MONTREAL - A Quebec cancer coalition is calling the province's treatment of the deadly disease second-rate, because the provincial health authority (RAMQ) will not fund certain chemotherapy drugs.

The decisions are actually made by another government body, the National Institute of Excellence in Health and Social Services (INESSS), which issued its list of authorized medications this week.

Four cancer drugs, Afinitor (a drug of last resort for metastasized kidney cancer), Alimta, Tarceva and Iressa (lung cancer) did not make the cut.

Several other drugs, namely Avastin (breast cancer), Herceptin (stomach cancer), Revlimid (myeloma) and Rituxan (leukemia) are still being evaluated.

The full list of approved drugs, along with those not funded by public health care and the reasons why, is available online.

Afinitor was refused as being too expensive and not having enough of a benefit.

Tarceva, which was accepted on a temporary basis in 2006, has now been refused.

Iressa and Alimta were first refused in 2005, then reviewed last year and once again refused as being too expensive.

Members of the coalition are disappointed, especially because INESSS refused to cover drugs based on expense, because Health Minister Yves Bolduc said last year that efficacy, and not the cost, would be the deciding factor.

For his part Bolduc says that there are different views, and he is not risking lives in favour of saving money.

He also said that he does not interfere with the decision-making by INESSS.

Doctors who focus on cancer, like oncologist Marie Florescu, say the drugs that have been denied are the best of the best.

"It's very difficult for us to be honest but we should be honest with the patients and we have to tell them... we have to go with the tools we have, the chemotherapy we have, and we don't have the best," said Dr. Florescu.

She added that not using the best drugs available goes against her medical ethics.

Meanwhile members of the coalition, at a news conference on Tuesday, said that charities which raise millions of dollars each year for cancer research should consider diverting funds to paying for expensive medications.

Alimta costs $3000 for a three-week course of treatment, and requires at least two sessions in order to know if it was effective.