Breast Cancer Drugs

Mary Creagh Excerpts

Thursday 26th January 2017 Commons Chamber

[Siobhain McDonagh]

I completely agree with my hon. Friend and hope to say a little more about that later in my speech.

This debate is about not just Kadcyla, but the lives of the thousands of women who rely on it to survive, so I want to share the words and experiences of two of my friends whose lives have been transformed by having access to Kadcyla. One of my friends is present today—I went to primary school with her, but I shall not tell the House just how many years ago that might have been. Her name is Samantha, and she said:

“When I got the breast cancer diagnosis, I glibly thought—oh it’s OK I’ll get cured, but sadly about 18 months ago I found out that this wasn’t the case and my cancer had spread to my liver. And that’s when I really knew that my cancer meant business!

And that is where Kadcyla comes in. You see for breast cancer, although I coped and kept going with surgery, chemo and radiotherapy, it was grim. I worked a bit, but regular chemotherapy is not a doddle. Exhaustion and hair loss is just the least of it.

Putting on a brave face and wearing a wig is just a surface issue, getting up vomiting and going to work to deal with the VAT is about the hardest thing I have ever done. It wasn’t simply because I don’t have enough sick pay at work to cover my mortgage, I actually like work—work allows me to make my contribution, and I think that’s pretty near the most important thing, making my life make a difference. And Kadcyla? Well that means that my life isn’t over, it really gives me hope.

There is a big hole where my 45 mm tumour used to be in my liver, and scar tissue and other bits, but I am cancer free without having to take another year off my life. My work is precious; I have kept the business going. Eight people are employed, because I could keep going, and Kadcyla made it possible for me.”

[Mary Creagh (Wakefield) (Lab)]

I congratulate my hon. Friend on securing this debate. She certainly makes a powerful speech on behalf of her friend. Does she agree that when NICE looks at the cost-value ratio, stories such as that of her friend, who kept eight people in work, should also be a factor? We should be looking at women’s economic life and economic role, in both the workplace and the home.

[Siobhain McDonagh]

I completely agree with my hon. Friend. I appreciate that the equations and calculations are difficult, and I do not underestimate NICE’s work, but it is about life and quality of life, and it is about so many more people than only those who have the cancer.

My friend Leslie said:

“In 2013 my world was turned upside down when I was diagnosed with inflammatory breast cancer, a rare and aggressive kind of cancer that develops in the lymph vessels.

After 15 months’ treatment comprising 8 chemotherapy treatments, a mastectomy, 15 radiotherapy treatments and a year of Herceptin, it appeared that the cancer had gone. However, 4 months later I noticed a rash around the scar tissue of the mastectomy and a biopsy showed that the cancer had recurred in my skin.

My oncologist told me that I was in a very tight corner. Because the cancer had returned so quickly I wasn’t eligible for the usual drug treatments, radiotherapy wasn’t an option because I had recently completed a course, and surgery wasn’t possible because of the location of the cancer. I was told the cancer was incurable and referred to the Royal Marsden. They confirmed that surgery was not feasible because the cancer had spread so quickly over a large area making skin grafts impossible. I was told Kadcyla was my best chance.

I have now been treated with Kadcyla for 22 months and I have been told of others that have been treated for 5 years. Signs of the cancer disappeared very quickly and so far I have remained cancer free. Kadcyla has enabled me to live a reasonably normal life and participate in and contribute to my local community. Kadcyla has been a life saver for me and without it my future was very uncertain. I feel profoundly fortunate to have received it and I am incredulous that such an effective drug will now be denied to other people in my situation.”

I also wish to mention Rosalie, who was featured in Friday’s Evening Standard. She is just 33 and is living with incurable breast cancer. She is a single parent to two children, aged three and six, and is terrified of a future without the option of Kadcyla and terrified of her kids’ growing up alone. These are Rosalie’s own words:

“I hate feeling like a victim. But I have to fight for my kids. They are more important than me feeling vulnerable about going public. I have to fight for life for them.”

Then there is Mani. Members may have seen her last week on the “Victoria Derbyshire” programme when she spoke so eloquently about how Kadcyla had given her hope. She said that it had improved her life both significantly and quickly, enabling her to live a much fuller and richer life, going on holiday and playing an active part in her young daughter’s life.

