We share an update on which breast cancer drugs may be assessed for use on the NHS this year, and recap which drugs were approved for use in 2020. 

dozens of pills of all shapes and sizes spread out on a counter

Ensuring patients have access to treatment

Drugs are a cornerstone of breast cancer treatment, which is why our work on access to drugs is so crucial. We participate in every assessment of a new breast cancer drug, always ensuring the patient voice is heard by decision-makers. We're grateful to everyone who has shared their experiences with us.

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) makes decisions on which new medicines will be available on the NHS in Scotland.  

Drugs approved in 2020

Atezolizumab (Tecentriq) with nab-paclitaxel

Atezolizumab is a type of immunotherapy given in combination with chemotherapy drug nab-paclitaxel. It's suitable for some people with with triple negative breast cancer that has spread. 

We’re delighted that both NICE and the SMC approved this treatment for routine use on the NHS. We worked hard behind the scenes to ensure this treatment was made available, highlighting the urgent need for new treatments for triple negative breast cancer.

Trastuzumab emtansine (Kadcyla)

Last year, NICE and the SMC approved Kadcyla for routine use on the NHS for certain patients with HER2 positive early breast cancer after their surgery.

The KATHERINE clinical trial looked at using Kadcyla in people who had treatment before surgery to shrink their cancer but who still had some cancer remaining. The trial showed Kadcyla was more effective than trastuzumab at stopping cancer coming back in these patients. 

Neratinib (Nerlynx)

In August last year, the SMC approved neratinib as an additional treatment option for certain patients with hormone positive, HER2 positive early breast cancer after surgery and trastuzumab. This follows a decision made by NICE in 2019 to approve this treatment.

Pertuzumab (Perjeta)

Last September, the SMC approved pertuzumab – in combination with trastuzumab and chemotherapy – for use after surgery for some patients with early breast cancer. This was initially rejected by the SMC in 2019 as it wasn’t considered to be cost-effective. It’s already approved by NICE. 

Reviewing how NICE evaluates new medicines 

Last year, as well as being involved in individual assessments of new drugs, we also responded to an important consultation launched by NICE about reviewing the way it evaluates new medicines. We’ve been involved in this review from the beginning to ensure the patient voice was heard when NICE considers new proposals.

This work is continuing in 2021, so keep an eye on our blog as we’ll be posting an update on this shortly.

What’s coming up in 2021?

Here, we highlight some of the drugs which may be assessed this year.

Timings are an estimate and there may also be new drugs added to the NICE and SMC schedules throughout the year.

Trastuzumab deruxtecan (Enhertu)

This treatment is currently being assessed by NICE for treating HER2 positive secondary breast cancer after two or more anti-HER2 therapies. We’re expecting a decision by NICE in spring and are awaiting timelines for the SMC.

Tucatinib (Tukysa)

Tucatinib is another emerging drug for people with HER2 positive secondary breast cancer. It is given in combination with trastuzumab and capecitabine, after people have already received several anti-HER2 therapies. The trial also included people whose cancer had spread to the brain. The appraisal is in development with a decision expected towards the end of the year.

Pembrolizumab (Keytruda)

Pembrolizumab is an immunotherapy which is currently being assessed by NICE in combination with chemotherapy for certain patients with triple negative breast cancer that has spread. We expect a decision to be reached in late summer and we are waiting to hear about timelines for the SMC.

Atezolizumab (Tecentriq) with chemotherapy

This year NICE is assessing atezolizumab with chemotherapy to treat early or locally advanced triple negative breast cancer before surgery. We are expecting a decision to be announced on the use of this treatment on the NHS towards the end of the year.

Cancer Drugs Fund review of CDK 4/6 inhibitors in combination with fulvestrant

In 2019, three CDK 4/6 inhibitor drugs (abemaciclib, palbociclib and ribociclib) in combination with fulvestrant were approved for use on the Cancer Drugs Fund (CDF) in England.

The CDF enables NICE to conditionally approve promising treatments while more data is collected. Following this, NICE reconsiders the treatment and makes a final decision on its routine use on the NHS.

Both abemaciclib and ribociclib have gone through this process. Palbociclib will also go through this process at a later date.

We have just heard the disappointing news that abemaciclib with fulvestrant has provisionally been rejected for routine use on the NHS. We’re working hard to ensure the provisional decision is reversed so this treatment combination can continue to be an option for patients in the future. This decision will not affect patients currently receiving the treatment.

If you have experience of this treatment, please get in touch with us at campaigns@breastcancernow.org to help us highlight the importance of this treatment option.

We are awaiting the decision on ribociclib with fulvestrant. 

These three treatments are routinely available in Scotland and will not need to be reassessed.

Anyone with questions about their breast cancer treatment can call our free Helpline on 0808 800 6000 to speak to one of our expert nurses. 


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