1.1 Atezolizumab with nab‑paclitaxel is recommended, within its marketing authorisation, for treating triple-negative, unresectable, locally advanced or metastatic breast cancer in adults whose tumours express PD‑L1 at a level of 1% or more and who have not had previous chemotherapy for metastatic disease. It is recommended only if the company provides atezolizumab according to the commercial arrangement.
Why the committee made these recommendations
There are currently no targeted or immunotherapy treatments for triple-negative breast cancer. The only treatment option is chemotherapy, usually with taxane monotherapy. Atezolizumab is the first immunotherapy to be approved for PD‑L1‑positive, triple-negative advanced breast cancer. It is used in combination with the chemotherapy agent, nab‑paclitaxel.
Clinical trial evidence shows that people having atezolizumab plus nab‑paclitaxel live longer before their condition gets worse than people having placebo plus nab‑paclitaxel. It also suggests that they live longer. There is no direct comparison of atezolizumab plus nab‑paclitaxel with taxanes that are used in the NHS, such as weekly paclitaxel. However, it is reasonable to assume that nab‑paclitaxel has a similar efficacy to weekly paclitaxel.
Atezolizumab plus nab‑paclitaxel is considered to be a life-extending treatment at the end of life. The cost-effectiveness estimates are within what NICE considers an acceptable use of NHS resources. Therefore, atezolizumab with nab‑paclitaxel is recommended.