National Institute for Health and Clinical Excellence (NICE)
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NICE says new triple negative advanced breast cancer drug too expensive for NHS use

NICE yesterday, 7 April 2022, issued draft guidance which does not recommend sacituzumab govitecan for treating locally advanced or metastatic triple negative breast cancer.

The draft guidance, which is available for public consultation until 29 April 2022, says that, although sacituzumab govitecan increases how long people have before their disease gets worse and how long they live compared with chemotherapy, at its current price it is too expensive to be considered a cost-effective use of NHS resources.

NICE is looking at sacituzumab govitecan (also called Trodelvy and made by Gilead Sciences) for treating triple negative breast cancer which can’t be removed surgically and which has spread nearby from where it started (locally advanced) or has spread to other parts of the body (metastatic). It is used after people have had 2 or more prior lines of systemic therapies, at least one of them for unresectable locally advanced or metastatic disease.

Because triple-negative breast cancer is not sensitive to hormone therapy or molecular targeted therapy, the usual treatment is chemotherapy. The aim of treatment is to stop the disease getting worse, extend life, and maintain or improve quality of life for as long as possible.

Sacituzumab govitecan is an antibody (sacituzumab) that works by targeting the activity of  proteins that are present at high levels on the surface of tumour cells. By targeting these proteins it delivers the anti-cancer component of the drug directly to tumour cells, preventing them from multiplying and eventually causing them to die.

Helen Knight, interim director of medicines evaluation at NICE, yesterday said:

“Because sacituzumab govitecan is a highly effective treatment, and given the lack of treatment options for people with this type of breast cancer, we’re very disappointed that its price means we can’t recommend it for use in the NHS at this point.   

“We hope that the company will consider what it can do to enable NICE to approve a treatment that has the potential to give people with advanced triple negative breast cancer more time with their loved ones.”   

Triple negative breast cancer can be more aggressive than other types of breast cancer and accounts for a quarter of all deaths from breast cancer despite accounting for only 1 in 5 cases. It is estimated there are around 2,000 people in England with triple negative breast cancer, of whom around 650 would have been eligible for treatment with sacituzumab govitecan if NICE had recommended it.

NICE already recommends atezolizumab with chemotherapy, the only other targeted treatment for this type of breast cancer.


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