Every three weeks Kay Barry travels from her home in Limerick to the cancer centre in Cork University Hospital, where she spends half an hour receiving treatment on a drip.
The substance coursing into her body is pembrolizumab, the latest blockbuster cancer drugs that has transformed the treatment of Barry and other patients.
Pembrolizumab is more effective and has fewer side-effects than “ippi” (ipilimumab), which itself was credited with major improvements in survival rates when introduced three years ago.
Barry is one of about 100 patients to whom the drug was made available by the manufacturers, MSD, under an early-access scheme. In contrast, at least 30 patients with advanced cancer cannot access the drug, and their number is growing.
Numerous controversies over the enormous costs of new drugs have erupted. This one is different because “pembro” has been found to be cost-effective.
All that remains is for the HSE to rubber-stamp the decision of the National Centre for Pharmacoeconomics and approve the drug. However, the HSE’s drugs committee has not met since March and so no approval has issued.
Barry, who has lived with cancer since 2002, has been on both ippi and pembro. She says the switch to pembro last year has improved her quality of life and prospects of good health.
"I feel lucky that I got it. In my case I think the combination of surgery and pembro kept me alive and is giving me a good quality of life. My oncologist Derek Power in Cork is happy with my progress. I feel the drug has stabilised my health."
In 2014, she had surgery to remove three brain melanomas and whole brain radiotherapy to remove a fourth. Despite this treatment and the use of ippi, she developed bowel complications and required surgery.
She was put on pembro last July and since then, she says, her scans have been largely clear and her tiredness has diminished.
Pembro doesn’t come cheap. In Ireland, the five-year total cost of the drug as a first-line treatment for melanoma alone has been estimated at €63 million. The cost of using it on patients who have tried ippi without success and, later, to treat other cancers, would obviously be far greater.
Prof John Crown said there are indications the new immunotherapies are effective against a wide range of cancers, including of the lung, kidney and bladder.
Health services everywhere are struggling to cope with the huge cost. In Ireland, a decision is due soon for another blockbuster drug, Orkambi, which costs €160,000 per year to treat a cystic fibrosis patient.
The massive cost of these new treatments is supposed to be paid from savings on the HSE’s current drug bill, but negotiations with the pharmaceutical industry have stalled. The Government has signalled the HSE will unilaterally cut the prices it pays for drugs, but success is not guaranteed.
Pembrolizumab and nivolumab are likely to replace ippi, the first new drug of this type to enter the market.
Results show a 74 per cent survival rate after one year on pembro, compared to 58 per cent on ippi, and 40 per cent survival after three years.
Oncologists want access to the best drugs, but the issues around cost make some uneasy. Dr Kyran Bulger admits doctors and patients have become "addicted" to the supply of novel treatments from drug firms under compassionate access programmes.
This is in contrast to the UK, where such programmes were not allowed, he says.
As an accountant, Barry is keenly aware of the high cost of the treatment she is receiving and the financial pressure the HSE is under. “But if you knew there was a drug out there that could keep people like me alive and keep up our health and quality of life, it’s hard to understand why you wouldn’t fund it.”