VIII Franco Brazilian Congress of Oncology

Breast cancer challenges in Brazil

Dr Gilberto Amorín – Brazilian Nacional Cancer Institute, Rio de Janeiro, Brazil

We have a huge number of patients in Brazil that came with breast cancer with a large tumour mass. Some of these patients are HER2 positive so we are aware to use the trastuzumab in this population before the surgery and concomitant with the chemotherapy. The new paradigm is the dual blockade: we have to use two different drugs. Sometimes the studies are talking to use lapatinib in combination with trastuzumab; other times we have to combine two antibodies like pertuzumab and also trastuzumab. We have some new research in this area, even in the advanced breast cancer we have recently seen the results in Madrid from ESMO 2014, the combination of pertuzumab and trastuzumab, a huge gain in survival. So the paradigm in the neoadjuvant setting is how to introduce these two drugs first, not after the surgery, for a patient with a distant metastasis but in order to reduce the tumour, improve the pathological clinical and pathological response. So we are discussing these aspects because in Brazil we are not allowed to use the double blockade, we are allowed only to use the chemotherapy with trastuzumab, not chemotherapy, trastuzumab and pertuzumab. We know that in the United States the FDA approves the combination of the two monoclonal antibodies so we are discussing this type of information. Probably in not a long time from now we are able to combine these drugs and to improve our results.

What access does the regular oncology patient have to these adjuvant treatments in Brazil?

In Brazil, especially for the HER2 population, in the adjuvant and the neoadjuvant setting we have at this time the opportunity to use chemotherapy with trastuzumab. We have problems with access to the drugs for the public hospitals to use the trastuzumab and the other compounds in adjuvant disease, the drug is not allowed to be used for this population. But in the private scenario we have in Brazil probably 30-40% of the population has some insurance company so we don’t have any problems to use pertuzumab, lapatinib, the new TDM1, this is a new drug that’s also approved in Brazil. But we have this difference between the patients with breast cancer in the public health system and the private systems. So this is a problem for us.