How a pioneering breast cancer drug trial transformed treatment for Australian women

Donna Rullo was forty years old when the diagnosis came through: HER2-positive breast cancer, the aggressive kind that grows fast but responds well to targeted drugs. It was early 2001, and in Australia, there was a problem. The drug that could help her—trastuzumab—wasn't available to patients outside of clinical trials. Women who needed it were paying fifty to seventy thousand dollars a year out of pocket, or they weren't getting it at all.

Rullo made a choice that would reshape the landscape for thousands of women who came after her. She heard that oncologist Richard Bell was running a trial for this new drug, so she drove five hours from her regional fruit farm to Melbourne to hear him speak. She called him once a week until he agreed to enroll her. When the call came confirming her place in the HERA trial—the HERceptin Adjuvant study that would eventually include more than five thousand patients across thirty-nine countries—she wept. "He said: 'It's Richard, I just wanted to tell you, you're patient number one of the HERA trial,'" she recalls. "I just cried and cried. I couldn't stop. I was so emotional." She was thinking of her son, then a boy, and the future she might see.

The trial proved what researchers had hoped: taking trastuzumab for a year significantly improved long-term disease-free survival for patients with HER2-positive early breast cancer. But proof on paper didn't automatically translate to access. Women continued to face impossible choices—selling houses, selling farms, selling holiday properties to afford a drug that might extend their lives by years or decades. Lyn Swinburne, who founded Breast Cancer Network Australia, heard these stories directly. "I was hearing from women who were selling their houses, selling their holiday houses, selling their farms to try and get this drug," she says. "Probably knowing it wasn't going to save their lives necessarily, but it was going to extend their lives, and especially when you've got young children, that's really, really important."

Swinburne and former Olympian Raelene Boyle, herself a breast cancer survivor, decided to act. In June 2001, they invited Prime Minister John Howard to Boyle's fiftieth birthday party and seated him between them. They talked to him all night about trastuzumab and what it meant for women facing this disease. The strategy worked. By late 2001, the government announced a special program allowing women with HER2-positive metastatic breast cancer to access the drug for free. Then, on October 1, 2006—twenty years ago to the day from the article's publication—trastuzumab was added to the Pharmaceutical Benefits Scheme for patients with HER2-positive early-stage breast cancer. The price barrier dissolved.

The impact rippled outward. Trastuzumab became the most common HER2-targeted therapy offered in Australia and New Zealand, often given alongside surgery, chemotherapy, radiation, or other targeted treatments. It works by attaching itself to the HER2 receptor on cancer cells, essentially disarming them. One in five breast cancer cases are HER2-positive, which means the drug's availability transformed care for a substantial population.

The broader picture has shifted too. Breast cancer remains common in Australia—one in seven women will be diagnosed over her lifetime—but survival has improved dramatically. Between 2017 and 2021, the five-year survival rate reached ninety-three percent, up from seventy-five percent in the late 1980s and early 1990s. Medical oncologist Rachel Dear at St Vincent's Hospital in Sydney attributes this to earlier detection, greater awareness, and crucially, more personalized and targeted treatments. "Treatment has changed depending on which subtype of breast cancer we're looking at," she says. "There are three main types of breast cancer, and within each of those three types, there are more drug treatment options that have improved survival rates."

Rullo has lived to see her son grow into a man, marry, and have two children of his own. She considers herself fortunate, and she speaks now to others facing uncertain diagnoses: learn everything you can, she says, and advocate for yourself if you need to. Her decision to join that trial twenty-five years ago, her persistence in calling Richard Bell week after week, her willingness to drive five hours for a chance—it was personal. But it became something larger. The drug that saved her life is now accessible to thousands, and the survival rates for women with her diagnosis have transformed.