Enhertu vs paclitaxel

Good afternoon beegee123,

Thank you for getting in touch and welcome to our online community, I hope you find it supportive. My name is Helen and I am one of the Cancer Information Nurse Specialists on the Macmillan Support Line.

I am sorry to read about your mother’s secondary breast cancer diagnosis. It’s understandable you’re seeking guidance about the next course of treatment. It can feel like an uncertain time when faced with making decisions about treatment so I hope the following information will be helpful for you.

Firstly, you may find our information about what you can do if treatment isn’t available. Depending on which part of the UK your mother lives, for example in England if a treatment is not provided by the NHS in your area, or is not available through the Cancer Drugs Fund, you can ask NHS England to pay for it. This is called an individual funding request (IFR). An IFR form must be completed and sent to NHS England by someone from your healthcare team. This is usually the cancer doctor who will give you the treatment. Before they send the IFR, they will discuss it with you, unless you are too unwell.

As I am unsure of the full medical history of your mothers type of breast cancer, as you’ve asked about Enhertu, I can only assume she would meet the criteria for this treatment.

In the Destiny Breast-06 cancer trial results, Enhertu demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (PFS) compared to standard-of-care chemotherapy in patients with HR-positive, HER2-low (IHC 1+ or 2+/ISH-) metastatic breast cancer.

“ENHERTU reduced the risk of disease progression or death by 38% by blinded independent central review (BICR) versus chemotherapy.”

As with all cancer drugs, it’s difficult to say how the side effects of paclitaxel or Enhertu would impact your mother’s daily life. Every person responds differently to treatment. Looking at both these drugs, the common side effects are very similar, for example, infection risk, effects on the digestive system, anaemia, hair loss.

Your mother’s consultant and clinical nurse specialist are best placed to talk you through their experience of treating patients on these drugs, the risks and benefits.

As we are unable to give individual medical advice through this platform, your mother’s cancer team should also able to advise the best type of anti-sickness drugs for her.

If you haven’t contacted the nurses on the Macmillan support line before, you’d be very welcome to call us. A two-way conversation often helps us better understand a person’s individual circumstances. It also gives you the opportunity to ask us questions and we can provide you with relevant information. There may be other avenues of support we can offer you.

I hope this information is helpful but if you have any more questions please don’t hesitate to get back in touch.

Best wishes,

Helen, Cancer Information Nurse Specialist 

You can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or email us. 

Ref/HeP/AM

I have been informed that for the NHS doctor to give the Enhertu it will cost £6,244 per cycle and £81,169.40 for 10 months. If a cycle is a month, shouldn’t it be £62,440 for 10 months? They’ve also said we will need to pay for CT scans, which seems massively unfair since these would be due whatever treatment she is on. Please can you advise?

Hi beegee123 

Thanks for getting back in touch. I’m Linda one of Helen’s colleagues and a cancer information nurse specialist from our support line.

This sounds like an understandably unsettling time just now, and I hope Helen’s response was helpful to read.

Looking at your initial contact I’m not sure whether your mum’s status is HER-2 low and this is why Enhertu couldn’t be considered through the managed access scheme or whether there were other reasons for this not being available through the NHS.

However, in terms of the costing, we would encourage you to speak with the person who informed you of the initial cost for a complete breakdown.

The recommendation for Enhertu, for metastatic breast cancer, is that it is given as a 21-day cycle. So rather than monthly this would be administered every three weeks within the 10-month period. This might account for the cost as it’s likely to be 13 cycles rather than 10.

It is also worth enquiring about any additional costs that might incur when having private care in the NHS. As well as CT scans your mum will have regular blood tests and cardiac monitoring. She may also require some take home medicines, such as anti-sickness drugs and anti- diarrhoea medication. This might vary from hospital to hospital. This is an example of an NHS protocol for administering Enhertu and it might help you understand more about what is involved and help guide you with further questions about the treatment.

Some people may also consider treatment in a private setting. After finding the full costing of the treatment it might be worth looking at local private hospitals to find out their charges. This might give you mum some extra options of where she would like her care if comparable with NHS private costs. It might be worth speaking with her hospital team for their guidance around this.

Like Helen suggested, I wonder if it would be helpful to talk to us. We can find out a little more of your mum’s circumstances and look at what further information and support might help.

In the meantime, please take care.

Linda, Cancer Information Nurse Specialist 

You can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm) or email us. 

Ref: LM/GMcR

The managed access scheme hasn’t been mentioned to us. Can you explain more please? We were just told we would need to pay for it (we are in England). They’ve now said that it’s just the Enhertu we need to pay for - everything else will be covered by the NHS - so all other meds, appointments, scans etc are free. They hadn’t mentioned the IFR either, but I asked the other day after your colleague’s very helpful reply. They’ve said hardly any requests for Individual funding are successful. I’m going to call tomorrow as I have no faith at all that we are being told helpful information by the hospital. 

Hi beegee123,

I am Sharon, one of Helen and Linda’s colleagues, and a nurse on the Macmillan Cancer Support Line.

I am sorry you are having to deal with this on top of everything else. Please don’t hesitate to call us if you want to talk things through with someone.

The managed access scheme is designed for medicines that are not yet approved by NICE, but are thought to have potential for use. An agreement between the drug company and NICE means that promising new drugs can be funded temporarily, whilst studies or negotiations are ongoing.

Daiichi-Sankyo are the drug company that makes Enhertu. They have a managed access agreement to allow Enhertu to be prescribed on the NHS and reimbursed by the Cancer Drugs Fund, which is a separate source of funding for cancer drugs in England.

Enhertu can only be given using this agreement if someone meets strict criteria:

• Breast cancer that is metastatic or cannot be removed by surgery
• HER2 positive (status 3 or above)
• At least one anti-HER2 therapy has been given and stopped working.

The only other way that it could be funded through the NHS is by using the individual funding request that Helen mentioned. Your consultant would have to be willing to apply for this on Mum’s behalf and it would take around 30 working days.

If you need further help it would be useful to discuss this with someone on the phone as it would be easier to discuss Mum’s individual circumstances and support you appropriately.

Best wishes,

Sharon

Cancer Information Nurse Specialist

You can also speak with the Macmillan Support Line team of experts. Phone free on 0808 808 0000 (7 days a week, 8am-8pm)

Ref; SA/HeP