At Breast Cancer Now, we work with people affected by breast cancer to help ensure that they have quick access to the drugs they need, at a price that is both fair and sustainable for the NHS.
What to expect
This year there are several breast cancer drugs being considered for use on the NHS. Here’s a brief round-up of which breast cancer drugs you can expect to see us talking about over the next year as they make their way through the National Institute for Health and Care Excellence (NICE) and the Scottish Medicines Consortium (SMC) assessment processes.
In England, NICE is the body which makes decisions on which medicines will be available on the NHS and Wales and Northern Ireland normally follow NICE guidance. In Scotland, the Scottish Medicines Consortium (SMC) make decisions on which medicines will be available on the NHS in Scotland.
CDK 4/6 inhibitors in combination with fulvestrant
Palbociclib (Ibrance), ribociclib (Kisqali) and abemaciclib (Verzenio) are a class of drugs called CDK 4/6 inhibitors. All three have already been approved for use by NICE for use with an aromatase inhibitor (a type of hormone therapy) for patients with previously untreated locally advanced or metastatic, hormone receptor positive, HER2 negative breast cancer. In Scotland, both palbociclib and ribociclib have been approved for use in combination with an aromatase inhibitor.
Now these three CDK 4/6 inhibitors are being assessed by NICE for use in combination with another type of hormone therapy known as fulvestrant. This would provide an important treatment option for patients who have already received prior hormone therapy and who currently cannot benefit from CDK 4/6 inhibitors. We’re expecting a decision to be made on abemaciclib with fulvestrant shortly. (Update: NICE abemaciclib with fulcestrant, 2 April 2019.)
Decisions by NICE on both palbociclib and ribociclib with fulvestrant are expected later this year. We’ll keep you up-to-date on how these progress.
In Scotland, abemaciclib is currently being assessed for use in combination with an aromatase inhibitor and also for use with fulvestrant. We expect to hear the outcome in May. (Update: SMC abemaciclib for two new treatment options, May 2019) The SMC is also currently considering palbociclib with fulvestrant.
Triple negative breast cancer makes up around 15% of all breast cancers and tends to be more aggressive and harder to treat than other types of breast cancer. Treatment options are currently limited to surgery as well as chemotherapy and radiotherapy.
NICE is currently assessing a drug called atezolizumab in combination with nab-paclitaxel (Abraxane) as an option for patients with untreated, locally advanced or metastatic triple negative breast cancer who express a marker called PD-L1.
As part of the assessment process, we’re looking to speak to people with locally advanced or metastatic triple negative breast cancer as well as those who have received atezolizumab as a treatment for their breast cancer. Please get in touch and tell us your story by 20 March 2019.
Update: on 14 March 2019 it was announced that the manufacturer of this drug, Roche, will be funding access to this treatment for eligible patients whilst it is still going through the process of being granted a licence. This is part of the Early Access to Medicines Scheme led by the Medicines and Healthcare products Regulatory Agency (MHRA). Patients should speak to their clinician about this option.
It’s important that we see real progress in treatment options for patients with triple negative breast cancer so we’re pleased that NICE will be considering another drug for this group of patients.
Pembrolizumab is already available for use on the NHS for other types of cancer, however, NICE will be assessing it for use in patients with previously treated metastatic breast cancer which is triple negative, as well as using it as an option before surgery in women with primary triple negative breast cancer. It is anticipated that the assessments will begin in 2019 with decisions expected in 2020 so watch this space!
Olaparib (Lynparza) and talazoparib (Talzenna) are from a new class of drugs known as PARP inhibitors. These drugs represent an important step forward in the treatment of BRCA1 or BRCA2 mutated metastatic breast cancer. They are targeted treatments tackling a particular type of breast cancer. The NICE assessment of olaparib is anticipated to begin in mid-July 2019, whilst timelines for talazoparib are to be confirmed.
In January, with help from several patients who shared with us their experiences of treatment, we made a submission to NICE in relation to a drug called neratinib. This would be a treatment option for women with early stage HER2 positive, hormone receptor positive breast cancer who have completed a year of trastuzumab treatment. A decision on this drug is expected in October 2019.
The manufacturer has a managed access programme in place which means people may be able to currently access the drug. Please speak to your clinician about whether this might be a suitable option for you.
You may have seen the recent news about Perjeta as NICE has recently approved it as a treatment option for women with HER2 positive primary breast cancer, whose disease is lymph node positive, following surgery. Treatment options such as this which can help further reduce the risk of breast cancer recurring are very welcome.
At the beginning of 2019, the SMC announced its decision to approve Perjeta for use on the NHS in Scotland for treating secondary breast cancer. The drug has been the standard of care in England since 2014 via the Cancer Drugs Fund, and was approved for routine use in England, Wales and Northern Ireland early last year.
Whilst these are the drugs we’re currently aware of that are either already being assessed for use on the NHS or are shortly due to be, timelines can sometimes change. Also, other new drugs which are not listed above may be submitted for assessment throughout the year.
If you have any specific questions about your treatment options, please speak to your clinician.
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