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The National Institute for Health and Care Excellence (NICE) has today (22 May 2020) approved atezolizumab (Tecentriq) in combination with chemotherapy drug nab-paclitaxel (Abraxane) for routine NHS use in England for certain patients with triple negative secondary breast cancer.
Atezolizumab (Roche) is an immunotherapy for use in treating newly-diagnosed patients with triple negative locally-advanced or secondary breast cancer whose tumours produce the protein PD-L1. There is an accompanying test to identify women whose cancers are PD-L1 positive.
Atezolizumab works by attaching itself to the PD-L1 protein on cancer cells, blocking it and reactivating an individual’s immune system to recognise and attack the cancer.
A major trial (IMpassion 130) demonstrated that atezolizumab with nab-paclitaxel delayed the progression of the disease by an additional 2.5 months on average, compared with nab-paclitaxel alone (7.5 months versus 5 months respectively). Additional informal analysis also suggests the treatment combination may also offer up to seven additional months of life on average, compared to nab-paclitaxel alone.1
Atezolizumab with nab-paclitaxel was provisionally rejected by NICE in October 2019 as it was not considered cost-effective. Through the Early Access to Medicines Scheme and then subsequently a free of charge scheme, the treatment combination has been available in some parts of England since March 2019.
It is estimated that around 600 people each year in England will now be eligible for treatment with atezolizumab with nab-paclitaxel.
Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, the research and care charity, said:
“It is fantastic news that this ground-breaking immunotherapy will now be available on the NHS for hundreds of secondary breast cancer patients and will provide hope of extra time to live well.
“With very few options to rely on and life expectancy still heartbreakingly short, triple negative secondary breast cancer remains one of the biggest areas of unmet need in breast cancer, and this new treatment now signals a landmark advance in care.
“This is the first immunotherapy to be available for women with secondary breast cancer on the NHS and it’s really exciting that it could now give hundreds of patients precious extra months before their disease progresses. The latest evidence suggests the treatment combination may also help extend their lives, offering women and their loved ones the hope of more time together, which will be really treasured.
“With some cancer treatments currently being paused or changed due to the coronavirus outbreak, it is important that this new immunotherapy, and its risks and benefits at this time, is discussed with any eligible patients. The decision to start this treatment must be made collaboratively with patients, doctors and multidisciplinary teams to ensure the right choice for each person, and it’s vital everyone has the information and support they need.”
On the appraisal process that has now seen the approval of atezolizumab with nab-paclitaxel, Baroness Morgan added:
“While we’re delighted this decision has now been made possible following an agreement between NHS England and Roche, it is really concerning that drawn-out negotiations have resulted in a seven-month delay in this immunotherapy reaching all patients that could benefit.
“Faster progress for patients had been promised through changes to the appraisal process but this unfortunately hasn’t materialised in this instance. It is crucial that NHS England, NICE and the pharmaceutical industry work together to ensure conversations about clinical and cost issues can happen as early as possible, to enable new treatments to reach patients sooner.”
Wales and Northern Ireland will usually follow decisions made by NICE, and The Scottish Medicines Consortium started to assess atezolizumab with nab-paclitaxel for routine use in Scotland in early 2020, but this is currently paused due to the SMC’s decision to pause all appraisals as a result of the COVID-19 outbreak.
Anyone worried about the impact of the COVID-19 outbreak on their breast cancer treatment can call Breast Cancer Now’s free Helpline on 0808 800 6000 to speak to the charity’s expert nurses.
Notes to Editors