival rates of the biggest cancer killer in Australia that claims one Australian’s life every hour,” he said.

There was also bad news in the Budget for health and medical research, with the NHMRC inflicted with a cut in real term funding. The Australian Society for Medical Research lamented that the Budget contained no new investment in research and the 1% increase in existing funding in the Budget was below inflation, leaving Australian to fall further behind other nations.

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