15 February 2019

NICE draft guidance recommends pertuzumab for new breast cancer indication after improved price offer from company

NICE has published final draft guidance recommending pertuzumab (Perjeta, Roche) for treating early HER2-positive breast cancer in people whose disease has spread to their lymph nodes.

This positive recommendation is for people who have had surgery for their breast cancer and whose cancer has already spread to their lymph nodes. The estimated 2700 people in this subgroup have a higher risk of their cancer returning.

The evidence shows that adding pertuzumab to trastuzumab and chemotherapy after surgery increased the proportion of people whose disease didn’t spread. However, there is a lack of evidence on how long, if at all, adding pertuzumab might increase the overall length of time people live.

Meindert Boysen, director of the Centre for Health Technology Assessment at NICE said: “We’re pleased that we’ve been able to work with the company to address the uncertainties of pertuzumab as a treatment for early HER2-positive breast cancer.

“Their response means that people who have a high risk of their cancer returning now have a new treatment option that could reduce the risk of that happening.”

NICE already recommends Pertuzumab, given with trastuzumab and chemotherapy, for treating early HER2-positive breast cancer before surgery. NICE also recommends it for treating HER2-positive breast cancer that has either come back in the breast following initial treatment or has spread from the breast to elsewhere in the body.

In NICE’s previous draft guidance the independent appraisal committee had concluded that the uncertainty in the clinical-effectiveness evidence made the cost-effectiveness estimates for pertuzumab uncertain.

Following consultation on the draft guidance the company proposed an improved discount to the price of pertuzumab. They also submitted a revised economic analysis which included only people whose disease had spread to their lymph nodes (the previous draft guidance also included people who can’t have treatment with hormonal therapy). The new analysis also used the committee’s lower estimates of how long the benefit of treatment with pertuzumab will last.  

This has meant that the cost-effectiveness estimate for pertuzumab is now within the range NICE considers to be a good use of NHS resources and so it can be recommended for people with early HER2-positive breast cancer in people with node-positive disease after they’ve had surgery.

Final guidance is expected to be published in March.

We’re pleased that we’ve been able to work with the company to address the uncertainties of pertuzumab as a treatment for early HER2-positive breast cancer.

Meindert Boysen, director of the Centre for Health Technology Assessment at NICE