1.1 Eribulin is not recommended for treating locally advanced or metastatic breast cancer in adults who have had only 1 chemotherapy regimen.
A positive recommendation on eribulin for treating locally advanced or metastatic breast cancer in adults who have had 2 or more chemotherapy regimens is given in a separate NICE technology appraisal guidance.
1.2 This guidance is not intended to affect treatment with eribulin that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
People with advanced breast cancer who have had 1 chemotherapy regimen are usually then offered an anthracycline, a taxane or capecitabine, depending on what they have had already. The clinical trial results for eribulin showed that it did not increase progression-free survival, but there was an average overall survival increase of 4.6 months compared with capecitabine. Since treatment is changed when the disease progresses, and eribulin would have been stopped at that stage, it is not clear whether the increase in overall survival is because of eribulin, or related to the treatments given after eribulin. Eribulin is already recommended after 2 previous chemotherapy treatments, and there are no trials which compare its effectiveness given after 1 or 2 previous treatments, so this remains uncertain.
Eribulin meets NICE's criteria to be considered a life-extending treatment at the end of life. The estimates of cost effectiveness for eribulin range from £36,200 to £82,700 per quality-adjusted life year (QALY) gained. The most plausible estimate of cost effectiveness, based on a revised company model and the committee's preferred assumptions, is £69,800 per QALY gained. This is above what NICE normally considers to be acceptable for end-of-life treatments. Therefore, eribulin cannot be recommended as a cost-effective option for locally advanced or metastatic breast cancer in adults who have had only 1 chemotherapy regimen.