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NICE, in its draft guidance said Roche’s drug Perjeta, for the treatment of patients with HER2-positive tumours that have either recurred in the breast or spread to other parts of the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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Ignored by the media, the Liberal Democrats are experiencing a revival

The crushed Liberals are doing particularly well in areas that voted Conservative in 2015 - and Remain in 2016. 

The Liberal Democrats had another good night last night, making big gains in by-elections. They won Adeyfield West, a seat they have never held in Dacorum, with a massive swing. They were up by close to the 20 points in the Derby seat of Allestree, beating Labour into second place. And they won a seat in the Cotswolds, which borders the vacant seat of Witney.

It’s worth noting that they also went backwards in a safe Labour ward in Blackpool and a safe Conservative seat in Northamptonshire.  But the overall pattern is clear, and it’s not merely confined to last night: the Liberal Democrats are enjoying a mini-revival, particularly in the south-east.

Of course, it doesn’t appear to be making itself felt in the Liberal Democrats’ poll share. “After Corbyn's election,” my colleague George tweeted recently, “Some predicted Lib Dems would rise like Lazarus. But poll ratings still stuck at 8 per cent.” Prior to the local elections, I was pessimistic that the so-called Liberal Democrat fightback could make itself felt at a national contest, when the party would have to fight on multiple fronts.

But the local elections – the first time since 1968 when every part of the mainland United Kingdom has had a vote on outside of a general election – proved that completely wrong. They  picked up 30 seats across England, though they had something of a nightmare in Stockport, and were reduced to just one seat in the Welsh Assembly. Their woes continued in Scotland, however, where they slipped to fifth place. They were even back to the third place had those votes been replicated on a national scale.

Polling has always been somewhat unkind to the Liberal Democrats outside of election campaigns, as the party has a low profile, particularly now it has just eight MPs. What appears to be happening at local by-elections and my expectation may be repeated at a general election is that when voters are presented with the option of a Liberal Democrat at the ballot box they find the idea surprisingly appealing.

Added to that, the Liberal Democrats’ happiest hunting grounds are clearly affluent, Conservative-leaning areas that voted for Remain in the referendum. All of which makes their hopes of a good second place in Witney – and a good night in the 2017 county councils – look rather less farfetched than you might expect. 

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.