2023-08-08 08:49:47
Susana Ketterer is faced with the decision to pay out of her pocket about 6,000 euros a month for a new generation treatment against her metastatic colon cancer since, despite being available in Spain, it is not financed by the National Health System. “How long can I afford it? Do I totally decapitalize my family? ”, She asks herself.
Ketterer, 60 years old and diagnosed since 2021, is part of a group of colon cancer patients with the V600E mutation in the BRAF gene, an aggressive type of tumor with a poor prognosis, which accounts for about 10% of all cancers colorectal disorders, some 4,000 diagnoses a year, awaiting new treatment options.
For this reason, his hope is placed in an oral biological therapy directed against the BRAF mutation, the active principle encorafenibwhich is prescribed in combination with another injectable, the cetuximabtargeting another receptor, EGFR, for patients with previously unsuccessful metastatic colon cancer.
A therapeutic combination approved by the US regulatory agencies, the FDA, and European, the EMA; authorized by the Spanish Agency for Medicines and Health Products and financed in some of the European countries around us.
However, the Interministerial Commission on Medicine Pricesin a public note from the meeting of March 2, 2023, agreed “not to include this medication in the pharmaceutical provision of the National Health System (SNS), taking into account the existence of medications or other similar therapeutic alternatives at a lower price or lower cost of treatment, as well as criteria for rationalizing public spending and budgetary impact”.
EFEsalud has consulted the Ministry of Health on this matter and the possibility of resuming the approval of its public financing but, for the moment, has not received a response.
Colon cancer patient Susana Ketterer in a file photograph provided by her.
Oncologists: A benefit for patients with a poor prognosis
He President of the Spanish Multidisciplinary Digestive Cancer Group (GEMCAD), oncologist Jorge Aparicioaffirms that his group has sent letters to the Ministry of Health asking them to reconsider the decision and explaining that the efficacy of this combined therapy “is significantly superior to conventional treatment” with the consequent “benefit for these patients with a poor prognosis”.
A therapeutic strategy that adapts precision medicine “by targeting a certain molecular profile”, the BRAF and EGFR targets, and that is based on the BEACON international studio in phase III, which means an increase in survival of three months for the group that tested the new combination compared to the group that continued with conventional treatment.
“In oncology, a median survival of three months is a significant difference, it is a relevant benefit. It is a median, there are patients who can live much longer with this treatment” and with less toxic effects than with chemotherapy, emphasizes the oncologist.
The also head of section in the Digestive Tumors Unit of the Medical Oncology Service of the La Fe University and Polytechnic Hospital in Valencia estimates that about 10% of colorectal cancer diagnoses present the BRAF mutation, about 4,000, although it is difficult to calculate how many of them would be candidates for the new therapeutic indication.
What alternative does Susana have?
Susana Ketterer, who lives in Madrid, is one of those affected who could benefit. “My need is immediate,” the patient who is about to finish chemotherapy, a previous step to start the new treatment, told EFE but she found that it was not financed.
If you can’t afford it, the alternative is other types of chemotherapy “which have horrible side effects and also diminishing effectiveness,” as her oncologists have explained to her.
She has metastases in different organs, her day to day is difficult: “I feel very deteriorated and very tired, every two by three I am in the hospital. My family and friends are very supportive, but my house is a vale of tears.”
A civil servant by profession, she has contributed 36 years to the General Mutual Society of Civil Servants of the State of Spain (MUFACE), “many years for them to leave you lying around now,” she laments.
José Antonio has already begun to draw on savings
José Antonio Abella, 67 years old and living in Segovia, also feels abandoned by the health system. He has been paying for this colon cancer treatment for almost two months with the salary of a retired doctor, so he has had to resort to savings after 38 years contributing to MUFACE.
“We are in a dilemma, we all want to continue living, I can pull savings for a year, no more”, he affirms, in addition to assuring that he has already noticed some improvement with the new therapeutic scheme.
He considers that the decision not to finance this medicine “is an invisible death penalty” for some patients whose median survival “is between four and eight months” and who do not have better alternatives, “other old basic treatments are not effective ”.
Has taken legal action against MUFACE; has opened one signature petition on Change.org and has denounced the situation before the Spanish Group of Cancer Patients (GEPAC), an association that has developed two protocols to activate cases due to the lack of equity and delay in the approval of cancer drugs.
“We are creating a health system for the rich and the poor in Spain and condemning to death many patients who cannot afford these treatments,” says EFE the President of GEPAC, Begoña Barragánwho on July 5 met with the Minister of Health, José Miñones, to present the aforementioned protocols and raise the situation of José Antonio Abella, but without obtaining a concrete response in this case.
“No one chooses to have cancer, or a certain mutation, which is why I ask that when it is the only possible treatment option, a mechanism is created so that patients do not have to die, that they are given the drug in an exceptional way”, concludes Barragán in order to find a solution for patients like Susana or José Antonio.
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