The UK’s National Institute for Health and Care Excellence (NICE) has rejected the first targeted immunotherapy treatment for people with triple negative breast cancer for use on the NHS.
The cost watchdog published draft guidelines rejecting Roche’s Tecentriq (atezolizumab), ruling that based on current evidence it is too expensive for NHS use.
Tecentriq given with the chemotherapy agent nab-paclitaxel specifically targets triple negative breast cancer where tumours have PD-L1 expression of 1% or more. It is given to people who have not had prior chemotherapy for metastatic disease and who cannot have surgery to remove it.
Evidence indicates that the combination extends progression-free survival by around 2.5 months compared to placebo plus nab-paclitaxel, increasing overall survival by about 9.5 months.
Roche did not submit trial data directly comparing atezolizumab plus nab-paclitaxel with other treatments used at this stage. NICE said its committee felt the company’s analysis indirectly comparing these treatments was not reliable and lacked validity.
The watchdog said when using nab-paclitaxel as a proxy for current treatment in the NHS, its independent committee could not recommend atezolizumab plus nab-paclitaxel as a cost-effective use of NHS resources, even after applying end-of-life criteria.
NICE will undertake a consultation on the draft guidance until 24 October. The watchdog’s committee will make a final decision on the use of treatment in November.
NICE director of the centre for health technology evaluation Meindert Boysen said: “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.
“We are committed to working with the company to try to resolve the issues identified by the committee. In the meantime, I would encourage anyone with an interest in this topic to give us their feedback on this draft guidance.”