Price discount helps give green light for Roche’s breast cancer drug

In its third positive draft recommendation for a cancer drug in as many weeks, NICE has announced that pertuzumab (Perjeta, Roche) can be made routinely available for patients on the NHS.

A discount to the price of pertuzumab agreed with the company was an important factor in enabling NICE to overturn its earlier provisional decision not to recommend the drug for treating HER2-positive breast cancer.

Guidance specifics

The draft guidance recommends pertuzumab in combination with trastuzumab (Herceptin) and docetaxel (a type of chemotherapy) as an option before breast cancer surgery to shrink the cancer so that it becomes operable.

The draft guidance looks at pertuzumab used in this way to treat HER2-positive breast cancer that is locally advanced, inflammatory, or early-stage and at high risk of coming back.

‘Lack of long term evidence’

The committee accepted that there was evidence that adding pertuzumab to trastuzumab and docetaxel was more successful at getting rid of cancer in the breast and lymph nodes before surgery. However, because of a lack of long-term evidence the committee remained very uncertain about the extent to which this would reduce the risk of the disease coming back and result in longer survival.

The draft guidance says the maximum number of cycles of pertuzumab treatment should not normally exceed 4. This reflects the number of cycles used in the clinical trials.

Over 50,000 women and around 340 men are diagnosed with breast cancer each year in the UK with about 10-15% of these characterised as HER2-positive breast cancer. Approximately 1400 people in England and Wales would be eligible for treatment with pertuzumab annually.

Cost of medication

The list price of pertuzumab is £2,395 per 420 mg vial (excluding VAT). The total cost of 4 cycles of treatment with pertuzumab is £9580. This does not take into account the patient access scheme agreed with the Department of Health. This scheme provides a simple discount to the list price of pertuzumab for the NHS. The level of the discount is commercial in confidence.

The draft guidance is now with consultees, who have the opportunity to appeal against it. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments.