NICE snubs Roche’s new breast cancer drug

The UK's health cost watchdog, the National Institute for Care and Excellence, has rejected Roche's newest cancer drug Perjeta - the seventh such cancer drug to be by NICE since 2011.

Pharma giant, Roche, and those with advanced breast cancer were dealt a blow on Tuesday by the UK’s health cost watchdog, the National Institute for Care and Excellence (NICE), when it rejected the company’s newest drug for the disease.

NICE, in its draft guidance said Roche’s drug Perjeta, for the treatment of patients with HER2-positive tumours that have either recurred in the breast or spread to other parts of the body, was not cost effective enough to be used on the National Health Service.

Roche has said it is “extremely disappointed” with NICE’s decision and criticised the watchdog for Perjeta being the “seventh such cancer treatment to be rejected by NICE” since 2011.

Breast Cancer Care, Assistant Director of Services, Liz Carroll also said those with advanced breast cancer will find the news “extremely disappointing”.

Nearly 50,000 women and 400 men are diagnosed with breast cancer each year in the UK and around one in five tumours will be ‘HER2-positive', a type of breast cancer that can be treated with Perjeta.

The drug, according to Roche, offers the kind of breakthrough treatment not seen since herceptin, Roche’s second best-selling drug, which was brought to market 10 years and is also for the treatment of breast cancer.

NICE’s main problem with the drug is its cost combined with the robustness of its clinical trial results.

Perjeta costs £2,395 per 420mg vial (excluding VAT) and treatment consists of an initial loading dose of 840mg, followed every three weeks by a maintenance dose of 420mg in combination with herceptin and chemotherapy...

Roche says Perjeta has shown in trials that on average patients live 6.1 months longer, without their cancer getting worse, compared with those receiving Herceptin and chemotherapy alone. This would mean an average cost of about £23,950 for Perjeta per patient for around six months of treatment (based on 8 doses plus the initial dose). This is compared to treating one patient for a year with herceptin for £21,800.

NICE did not find the three drugs – Perjeta, Herceptin and  chemotherapy – combined cost effective by its incremental Cost-Effectiveness Ratio (ICER), which it uses to measure whether a drug is cost effective or not,  compared to just Herceptin.

The Appraisal Committee at NICE also noted that Perjeta seemed to delay growth and spread of the breast cancer for around this time but “there were no firm figures to demonstrate the treatment's impact on overall survival.”

In July NICE also rejected breast cancer drug Afinitor from Novartis.

However, there is another life line for the Perjeta; a patient access scheme proposed by Roche, which has already been approved by NICE and has been sitting with the Department of Health waiting for ministerial ratification for several weeks now.

With the Cancer Drugs Fund, which holds money set a side for drugs not approved by NICE and therefore not available on the NHS, in England due to expire in six months the Department of Health’s decision will be a last hope for Roche and advanced breast cancer patients seeking more treatment options.

Despite criticism from Roche, the Department of Health have as yet given no indication when they will provide an answer on the proposed price plan for Perjeta. 

The Swiss pharmaceutical giant Roche. Photograph: Getty Images.

Heidi Vella is a features writer for Nridigital.com

Photo: Getty
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Is Scottish Labour on the way back, or heading for civil war?

There are signs of life, but also recriminations.

The extraordinary rise of the Scottish Tories and the collapse in SNP seat numbers grabbed most of the headlines in the recent general election. Less remarked on was the sudden, unexpected exhalation of air that came from what was thought to be the corpse of Scottish Labour.

In 2015, Labour lost 40 of its 41 Scottish seats as the SNP rocketed from six to 56, was wiped out in its Glaswegian heartlands, and looked to have ceded its place as the choice of centre-left voters – perhaps permanently – to the Nationalists. But while the electorate’s convulsion in June against the SNP’s insistence on a second independence referendum most benefited Ruth Davidson, it also served to reanimate Labour.

