Weakened by aggressive skin cancer, Sheylla dos Reis Ribeiro, 42, depends on her mother, Cleusa Pereira dos Reis, 66, to survive. The patient is fighting in court to obtain treatment through the Unified Health System (SUS) of the Federal District (DF). Dona Cleusa is depressed every day by her daughter’s tears and anguish.
“She’s crying. It hurts me a lot. She needs medicine. What mother doesn’t cry when she sees her daughter suffering?” she said. According to Cleusa, Sheylla no longer has the strength to perform simple routine tasks or even walk down the street. “We cannot afford to buy this medicine,” he added.
According to Cleusa, her daughter is in a difficult situation. “My daughter was very beautiful, very beautiful. She is so thin, so thin that it hurts my heart to see her in this situation. This medicine does not cost the government that much. Release the medicine so that my daughter can live,” he said.
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Sheylla’s fight for life has sparked debate over updating the list of medications offered by the SUS. Desperate, she feels mistreated by the public network. Indeed, even if new drugs likely to save her were introduced by the Ministry of Health (MS) more than five years ago, they are not yet made available to public hospitals.
The woman was diagnosed with melanoma in 2020. She began treatment via SUS, but the medications and therapies offered at the time did not yield any results. The patient then approached a private hospital and the doctor recommended treatment with Nivolumab and Ipilimumab.
However, both drugs were not covered by the SUS and the cost of the therapy amounted to R$342,000. Seeking a chance to survive the aggressive progression of the cancer, Sheylla took legal action in the High Court (TJDFT) to gain access to the medication. Without success.
“It’s unfair. We pay taxes. And they know that the SUS drugs are not effective against my cancer. The doctors who treat me know that the drugs I take are not effective. They are worried,” he said.
Authorization from the Ministry of Health
Contacted by the report, the Ministry of Health said that Nivolumab had already been incorporated into the list of medicines. According to the ministry, in accordance with the decision of the National Commission for the Incorporation of Technologies (Conitec), the drug was incorporated into the SUS for the first-line treatment of non-surgical and metastatic advanced melanoma.
“The best available scientific evidence is analyzed, covering analyzes of effectiveness, safety and cost-effectiveness. Currently, the department is carrying out the administrative process of acquisition and effective offering to patients,” the ministry said.
According to the file, the drug Ipilimumab received an unfavorable opinion at Conitec and, at the moment, there is no new request for analyzes to integrate technologies intended for the treatment of melanoma.
Immunotherapies
Treatment with Nivolumab and Ipilimumab is a form of immunotherapy. According to the director general of the National Cancer Institute (Inca), Roberto Gil, there is not a single immunotherapy: there are several drugs in this class.
“The combination between Nivolumab and Ipilimumab is just one of these therapeutic options. In total, immunotherapies currently have around 54 different indications. However, the prices of these drugs remain very high, which represents a great difficulty of access,” he explained.
In isolation, Inca does not conduct studies to incorporate drugs. The organization is part of the integrated health system and can, with Conitec, participate in evaluations of possible inclusions. One of the challenges is to analyze the effectiveness of therapies taking into account budgetary parameters and the capacity to offer them to patients.
Inca maintains clinical research protocols to evaluate the effectiveness of certain medications, but these studies are clinical research in nature and are not directly incorporated into the SUS.
“The first step of any new technology is to analyze a specific oncological pathology and evaluate the entire field of care, including chemotherapies and other systemic therapies, to define whether an action plan will be protocolled,” explained Roberto Gil.
For the incorporation of drugs, the Ministry of Health works with Clinical Protocols and Therapeutic Guidelines (PCDT).
If incorporated, the drug must be adopted by all SUS institutions, respecting the principle of equity, never in isolation by a single unit.
Secretary of Health
The DF Health Directorate informed that the patient is being monitored by the public health network and that he is regularly scheduled for consultations and examinations, including an oncology consultation scheduled for this Thursday (12/18).
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