Perjeta can help shrink breast cancer tumours before patients undergo surgery to remove them
A consultant studying a mammogram. Photograph: Rui Vieira/PA
(The Guardian)A drug that can help shrink breast cancer tumours before patients undergo surgery to remove them has been approved for use in the NHS, after the manufacturer agreed a substantial discount on the list price.
Perjeta, the brand name of pertuzumab, could be helpful in the treatment of 1,400 women a year who develop a particularly aggressive form of breast cancer, but it was initially turned down by Nice, the National Institute for Healthcare Excellence, because of the high price set by the manufacturer, Roche.
Nice said it was also uncertain that the drug treatment would help prevent the cancer coming back.
Prof Carole Longson, director of the centre for health technology assessment at Nice, said there was only limited evidence of how well the drug worked because it had been quickly licensed on the back of promising but early trial data.
She said Nice was glad Roche had agreed to drop the price, though she would not reveal by how much.
“The price discount means that, even with the uncertainties in the evidence highlighted by the committee, pertuzumab represents a cost-effective use of NHS money,” Longson said.
The list price of pertuzumab is £2,395 per 420mg vial (excluding VAT). The total cost of four cycles of treatment with pertuzumab – the maximum Nice says should be used – would be £9,580 before the agreed discount.
The drug is used in combination with two others, trastuzumab (Herceptin) and docetaxel (a type of chemotherapy), to shrink tumours prior to surgery. If it works well, it may mean some tumours that were previously inoperable could be surgically removed.
Pertuzumab has been developed to help treat the 10-15% of breast cancers that are HER2-positive, which can be particularly aggressive.
Nice pointed out that the decision was the third green light for a cancer drug in as many weeks. It has been criticised for failing to approve cancer drugs, which often come on to the market at high prices.
Mia Rosenblatt, assistant director of policy and campaigns at Breast Cancer Now, said it was a huge leap forward. “Perjeta is the first addition to primary breast cancer treatment to be approved by Nice since 2006 and marks the introduction of a new type of breast cancer medicine, to be used before surgery,” she said.
“For the small number of women eligible, this drug could mean an enormous amount. It could help shrink their tumours to reduce the extent of the surgery they require or even make inoperable cancers operable.”
Samia al-Qadhi, the chief executive of Breast Cancer Care, said: “This is an exciting turning point. Women with certain aggressive types of breast cancer will have access to an extra drug before surgery that can boost the success of shrinking the tumour. Crucially this may mean people’s long-term survival improves.”