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We welcome SMC approval of adjuvant Kadcyla and atezolizumab with nab-paclitaxel for use on the NHS

The Scottish Medicines Consortium (SMC) has today - 9 November 2020 - approved:

  • Trastuzumab emtansine (Kadcyla) for routine NHS use in Scotland for certain patients with HER2 positive primary breast cancer after their surgery.
  • Atezolizumab (Tecentriq) in combination with chemo drug nab-paclitaxel (Abraxane) for routine NHS use in Scotland, for certain patients with triple negative secondary breast cancer.

Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, said: 

“The SMC’s approval of two new treatment options in Scotland holds the promise of changing the lives of hundreds of women with primary and secondary breast cancer, for the better.

“For patients with primary breast cancer, access to adjuvant Kadcyla offers an invaluable new line of defence for patients who haven’t fully responded to treatment given to shrink the tumour before surgery. This can help to further reduce the risk of the disease coming back, and brings hope for many people who, until now, have faced a bleaker prognosis.

“Alongside this, approval of atezolizumab with chemotherapy marks a huge leap forward in treatment options for some women with triple negative secondary breast cancer.

"For these patients, who currently face a heartbreakingly short life expectancy and limited treatment options, access to this treatment could give them the precious chance to live well for longer, having more time with loved ones.

“Both treatments are significant advances driving us towards achieving our ambition that, by 2050, everyone who develops breast cancer will live, and live well.

“Healthcare teams must discuss the associated risks and benefits of these treatments with eligible patients, and this is especially important during the COVID-19 pandemic.

"Individuals must be given the information and support they need to make treatment decisions that best meet their individual needs.

"Anyone with questions about breast cancer treatment, including how COVID-19 is impacting  this, can also speak to our expert nurses by calling our free Helpline on 0808 800 6000.”


Notes to editors

  • Kadcyla (produced by healthcare company Roche) is a targeted treatment for HER2 positive breast cancer. It consists of an antibody (trastuzumab) that attaches to HER2 proteins on the surface of cancer cells, and releases a dose of chemo (emtansine) directly into the cells, leaving normal cells relatively unharmed.
  • Previously approved by the SMC in 2017 as a treatment for HER2 positive secondary breast cancer, Kadcyla will now provide a new option for patients with primary breast cancer who have a remaining invasive disease [in the breast and/or lymph nodes] after neoadjuvant treatment and surgery. It is estimated that 40-60% of patients do not respond completely to neoadjuvant treatment, which can lead to some cancer cells remaining after surgery.
  • The clinical trial called Katherine demonstrated that for patients with residual disease after neoadjuvant therapy, 88.3% treated with adjuvant Kadcyla after their surgery were free of invasive disease after three years, compared to 77% of patients treated with trastuzumab.
  • It is estimated that in the first year, around 107 people each year in Scotland will be eligible for treatment with Kadcyla following surgery, rising to 162 people in year five.
  • Atezolizumab (produced by healthcare company 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. 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. There is an accompanying test to identify women whose cancers are PD-L1 positive.
  • A major trial called 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.
  • The SMC started to assess atezolizumab with nab-paclitaxel for routine use in Scotland in early 2020. But this was initially paused due to the COVID-19 outbreak. It is estimated that in the first year, around 31 people in Scotland will now be eligible for the newly approved treatment, rising to 62 patients in year five.

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