The six seats grabbed back (making a total of seven) included three in the West of Scotland, proving that the Nat stranglehold on Labour’s territory was not quite as secure as it had seemed. There is, it appears, life in the old dog yet.

Not only that, but the surprise success of Jeremy Corbyn across the UK has stiffened Labour’s spine when it comes to insisting that it, and not the SNP, is the rightful home of Scotland’s socialists.

Corbyn was largely kept south of the border during the election campaign – Kezia Dugdale, the leader at Holyrood, had supported Owen Smith’s leadership challenge. But in August, Corbyn will embark on a five-day tour of marginal SNP constituencies that Labour could potentially take back at the next election. The party has set a target of reclaiming 18 Scottish seats as part of the 64 it needs across Britain to win a majority at Westminster. The trip will focus on traditional areas such as Glasgow and Lanarkshire, where tiny swings would return seats to the People’s Party. Dugdale is no doubt hoping for some reflected glory.

Corbyn will present himself as the authentically left-wing choice, a leader who will increase public spending and invest in public services compared to the austerity of the Tories and the timidity of the SNP. “Labour remains on an election footing as a government-in-waiting, ready to end failed austerity and ensure that Scotland has the resources it needs to provide the public services its people deserve,” he said. “Unlike the SNP and the Tories, Labour will transform our economy through investment, insisting that the true wealth creators - that means all of us – benefit from it.”

The SNP has benefited in recent years from the feeling among many north of the border that Labour and the Tories were committed to differing shades of a similar economic programme, that was starving public services of cash and that paid little attention to Scottish desires or needs. But as the Nats’ spell in government in Edinburgh has worn on, first under Alex Salmond and now Nicola Sturgeon, with little being done to tackle the nation’s social problems, patience has started to run out.

Dugdale said yesterday that she “looked forward to joining Jeremy in August as we take our message to the people of Scotland”. That’s not a sentiment we would have heard from her before June. But it does raise the future spectacle of Davidson’s Tories battling for the centre and centre-right vote and Labour gunning for the left. The SNP, which has tried to be all things to all people, will have to make a choice – boasting that it is “Scotland’s Party” is unlikely to be enough.

The 20th anniversary of the referendum that delivered the Scottish Parliament is almost upon us. Then, Scottish Labour provided the UK and the Westminster government with figures of the stature of Gordon Brown, Robin Cook, Donald Dewar and George Robertson. That was a long time ago, and the decline in quality of Labour’s representatives both in London and Edinburgh since has been marked. The SNP’s decade of success has attracted much of the brightest new talent through its doors. Young Scots still seem to be set on the idea of independence. Labour has a credibility problem that won’t be easily shaken off.

But still, the body has twitched – perhaps it’s even sitting up. Is Scottish Labour on the way back? If so, is that down to the SNP’s declining popularity or to Corbyn’s appeal? And could Dugdale be a convincing frontwoman for a genuinely left-wing agenda?

There may be trouble ahead. Yesterday, the Scottish Labour Campaign for Socialism – whose convener, Neil Findlay MSP, ran Corbyn’s leadership campaign in Scotland – accused Dugdale of “holding Corbyn back” in June. A spokesperson for the group said: “While it’s great we won some seats back, it’s clear that the campaign here failed to deliver. While elsewhere we've seen people being enthused by ‘for the many, not the few’ we concentrated on the dispiriting visionless ‘send Nicola a message’ – and paid a price for that, coming third in votes and seats for the first time in a century. In Scotland we looked more like [former Scottish leader] Jim Murphy’s Labour Party than Jeremy Corbyn’s – and that isn’t a good look.”

While the group insists this isn’t intended as a challenge to Dugdale, that might change if Corbyn receives a rapturous reception in August. We’ll learn then whether Scotland is falling for the high-tax, high-spending pitch that seems to be working so well elsewhere, and whether Scottish Labour has jerked back to life only to find itself staring down the barrel of a civil war.

Chris Deerin is the New Statesman's contributing editor (Scotland).