Alberta's advanced prostate cancer patients urge Health Canada for public access to life-saving treatment

Alberta's advanced prostate cancer patients are hopeful that a new type of radiation treatment will soon be made available to the general public following a series of successful clinical trials.

Radioligand Therapy (RLT) is a precise targeting of cancer cells with radiation given intravenously.

"This really harnesses the power of radioactive atoms," said Dr. Steven Yip, a medical oncologist at the Tom Baker Cancer Centre and RLT expert.

"We understand that when patients are very heavily pre-treated and they have advanced disease and are running out of options, this can improve their survival."

Yip notes that RLT's effectiveness is prolonging life for patients with metastatic prostate cancer, often with considerably lower side-effects than traditional chemotherapy.

Dale Pfahl is a 67-year-old rancher from the Southern Alberta hamlet of Rolling Hills who was first diagnosed with prostate cancer in 2016.

Now, in Stage 4, he recently received his first RLT treatment as part of a clinical trial just three weeks ago, but had to travel to Burnaby, B.C., to access the treatment.Dale Pfahl and his wife Lacey on their ranch.

"I guess, like everybody else, you're kind of shocked when you find out you have cancer, but I'm trying to have a positive mindset" Pfahl said.

"If this treatment works as good as they say it does – and I think it is it could be life-saving – it should be made available to anybody with prostate cancer."

Currently, only a small number of patients are being treated with RLT at specific hospitals outside of Alberta.

Prostate cancer patients who aren't in a clinical trial don't have free access to it, and must pay out of pocket.

Past clinical trials, however, have already shown RLT's effectiveness, leading to Health Canada approving Pluvicto – the radioactive drug that kills the targeted cancer cells – in August 2022 for patients whose prostate cancer has spread and chemotherapy has failed.

Now, two years later, the drug is still not publicly available for advanced prostate cancer patients, because the pan-Canadian Pharmaceutical Alliance is still negotiating with manufacturers on how much it should cost government health plans.

Yip says he knows all parties are working very hard, and in the meantime, he's continuing to advocate for his patients

"I'm trying to find other ways in which we can get access for our patients, so that's through clinical trials," he said.

"There are some programs in which patients might have to consider going out of province, but even still, even those patients in other provinces where it is accessible, it still means that patients are potentially having to pay out of pocket – and certainly that isn't something that I want to support.

Yip is pushing for fully funded therapy for our patients in Calgary, and certainly at the new cancer centre moving forward.

It's promising news for Pfahl, who says it would make a huge difference in lowering his costs to receive care.

"I guess the biggest pain for me and probably for a lot of patients in Alberta, and a lot of other places, is the fact that I'm three hours from Calgary," he said.

"We live on a ranch in southern Alberta, so it's a three hour drive to Calgary, and then an hour flight, and then I have to stay in Burnaby or Vancouver or wherever, so just the cost of travel and the cost of staying, it would sure be nice if there was a place in Alberta to get this care."

Currently, RLT for cancer treatments is only publicly available for patients with neuroendocrine tumours, an uncommon but not rare cancer that starts in neuroendocrine cells in the gastrointestinal system or the pancreas.

A drug called Lutathera is used specifically for neuroendocrine tumours, and was already approved in Canada as a last line of cancer treatment, but recent trial results published in The Lancet earlier this year show it could be used as a starting treatment.

In addition to neuroendocrine and prostate cancer, RLT treatment using different radioactive drugs is currently in clinical trials for other types of cancers.

Negotiations ongoing

Alberta Health Minister Adriana LaGrange says the province is aware of RLT as a treatment and hopes to make it more accessible to prostate cancer patients in the future.

"Alberta's government is committed to exploring innovative treatments," said LaGrange in an emailed statement.

"Following the completion of negotiations and a thorough review of the treatment, Alberta Health will evaluate the potential integration of Pluvicto into the health-care system."

Global pharmaceutical company Novartis manufactures both Pluvicto and Lutathera.

Both the company and the agency in charge of negotiating drug pricing confirmed to The Canadian Press that they have not yet reached an agreement on how much Pluvicto should cost.

The negotiations began in August of last year, but then had "an unanticipated delay," said Dominic Tan, acting CEO of the pan-Canadian Pharmaceutical Alliance (pCPA) in an emailed statement.

"The pCPA always strives to complete the process as quickly as circumstances allow," Tan said.

"However, negotiations are a two-way street, and as such we are unable to provide a precise timeline for when the process will be complete."

Novartis said it recognizes the "high unmet need" of advanced prostate cancer patients.

"It is with these patients in mind that we continue to actively collaborate with the pCPA with the goal of achieving timely and responsible access to this therapeutic advance," Novartis Canada spokesperson Rosa D'Acunti said in an emailed statement.

"We are hopeful that an agreement with pCPA that recognizes the significant innovation Pluvicto represents and the value it brings to patients is within reach."

With files from The Canadian Press