We share an update on which drugs will be assessed for use on the NHS this year, as well as look back at those approved in 2019.
Ensuring patients have access to treatment is our priority
At Breast Cancer Now, we work to ensure clinically effective breast cancer drugs can quickly reach patients on the NHS at a price that is fair and sustainable for the NHS.
In England, the National Institute for Health and Care Excellence (NICE) is the body that makes decisions on which new medicines will be available on the NHS. Wales and Northern Ireland normally follow NICE guidance. In Scotland, the Scottish Medicines Consortium (SMC) make decisions on which new medicines will be available on the NHS in Scotland.
For new drugs to become available on the NHS they must be approved by NICE or the SMC. We always make sure that the patient voice is heard in the process of assessing each breast cancer drug.
We’ve successfully campaigned to reverse provisional negative decisions on individual drugs by calling on all parties to work together. We know the impact of treatments on patients is significant and we ensure this information reaches decision-makers.
Drugs approved in 2019
CDK 4/6 inhibitors
Palbociclib (Ibrance), ribociclib (Kisqali) and abemaciclib (Verzenio) are a class of drugs called CDK 4/6 inhibitors.
In 2019, all three of these drugs were recommended by NICE for use on the NHS via the Cancer Drugs Fund, in combination with fulvestrant, for patients with secondary breast cancer who have already received prior hormone therapy.
The SMC also recommended these treatment options for use on the NHS in Scotland.
Thank you to everyone who shared their experience of CDK 4/6 inhibitors so that we could highlight to NICE and the SMC the importance of these treatments for breast cancer patients.
Compared with fulvestrant alone, these combination treatments have been shown to offer patients invaluable extra time before their disease progresses and can also help delay the need for chemotherapy.
In early 2019, the SMC announced its decision to approve Perjeta for use on the NHS in Scotland for treatment of secondary breast cancer. This drug has been available in England since 2014 via the old Cancer Drugs Fund and it was approved for routine use in England, Wales and Northern Ireland in 2018.
NICE also approved Perjeta in combination with trastuzumab and chemotherapy as a new option after surgery for some patients with primary breast cancer, to help further reduce the risk of recurrence or secondary breast cancer. This treatment was rejected for use by the SMC in late 2019. We continue to urge the Scottish Government, the SMC and the manufacturer to work together to ensure this treatment is routinely available for NHS patients in Scotland.
Neratinib was approved for routine use on the NHS in England as an additional treatment option for certain patients with hormone positive, HER2 positive primary breast cancer after surgery and adjuvant treatment with trastuzumab.
The SMC are now assessing neratinib for use on the NHS in Scotland and we will be inputting into this.
Looking ahead to 2020
Atezolizumab (Tecentriq) with nab-paclitaxel
Atezolizumab is a type of immunotherapy given in combination with chemotherapy drug nab-paclitaxel for patients with untreated locally advanced or secondary triple negative breast cancer which produces a marker known as PD-L1.
In October 2019, NICE provisionally rejected the treatment for use on the NHS. We were extremely disappointed with this provisional decision. Read our response to this draft decision. This treatment is also being assessed for use in Scotland which we are inputting into.
The assessment of this drug continues. We are continuing to work behind the scenes to highlight the importance of this new treatment option and we’re urging all parties to work together to ensure a positive final decision is reached. For more information on this drug assessment, read our latest blog.
Trastuzumab emtansine (Kadcyla)
In 2017, we successfully campaigned for Kadcyla to be made routinely available on the NHS as a treatment for secondary breast cancer.
A clinical trial has now shown that Kadcyla is also an effective treatment for women with HER2 positive primary breast cancer, in cases where the cancer remains after treatment with trastuzumab and surgery. NICE is currently assessing this new use of Kadcyla and we expect a decision will be made by summer 2020.
Alpelisib (Piqray) with fulvestrant
Alpelisib is a new type of targeted drug for patients with hormone positive secondary breast cancer who have already received prior hormone therapy, and whose cancer has mutations in a gene called PIK3CA. It is given in combination with the hormone therapy fulvestrant. NICE will begin their assessment of this new treatment in the first half of this year.
To help us input into the NICE assessment, we’re looking to speak to people who have received Alpelisib as a treatment for secondary breast cancer. If you’ve had this treatment and would like to share your experience, please get in touch.
Pembrolizumab is another new immunotherapy for certain patients with triple negative breast cancer. Promising early results from clinical trials suggest that pembrolizumab can be used before surgery in patients with primary breast cancer and may also benefit people with previously untreated locally advanced or secondary breast cancer.
NICE may start to assess these different uses of pembrolizumab later this year.
Olaparib (Lynparza), talazoparib (Talzenna) and veliparib belong to a new class of drugs known as PARP inhibitors. These are targeted drugs for patients with secondary breast cancer which has a mutation in the BRCA1 or BRCA2 gene. PARP inhibitors represent an important step forward in the treatment of this type of breast cancer and we hope that NICE will be able to begin assessing them this year so patients can quickly benefit from these new innovative treatments.
Anyone with questions about their breast cancer treatment can also call our free Helpline on 0808 800 6000 to speak to one of our expert nurses.
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