No Early Christmas Present For Brain Cancer Patients

Brain Tumour Support NZ is disappointed that Pharmac has decided not to fund bevacizumab for recurrent glioblastoma, the most common and aggressive type of primary brain cancer in adults.

Pharmac announced today that it is proposing to fund the Vegzelma brand of bevacizumab for the treatment of liver cancer and advanced ovarian cancer, however that it would not be funded for glioblastoma or cervical cancer. In August 2024, glioblastoma was listed in a Request for Tender (RFT) for bevacizumab, raising the hopes of brain cancer patients who are currently self-funding their treatment.

Today’s announcement has dashed those hopes, leaving the brain cancer community devastated.

Bevacizumab is an anti-angiogenic therapy designed to block the blood supply that feeds tumours. It was approved to treat recurrent glioblastoma by the US Food and Drug Administration (FDA) in 2009, has been funded in Australia since 2019, and is used in the treatment of brain cancer in many other countries around the world.

However Pharmac’s Cancer Treatments Advisory Committee (CTAC) has assessed that there was a lack of evidence of meaningful, clinical benefit from bevacizumab to brain cancer patients in terms of overall survival, quality of life or corticosteroid sparing effects.

Brain Tumour Support NZ chair, Chris Tse, says that no drug has ever shown an overall survival benefit for recurrent glioblastoma in randomised clinical trials. However in several studies bevacizumab has shown to prolong progression free survival, meaning people live longer without their cancer coming back, which is a huge benefit to patients, according to Tse.

“This is a devastating disease with no cure. As we approach the festive season, more quality time with their loved ones is all that our patients are asking for,” he said.

“One more Christmas spent together with family, one more New Year’s Eve, a significant birthday, seeing your child off to school, these are precious memories which are hard to put a price on.”

Tse said that because bevacizumab was approved in the US so many years ago and was already off-patent there is little likelihood that further clinical trials will be conducted overseas. He said that clinical trials are hugely expensive to run and there was no incentive for pharmaceutical companies to conduct further trials for a drug which is already approved in many countries around the world.

“It seems that Pharmac is waiting for evidence that will never come,” he said.

On the other hand, New Zealand oncologists who regularly treat brain cancer patients are continuing to prescribe bevacizumab, also known under the brand name Avastin, to those who can afford to pay for it. A cost share programme which is currently available to patients taking Avastin may also be under threat as Pharmac moves to award the tender to a principal supplier.

“We feel disheartened that CTAC has seemingly not looked at real world data and the way that New Zealand oncologists are using this drug. Lack of funded access to bevacizumab perpetuates inequities, particularly amongst disadvantaged populations, including people with disabilities who may not be able to work,” Tse said.

Pharmac’s decision is also at odds with international guidelines. Two sets of guidelines which are closely followed by New Zealand oncologists, the National Comprehensive Cancer Network (NCCN, US) and the European Association of Neuro-Oncology (EANO) both list bevacizumab as a recommended treatment for recurrent glioblastoma. New Zealand does not have its own set of guidelines for brain cancer and oncologists use these and other international guidelines to help guide patient treatment.

Tse would like to see Pharmac make better use of real-world data, particularly in cases where the clinical trial data was generated many years ago. “Oncologists have moved on from the way the bevacizumab was used in clinical trials fifteen years ago and now know how and when to use it to maximise patient outcomes”, he said.

He would also like to see increased opportunities for patient and expert clinician input earlier in the Pharmac assessment process, including at special advisory committee assessment stage. He says this is especially important in the case of rare cancers or rare disorders, such as brain tumours, because members of the advisory committees cannot be expected to be experts in every rare disease.

This latest decision will go out for consultation but many brain cancer patients feel that the horse has bolted and the decision has already been made.

Brain Tumour Support NZ welcomed the $604 million budget uplift announced by the government in June this year which has resulted in several new medicines being funded for patients with malignancies such as breast, lung, colorectal and liver cancers. However Chris Tse says that with brain cancer once again being neglected there is very little Christmas cheer for New Zealand’s battling brain tumour community.

About Brain Tumour:

• Around 350 New Zealanders are diagnosed with primary brain cancer each year representing 1.4% of all cancers diagnosed. Many more are diagnosed with secondary, or metastatic, brain tumours (cancers which have spread to the brain from elsewhere in the body).

• The 5 year survival rate for glioblastoma, the most common type of brain cancer in adults, is just 5%. Survival rates for brain cancer have not improved significantly in the last 30 years.

• Around 260 New Zealanders die each year from brain cancer, making it the 10th most fatal cancer. • Brain cancer is the biggest cancer killer of children in New Zealand, being responsible for 42% of all childhood cancer deaths (almost double that of leukaemia).

• Brain tumours can affect anyone, of any ethnicity, and at any age. The causes of most brain tumours are unknown so prevention and screening are not possible.

About Brain Tumour Support NZ:

Brain Tumour Support NZ is dedicated to improving the quality of life for all New Zealanders affected by brain tumours through advocacy, support services, and educational initiatives. Founded with a commitment to raising awareness and driving research, the organisation offers a range of resources to help patients and their families navigate their journey from diagnosis to treatment and beyond.

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