These are just a few of the many women whose lives have been made possible through access to Kadcyla. I am sure that many hon. Members will share the experiences of their constituents. The hon. Member for Croydon South (Chris Philp) will no doubt talk about the incredible Bonnie Fox, the face of the Keep Kadcyla campaign of Breast Cancer Now. Thanks to the hard work of Bonnie and of Breast Cancer Now, this campaign has seen more than 100,000 people sign the petition, calling for NICE and Roche to come together to reassess the decision and find a solution to keep Kadcyla available.

Bonnie is an incredible advocate for the Keep Kadcyla campaign, inspiring so many others as she leads the case for this treatment. Bonnie says that her inspiration comes from wanting to have as much time as possible with her two-year-old son, Barnaby. These are her own words:

“I already feel cheated being diagnosed with secondary breast cancer at 37 with a baby, so having a drug taken away that would potentially add years to my life and give me more quality time with my son is so cruel.”

--- Later in debate ---

[Iain Stewart]

The hon. Gentleman makes an important point. I do not pretend to be an expert on how NICE works, but I hope to bring to the debate the personal experience of my constituent and underline the human effect of these issues. I do not necessarily have a solution, but I hope that the outcome of the debate will be that we not only consider Kadcyla, but take a fresh look at the whole process.

[Mary Creagh]

The NICE framework works very well for mass drugs for the entire population or where a whole vaccination is going to work, but for very small numbers of people, such as the 1,200 women who really need this drug, I do not think it is as effective a process. There are two organisations in this negotiation, NICE and Roche, and we must not have Roche seeing its new drugs Perjeta and Kadcyla as a new cash cow as Herceptin goes off-patent in 2017-18. Women’s lives should not be treated as cash cows by this drugs company.

[Iain Stewart]

I agree with the hon. Lady. I have not had any personal discussions with Roche; I can only refer to and take at face value the briefing note that it sent me early this morning, which seemed to represent a genuine wish to negotiate with NICE and get the drug down to an acceptable price. I hope the debate is joined in that spirit.

Perhaps it is appropriate to mention now something I was going to bring up later in my speech: one area that needs to be examined is the pharmaceutical price regulation scheme, which is a five-year voluntary contract between the pharmaceutical companies and NICE. If I understand how it is intended to work, the pharmaceutical companies will underwrite any overspend for a particular drug. For various reasons that does not seem to be working in practice. I urge my hon. Friend the Minister to look at that point, which has been made by some in the industry.

In the case of my constituent, Mrs Mears, when her current medication ceases to be effective, Kadcyla is the only option. Although she has responded well to the current treatment, there is every likelihood, and her consultant agrees, that she will respond in a similarly positive way to Kadcyla. There is every chance that she would enjoy the benefits of that drug for a time well in excess of the expected nine months. I would therefore argue that a blanket ban on the drug would be inappropriate. At the very least, there should be some flexibility in the system to make the drug available to people such as my constituent, for whom there is a very high probability that it would have more than the expected benefit. She has responded so well to her existing drug, and if her life could be extended considerably by Kadcyla, that would allow more research to be done on the efficacy of her existing medication, which would be an important body of evidence to add to the appraisal process.

The hon. Member for Mitcham and Morden rightly said that the prescription of drugs should be based solely on clinical need and no other factor, but when I met Mrs Mears, she made one point to me that I could not really answer. Through her life, she worked professionally in the criminal justice system and has done a lot of work saving the public purse money by innovating programmes to reduce youth offending. That value cannot be calculated, but she made the point to me, “At the one point in my life that I need something back from this country, it is being denied to me.” I really could not give an answer to that. I hope that something can be done to make the drug available.

The NICE decision is provisional. I contributed to the consultation and I hope that when NICE meets next—in, I think, early March—it will review the decision.

I know that NHS resources are finite and that there are many competing demands on its budget. The debate on the overall size of the NHS budget must be a matter for another time, but cases such as this illustrate the need to use what resources we have as efficiently as possible. Just before I met Mrs Mears the other week, I happened to see a story in the media that really made my blood boil. I do not pretend to be an expert on the prescription system, but I simply put this on the table. The story reported that the NHS wastes about £80 million per annum by prescribing simple painkillers such as paracetamol, which can be bought in a supermarket for 20p or 30p a packet. Those prescriptions go through the usual prescription system and cost £80 million a year. Surely there is a way of getting around that, perhaps by giving GP practices a stock of basic painkillers. I am not asking for people who get free prescriptions to start paying but, surely, there is a way for doctors to issue them when it is appropriate to do so, and stop this merry-go-round of paperwork that costs many millions of pounds.