New treatment for advanced breast cancer given NICE recommendation

As part of NICE’s newly released draft guidance, the drug atezolizumab has been recommended for treating patients with a type of breast cancer, known as triple negative breast cancer, that has spread to other parts of the body.

The positive recommendation from the National Institute of Health and Care Excellence (NICE) comes following consultation on its previous draft guidance which did not recommend atezolizumab. After the company responsible for its manufacture updated their economic model to address concerns raised by the appraisal committee and agreed to provide a larger discount to the drug’s list price in a deal with NHS England & NHS Improvement, the recommendation was made.

Atezolizumab, when given with chemotherapy drug nab-paclitaxel, represents the first immunotherapy to specifically target triple negative breast cancer where tumours have PD-L1 expression of 1% or more. It is given to people who have not had chemotherapy for breast cancer that has spread to other parts of the body and where surgery to remove it is not possible.

Given by injection ever two weeks, the drug works by blocking the activity of a protein known as PD-L1 which is produced in larger amounts on cancerous cells than normal cells. By blocking the PD-L1 protein, it helps the patient’s own immune cells attack the cancer.

Evidence suggests atezolizumab plus nab-paclitaxel increases the time before the disease worsens by around two and a half months compared with placebo tests just using nab-paclitaxel – up to seven and a half months compared to five months respectively – as well as improving overall survival by an additional nine and a half months on average.


Triple negative breast cancer affects around 2000 people in England, of whom around 600 would be eligible for treatment with atezolizumab and nab-paclitaxel

Meindert Boysen, Director of the Centre for Health Technology Evaluation at NICE, said: “We are pleased to have been able to work with the company to resolve the issues identified by the committee in our previous draft guidance. I know that today’s announcement will be welcomed by people with this type of breast cancer as well as for their families and carers. Atezolizumab is considered to be a breakthrough treatment in an area where there are currently few options.

“The committee heard that the availability of a new treatment that increases progression-free survival compared with chemotherapy alone will give hope to patients because it is important to them to be able to maintain a good quality life for as long as possible.”

Professor Peter Johnson, NHS Clinical Director for Cancer, added: “As well as ensuring the safety of cancer patients during the pandemic, the NHS is also working hard to make sure that the best care and treatment options are available for them.

“We are delighted that we were able to strike a deal with the company to support NICE’s recommendation for atezolizumab, which will help hundreds of people with breast cancer and their families – it means that patients with triple breast cancer have a significantly better option for treatment.”

Advanced triple negative breast cancer can often present more aggressively than other types of breast cancer – accounting for 25% of deaths, despite only representing 15-20% of breast cancer cases. Triple negative breast cancer affects around 2000 people in England, of whom around 600 would be eligible for treatment with atezolizumab and nab-paclitaxel.

NICE expects to publish its final guidance on atezolizumab for triple negative breast cancer in June 2020.


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