Funding Keytruda for melanoma but not for lung cancer is racist, health advocates say

Tuesday, 7 December 2021

Today marks World Lung Cancer Day and the Lung Foundation is seeking better funding to treat New Zealand’s deadliest cancer. (First published August 2018)

Pharmac has been accused of institutional racism and breaching the Treaty of Waitangi for funding drugs for melanoma, but not lung cancer – a disease responsible for a disproportionately high number of cancer deaths among Māori.

Cancer Society medical co-director and Hei Āhuru Mōwai, Māori Cancer Leadership Aotearoa spokesman George Laking said a 2016 decision to fund immunotherapy drug Keytruda to treat advanced melanoma had created an unjust precedent.

“Here’s the tricky thing: melanoma is a disease that, all things considered, is more likely to happen in people of fairer complexion.”

Lung cancer accounts for about 20 per cent of all cancer-related deaths in New Zealand, with incidence and mortality rates up to four times higher for Māori and Pacific people.

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Lung cancer robs about 300 Māori whānau of loved ones each year. In August, Mero Rokx and her children Natia and Te Uranga o te Rā lost their mother and grandmother, Huhana Rokx.

Laking said it was hard to escape from the conclusion that the funding policy was racist.

But the medical oncologist also took aim at multinational pharmaceutical company Merck Sharp & Dohme (MSD), which manufactures and supplies Keytruda, saying the drug was “over-priced”.

Lung cancer specialist George Laking says Pharmac’s policy on immunotherapy drugs is inequitable and a breach of Te Tiriti of Waitangi.

“I’d go so far as to say it’s price gouging.”

The company had capped the cost of Keytruda for New Zealand patients at $60,000, with a three-weekly infusion costing about $8000, MSD New Zealand managing director Paul Smith said.

Lung cancer has by far the biggest gap in death rates between MÄori and non-MÄori. Source: NZ Cancer Action Plan

Laking’s comments follow the release of a report on lung cancer in the Asia Pacific region by the Economist Intelligence Unit, sponsored by MSD, which found New Zealand was on par with the Philippines and Thailand in respect to lung cancer funding.

Of seven drugs used across 13 non-small cell lung cancer indications, none were funded in New Zealand.

Pharmac operations director Lisa Williams says the drug-buying agency has several applications pending for lung cancer treatments.

This was in stark contrast to Australia and Japan, which funded 11 and 13 of the indications respectively, the report found.

Pharmac, which has a budget of more than $1 billion and funds about 1000 medicines for 3.7 million people, is currently under review by an independent panel appointed by the Government.

A damning interim report released by Pharmac Review last week found the agency's medicine-buying strategy appeared to disadvantage Māori, Pasifika, disabled people and those with rare disorders.

A 2020 study by Waitematā health board staff, published in the New Zealand Medical Journal, found cancers of the airways caused by smoking tobacco were responsible for one year of the seven-year life expectancy gap between Māori and Pacific people and non-Māori/non Pacific people.

Laking said while there may be evidence of greater efficacy of Keytruda for melanoma, the much poorer outcomes for Māori lung cancer patients had not been taken into account.

Pharmac’s director of operations, Lisa Williams, said the decision to fund two immunotherapy drugs for melanoma “was based on its relative value compared to all other funding applications we were considering at that point in time, as well as available budget”.

Pharmac had “several open applications for treatments for lung cancer”, she said.

Merck Sharp & Dohme New Zealand managing director Paul Smith says the company has made multiple applications to Pharmac for funding of Keytruda for certain lung cancer patients.

“They are medicines that we would like to fund, when there is budget available.”

Williams said the agency was focused on ensuring New Zealanders had equitable access to funded medicines, but “solutions to health inequities do not lie solely with the funding of medicines, or even within the health system across the board”.

MSD had put in several applications to Pharmac for funding of Keytruda for lung cancer over the past five years, Smith said.

The company’s 20-year patent on the drug had a “few years yet”, before generic versions could be made, allowing competition on price.

Smith said the high price reflected the company’s investment in the drug’s development and the cost of paying for thousands of clinical trials.

Professor Diana Sarfati – chief executive of Te Aho o Te Kahu, the Cancer Control Agency – said the agency continued “to talk with Pharmac about ensuring equity is central to their decision-making” but had not specifically advocated for the funding of Keytruda for lung cancer patients.

“As an independent agency, Pharmac is solely responsible for what medications are funded.”

Melanoma New Zealand chief executive Andrea Newland said the organisation “unequivocally” supported equitable access to treatment for all cancer patients.

“Properly funding lung cancer (or any other) drugs shouldn’t come at the expense of others – access to treatment should not be an either/or situation.”

Lung Cancer Foundation chief executive Philip Hope said the Government and its agencies talked about inequity for Māori, but had so far not acted to address it.

“It’s really quite saddening because we are losing our most vulnerable primarily because they don’t have access to a standard of care … because they don’t have the … means to pay for it.

“How can that be fair?”