Breast cancer was once a subject that most Indians were reluctant to talk about. However, with phenomenal increase in the number of breast cancer cases in the past two decades, it has emerged as a major cause of cancer related death among women in India. According to a study conducted by an international consortium of researchers led by the University of Washington's Institute for Health Metrics and Evaluation (IHME), the number of breast cancer cases in India has increased by 166% in the last 23 years.
Notwithstanding the remarkable improvement in breast cancer treatment, inadequate accessibility to good quality treatment is responsible for the high mortality rate among breast cancer patients in India. Although the scenario is gloomy, new and more effective breast cancer drugs are being launched in India. The latest breast cancer drugs that are offering new hopes of survival to breast cancer patients are Perjeta and Kadcyle, developed by the Swiss drug maker Roche. Both these drugs are approved for late stage breast cancer cases when cancer had spread to the different body organs.
Benefits: Perjeta is the brand name of pertuzumab. It is one of the latest drugs for HER-2 positive cancer, which is an aggressive form of advanced breast cancer. Pertuzumab specifically targets HER2. Hence it helps in significantly improving the prognosis and survival rate. It is used in combination with trastuzumab and docetaxel. Clinical trials have shown that including pertuzumab in the combination treatment with trastuzumab and chemotherapy extends the average life of women with HER2 positive metastatic breast cancer by 56.5 months, whereas the average life of women treated only with trastuzumab and chemotherapy increases by 40.8 months. When included in the treatment regimen at the early stage of breast cancer, pertuzumab helps in shrinking the cancer tumor, which may even disappear after treatment.
Side Effects: Just as the other cancer drugs, pertuzumab too entails a number of common side effects such as nausea, diarrhea, hair loss, fatigue and low white blood cell count. It may affect the function of the heart and may even cause congestive heart failure. Hence, the heart function of breast cancer patients needs to be monitored before and during treatment. The breast cancer drug is not recommended for pregnant women and people allergic to pertuzumab.
Cost Effect: Despite the benefits of pertuzumab, because of its exorbitant price only a very small number of breast cancer patients can access this drug. Currently Perjeta is the most expensive breast cancer drug in India. Each dosage of Perjeta costs Rs 249,000. The cost of a nine-month long treatment will hover around Rs 30 lakh.
Benefits: Kadcyla is the brand name for ado-trastuzumab emtansine. It is a combination of a chemotherapy drug and trastuzumab. It is used for HER-2 positive metastatic breast cancer that has not responded to treatment with trastuzumab and taxane. According to clinical trials, breast cancer patients treated with Kadcyla on average lived 6 months longer than patients treated with a combination of lapatinib and capecitabine. The average survival rate of patients after treatment with Kadcyla is 30.9 months. It also has a lower incidence of hair loss. Only 3.5% women who took Kadcyla lost their hair during treatment.
Side Effects: The common side effects of Kadcyla are nausea, fatigue, low platelet count, constipation, bleeding, muscle and joint pain, nosebleeds and liver problems. It is associated with serious side effects such as liver inflammation, life-threatening bleeding, nerve damage and infusion-related reactions.
Cost Effect: Priced at Rs 210,000 per 200 ml vial, Kadcyla is currently the second most expensive breast cancer drug in India. The total cost of the treatment is about Rs 12 lakh. On the other hand the cost of one lapatinib tablet is about Rs 393 and the price of one capecitabine tablet is around Rs 182. Hence, the overall cost of treatment with lapatinib and capecitabine is far less than treatment with Kadcyla.