Key points
- There are a number of targeted therapies available for advanced breast cancer.
- Some of these are publicly funded in New Zealand. Unfunded medicines can be accessed by GPs, on behalf of their patients, or through Cost Share Programmes.
- Clinical trials can be beneficial to identify treatments that would otherwise not be available through the public health system.
HER2+ advanced breast cancer
There are several targeted therapies available for HER2+ advanced breast cancer. Trastuzumab (Herceptin) is publicly funded in New Zealand and patients may benefit from prognostic testing or clinical trials to identify further treatment options.
Trastuzumab (Herceptin)
Trastuzumab is the most widely used targeted therapy to treat HER2+ mBC. It can be given with other chemotherapy drugs and is administered every three weeks via IV infusion - funded, or SC injection - unfunded, for as long as the patient continues to benefit. For more information about Herceptin and possible side effects see the Medsafe consumer information booklet.
Pertuzumab (Perjeta)
This is another monoclonal antibody treatment that is used to treat advanced/metastatic HER2+ breast cancer. It is given by intravenous infusion and is administered every three weeks. Perjeta is used at the same time as Herceptin and docetaxel chemotherapy. Perjeta is currently indicated for patients with HER2+ metastatic breast cancer who have not received previous anti-HER2 therapy or chemotherapy for their advanced disease. As of January 2017, Perjeta is funded for use in the New Zealand public health system. For more information about Perjeta and possible side effects see the Medsafe consumer information.
Trastuzumab emtansine (Kadcyla)/TDM-1
This is known as an antibody drug conjugate, combining an antibody and a chemotherapy drug. It can be used to treat metastatic HER2+ disease. Kadcyla uses the monoclonal antibody in trastuzumab to deliver DM-1 directly to the inside of the cancer cells while minimising the effects on healthy tissues. It is delivered every three weeks via IV infusion. Kadcyla is publicly funded for New Zealanders with HER2+ advanced breast cancer. For more information about Kadcyla and possible side effects see the Medsafe consumer information.
Lapatinib (Tykerb)
Lapatinib is a small-molecule drug belonging to a group known as Tyrosine Kinase Inhibitors, which target both HER2 and epidermal growth factor receptor (EGFR) pathways. It is publicly funded for people with metastatic HER2+ breast cancer that have not been treated with Herceptin, or for people who have not been able to tolerate Herceptin in this setting. Lapatinib is an oral chemotherapy, given in combination with capecitabine (Xeloda) or paclitaxel (Taxol). It can also be given with an aromatase inhibitor. Treatment can continue after chemotherapy for as long as the cancer responds. Lapatinib is not publicly funded in New Zealand. For more information about Lapatinib (Tykerb) and possible side effects see the Medsafe consumer information.
Hormone/Estrogen receptor-positive advanced breast cancer
There are a number of therapies available for hormone receptor-positive advanced breast cancer. Palbociclib is publicly funded in New Zealand and prognostic testing and clinical trials may identify further avenues for treatment.
CDK4/6 inhibitors:
This treatment is a small molecule that targets cyclin-dependent kinases (CDK4/6). These are proteins that inhibit cell proliferation and help mediate endocrine resistance.
Palbociclib (Ibrance)
Palbociclib is indicated for use in post-menopausal women with estrogen receptor positive (ER+), HER2- locally advanced or metastatic breast cancer. It is given in conjunction with an aromatase inhibitor. In women who have had prior endocrine therapy it is given with fulvestrant. This therapy is delivered as a tablet, taken once a day for three weeks, followed by a week for recovery before starting again. Palbociclib has been publicly funded in New Zealand since April 2020.
KISQALI (ribociclib, formerly called LEE011)
KISQALI can be used in combination with an aromatase inhibitor as initial therapy to treat advanced HR+(?), HER2-negative breast cancer in postmenopausal women. KISQALI is a tablet, taken orally. It is not registered for use or funded in New Zealand.
Abemaciclib (Verzenio)
Abemaciclib stops the proliferation of cancer cells in HR+, HER2- locally-advanced or metastatic breast cancer. While it is registered in other countries as a first and second-line treatment, it is not registered in New Zealand.
Other targeted therapies:
Everolimus (Afinitor)
Everolimus belongs to a class of drugs known as mTOR inhibitors, which target the mTOR proteins that fuel cancer cell growth and division. It can be used in post-menopausal women with metastatic HR+, HER2- breast cancer, in conjunction with exemestane (Aromasin), but only if the patient has previously been treated with AIs. It is taken as a daily tablet. It is not funded in New Zealand.
Triple negative advanced breast cancer
From 1 October 2025, Keytruda (pembrolizumab) is funded for advanced Triple Negative Breast Cancer (TNBC).
Keytruda
Keytruda (Pembrolizumab) may be given alongside chemotherapy in advanced triple negative breast cancer and where the tumour also expresses the PD-L1 protein. Keytruda is a type of monoclonal antibody and checkpoint inhibitor that binds to the protein PD-1 to help immune cells recognise and kill cancer cells. It is funded for eligible patients.
Atezolizumab (Tencentriq)
Atezolizumab is an immunotherapy treatment and is used in combination with chemotherapy. It works by attaching to a protein called programmed death-ligand 1 (PD-L1), which is found on some tumour cells, and this makes it easier for the immune system to target cancer cells. It can be used in patients with advanced triple negative breast cancer, and is given intravenously every two weeks. Atezolimuzab is not publicly funded in New Zealand, although Roche offers a Cost Share Progamme to assist with the cost of the medicine.
