Providing metastatic melanoma patients with access to new treatments

New Zealand has one of the highest rates of Melanoma in the world. Metastatic melanoma is one of the most aggressive, severe types of cancers. It is cancer that has ‘spread’ to other parts of the body and rapidly mutates. Sadly, people with metastatic melanoma have a mean life expectancy of about six months.

It is cancer that has ‘spread’ to other parts of the body and rapidly mutates. Sadly, people with metastatic melanoma have a mean life expectancy of about six months.

There was increasing awareness of the benefits of innovative melanoma medicines trametinib and dabrafenib as experience grew in clinical trials. As such, we had an increasing number of requests from oncologists familiar with the trial results to explore access options in order to help their metastatic melanoma patients in New Zealand who had very few options for treatment.

As patients in NZ had limited treatment options we worked with authorities to make trametinib and dabrafenib available under a Compassionate Access Scheme for people that qualified with metastatic melanoma.

Although these medicines were relatively new and were still being investigated around the world, it was apparent that they offered an extended good quality life for some patients. Even though we were seeing positive results from these medicines, it was only a matter of time before the melanoma would mutate and stop responding to the medicine. Patients put onto the compassionate access scheme were aware of this.

Since the compassionate access program was put in place, over one hundred patients in New Zealand have been able to gain access to medicines that would not have been available otherwise, and who would have had no other options via the NZ public health system. Access to this program was only for those with no other treatment options who had the BRAF V600 mutated metastatic melanoma. The medicines were not available commercially in New Zealand at the time. Patients were not asked to pay for these medicines.

As the New Zealand scheme was an extension of the European scheme, it came with logistical challenges. In addition, trametinib required specialised transport as the medicine needs to be kept at a cold and consistent temperature.

We had to make the difficult decision to provide access to this treatment and help patients with metastatic melanoma to knowing that it had some supply risks or alternatively not provide the treatment at all. For us, there really was no choice; we were aware of the risk and challenges we were going to have to manage but felt strongly this was outweighed by the needs of kiwis to have access to this treatment given that there were no other options available.

There were no interruptions to supply to the core component of treatment, dabrafenib. However the additional component of therapy (trametinib) did face some interruptions. As far as we are aware, this may have affected around 20 patients for approximately one month. All oncologists and oncologist specialist pharmacists were informed of the supply constraint and the reasons for the disruption.

During the supply constraints we worked with what we had in New Zealand, shifting stock around hospital pharmacies, ringing others to ask for any stock they had which we could share with others and making arrangements at our expense to transport the stock where needed. When an oncology pharmacist contacted us in need of supply, we went to significant efforts to make stock available where possible.

Life-threatening illnesses like cancer are terrible for patients and their loved ones. Our goal is to discover innovative medicines that help improve people’s lives and we are committed to finding innovative ways of getting them to the people who need them.