NICE guidance for access to advanced breast cancer treatment

NICE has published draft guidance today recommending trastuzumab deruxtecan for use in the Cancer Drugs Fund (CDF) as an option for treating HER-positive unresectable or metastatic breast cancer in adults, after two or more anti-HER2 therapies.

The decision means it will be the first time trastuzumab deruxtecan (also called Enhertu) has been commissioned for use in any European country. Up to 400 people will have immediate access to the treatment while more data is collected showing how much longer people who are taking it live, compared with people taking chemotherapy.

There is currently a lack of clinical trial data directly comparing trastuzumab deruxtecan with chemotherapy. However, the committee concluded that data from ongoing trials of trastuzumab deruxtecan and from NHS practice would help address the uncertainty about clinical effectiveness. Trastuzumab deruxtecan is therefore recommended for use in the Cancer Drugs Fund.

Current treatment for HER2‑positive unresectable or metastatic breast cancer includes anti‑HER2 therapies. After two or more anti‑HER2 therapies, the standard care is chemotherapy (such as capecitabine, vinorelbine or eribulin).

Meindert Boysen, Deputy Chief Executive and Director of the Centre for Health Technology Evaluation at NICE, said: “Unfortunately there is no cure for breast cancer that has spread to other parts of the body or that can’t be removed surgically.

The committee heard from patient experts who explained that, because of its side effects, people want to avoid having chemotherapies for as long as possible.

“Trastuzumab deruxtecan is a promising new treatment that has the potential to increase the length of time before the disease gets worse and how long people live overall.

"We’re therefore pleased that our work has allowed a deal to be struck between the company and NHS England supporting access to trastuzumab deruxtecan as an option in the CDF for people with this type of breast cancer.”

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