Breast cancer is one of the most prolific killers in the UK and the most common type of cancer, affecting one in eight women and one in around 800 men in their lifetime. Due to a combination of factors spanning lifestyle changes, longer life expectancies and side-effects of medicines like HRT or the contraceptive pill, incidence rates for breast cancer are on the rise, projected to increase by 2% in the UK between 2014 and 2035. Breast cancer is more of a threat to women's and men’s health than ever before, yet some of the most effective drugs to treat the disease are not getting to the people who need them. For that very reason, at 8am this morning, a group of doctors, students, activists, cancer patients and their family members assembled outside the Association of the British Pharmaceutical Industry in London. They were there to protest against the extortionate prices placed on critical breast cancer medications by the Swiss multinational pharmaceutical company Roche. Holding a big, pink banner that read “Pharma Greed Kills”, the protesters' message was loud and clear: overcharging the NHS and private hospitals for lifesaving cancer drugs is potentially costing people their lives. One of these drugs is Herceptin, which is the brand name of a medicine called trastuzumab. It can be a highly effective treatment for breast cancers that are HER2 positive, which is about one in five. Roche charges tens of thousands of pounds per person for treatment (around £21,000, to be more accurate); activists claim it could be produced and sold for just £190, and still generate a profit for the drug company. Although it’s currently available in the UK, it costs the NHS a huge amount of money to provide, at a time when austerity cuts are severely impacting NHS budgets.
The price of 14 cancer drugs has risen between 100% and 1,000% over the last five years
The situation is more complex overseas, however. In countries like South Africa, many women with breast cancer cannot access Herceptin at all because it is too expensive, charged at roughly the same price as in the UK. Tobeka Daki, a single mother and leading cancer activist from South Africa, was one such woman – she died from her cancer last year. The organisation Treatment Action Campaign (TAC), which fights for better healthcare access in South Africa, arranged today’s protests in her honour. Demonstrations took place in London, South Africa, Brazil, France, Brussels, New York, Thailand, Malaysia and beyond. Graciela Rodriguez, a women’s rights activist from Brazil, says: "The Brazilian government pays 73 times more than what health economists estimate trastuzumab could be sold for. It’s just too expensive.” In 2016, Roche made around £15 billion in operating profit. In 2015, CEO Severin Schwan earned around £9 million. “It is highly plausible that Roche cut the price of Herceptin dramatically and still be very profitable,” argues TAC. When a drug is created by a drug company, that company can patent the drug for a number of years, meaning that no one else can manufacture it while they supposedly recuperate their development costs. After the patent expires, licenses to make generic copies of the drug can be sold by the drug company, driving down the cost, thus usually improving global access. In reality, however, this system allows drug companies to use their market monopoly to overprice drugs, selling them to healthcare systems around the world at drastically inflated prices.
Hiking the price of cancer drugs is not a new story, but it has been in the UK press a lot of late. Reports in The Telegraph at the end of January noted that the price of 14 cancer drugs had risen between 100% and 1,000% over the last five years. The NHS explained that this was leading them to limit prescriptions by 20%, while experts estimated that it might be costing the NHS as much as £1 billion a year. They could not access the true cost because data that accounts for hospital prescriptions was unavailable, but they know that, for GPs and pharmacists alone, the figure spent on these drugs in 2015 was £380 million higher than it had been five years ago. Julie Strelley-Jones could be directly affected by the increase in costs. In October 2012, at the age of 42, Julie was diagnosed with a rare and aggressive form of breast cancer, called inflammatory breast cancer, which doesn’t appear as a lump so can be hard to identify. She had the standard treatment – mastectomy, radiation, chemo and Herceptin – but after 18 months, doctors discovered the cancer had spread to her lungs, liver, bones and brain. Julie was immediately put on a drug called Kadcyla, which also targets HER2 positive breast cancers and is usually used when Herceptin isn’t working. This was in February 2014. Julie was the first person in her hospital to try the drug, just one day after it was released by the Cancer Drugs Fund, a government-sponsored body set up to help access cancer drugs that aren’t available on the NHS. Julie responded well to Kadcyla and has been taking it ever since – she's now in her 46th cycle (a cycle being one treatment every three weeks).
You can't put that feeling into words. It's like hope is going to be taken away.
It’s very likely that Kadcyla is keeping Julie alive, but – because of its toxicity – her body may soon require a break. She would then be able to go back on the drug and continue her treatment, only by that point, Kadcyla may no longer be available. That’s because the Cancer Drugs Fund is coming up to a review, after which Kadcyla is likely to be removed as an option for patients in the UK, deemed too expensive for the NHS (it costs up to £90,000 for 14 months' treatment). “You can’t put that feeling into words,” says Julie, “it’s like hope is going to be taken away.” Along with Herceptin, Kadcyla is produced by Roche, and is one of the drugs that activists at this morning’s protests wanted to make some noise about. If Roche can be convinced to drop the price of Kadcyla, NICE (the independent body which evaluates which drugs can be provided on the NHS) is more likely to approve it for routine use. Julie recently met with the head of Roche at the offices of Breast Cancer Now to set out her case. A petition, which calls for Roche to rethink its pricing strategy and has been signed by over 100,000 people, has also been presented to the company. It remains to be seen whether Roche and the other pharmaceutical companies manufacturing drugs like Herceptin and Kadcyla drop the prices. In the meantime, Julie reminds us that HER2 positive cancers are most likely to target young mothers like herself, who may have children and elderly parents who need looking after. “Everybody responds differently to these drugs, but it’s been shown that they can give you another six months to live and it’s a good-quality six months," she says. "Yes, you have a chronic illness, but you still want to live your life. This drug can enable people to do that.”