A Herceptin-style drug that can offer some women with advanced breast cancer nearly six months of extra life has been turned down for use in the NHS because of its high cost.
In draft guidance now open to consultation, the
But the decision was slammed by Roche and by some breast cancer charities, who say the drug is needed and that Nice has turned down too many breast cancer drugs already.
The drug, called Kadcyla (generic name trastuzumab emtansine), is already being paid for through the dedicated
But the Nice verdict raises questions about the future of such expensive cancer drugs once the fund ceases to exist at the end of
Kadcyla is a new kind of medicine, according to Roche, combining Herceptin (trastuzumab) with a chemotherapy agent. It is designed for women with HER2+ cancer which has spread to other parts of the body and is inoperable.
It is not a cure, but in trials it extended life by a median of 5.8 months, compared with the current combination of lapatinib plus capecitabine.
Nice says the drug does not work well enough to justify the price tag and called on Roche to rethink during the consultation period.
"We had hoped that Roche would have recognised the challenge the NHS faces in managing the adoption of expensive new treatments by reducing the cost of Kadcyla to the NHS," said Nice chief executive Sir
"This drug is already being funded through the special
"We apply as much flexibility as we can in approving new treatments, but the reality is that given its price and what it offers to patients, it will displace more health benefit which the NHS could achieve in other ways, than it will offer to patients with breast cancer."
The cost of Kadcyla is tens of thousands of pounds more than existing second-line treatments for this cancer, said Nice.
"The drug tackles the disease in a different way to any other breast cancer medicine and provides women with valuable extra time with their families and loved ones - time that you cannot put a price on. Not only this, Kadcyla is also much better tolerated by women than current standard treatment options, causing much less in the way of traditional chemotherapy associated side effects. As such, the quality of life of women taking Kadcyla is significantly improved."
Around 1,000 women a month die of advanced breast cancer, although not all of them have the HER2+ variety which the drug targets.
A spokesperson for NHS England said: "
"A negative Nice appraisal on trastuzumab emtansine will not affect the availability of this drug via the
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