National Institute for Health and Care Excellence

Nice approves life-extending drug for patients with incurable breast cancer

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NHS doctors in England able to prescribe pertuzumab after price cut agreed with maker

Doctor looking at mammograms

A drug that can give women suffering from incurable advanced breast cancer an extra 16 months of life has been approved for general use in the NHS in England after a price cut was negotiated with the manufacturer.

The decision by Nice, the National Institute for Health and Care Excellence, to give the green light for NHS doctors to use pertuzumab, sold under the brand name of Perjeta by the Swiss drug company Roche, was enthusiastically welcomed by breast cancer charities.

Baroness Delyth Morgan, chief executive of Breast Cancer Now, said the benefits of the drug for patients with the aggressive form known as Her2-positive breast cancer were extraordinary.

“This is the best news patients with Her2-positive breast cancer and their doctors could have hoped for,” she said. “Perjeta is a truly life-changing drug and we are absolutely delighted and relieved that Nice has finally been able to recommend it for routine NHS use in England.”

Perjeta had been too expensive to be considered for NHS use by Nice, which approves or rejects drugs on the basis of cost-effectiveness. But recently NHS England has begun to intervene with the manufacturers over the fraught issue of the prices of new drugs. Last November, it announced it had struck a deal with Roche.

“While a long time coming, we’re thrilled that tough negotiation and flexibility by NHS England and Nice, and the willingness of Roche to put patients first and compromise on price, has again ensured thousands of women can be given more time to live,” said Morgan.

But she was concerned that women with metastatic breast cancer – which has spread to other parts of the body and is incurable – would not get the drug in other parts of the UK.

“While Perjeta will now continue to be the gold standard of care in England, it has never been routinely available in Scotland, Wales or Northern Ireland. This is the most effective breast cancer drug in years and we must urgently see equality in access for NHS patients across the UK,” she said. She called for other countries to negotiate a deal with Roche.

Roche said the decision ends several years of uncertainty over a drug that is approved for use in 19 other European countries including France, Italy and Spain. “We are extremely pleased that due to the collaborative approach Roche, NHS England and Nice have taken, Perjeta will now be routinely funded on the NHS for eligible patients with advanced breast cancer,” said Richard Erwin, general manager of Roche Products Ltd.

Nice decided not to approve a second drug for advanced breast cancer, fulvestrant, sold under the brand name Faslodex, which slows its progress by suppressing the hormones that feed it. Samia al Qadhi, chief executive of charity Breast Cancer Care, said “This closed door will be a blow to many diagnosed with the cruel disease.”

Decision to deny surgery to obese patients is like ‘racial discrimination’

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Bariatric surgeon Shaw Somers said move by local NHS in Vale of York amounts to discrimination because obesity is an illness

An overweight man sitting on the edge of a wall.
Anyone classified as obese – with a BMI of over 30 – will have to wait a year for surgery in the Vale of York.
The decision by an NHS body to restrict obese patients’ access to elective surgery until they lose weight is comparable with racial or religious discrimination, a surgeon has said.

The Vale of York clinical commissioning group (CCG) will make people wait for up to a year for treatment for non-life-threatening conditions such as hip and knee replacements if their body mass index is 30 or higher.

The group said it had taken the decision because it was the “best way of achieving maximum value from the limited resources available”.

Shaw Somers, a bariatric surgeon from Portsmouth, said the move was a logical step and could save money, but amounted to discrimination because obesity was an illness.

“They [the patients] are trying to lose weight in the vast majority of cases and to deny them treatment that they need on the basis of their weight, without then offering them effective help to help them lose weight is rather like discriminating [against] a segment of the population on the basis of their colour or religious persuasion,” he told BBC Radio 4’s Today programme.

“Just saying you can’t have surgery and there is no access to alternative treatments really doesn’t help anyone.”

Chris Hopson, the head of NHS Providers – which represents acute care, ambulance and community services – said the move amounted to “rationing care to save money”.

He told Today that the health service was being asked to deliver too much for the funding available. Rather than commissioning groups making “piecemeal decisions”, Hopson said there should be a national debate about the future of the UK’s healthcare system involving not only politicians, NHS leaders and clinicians – but the public as well, given that tax revenues funded it.

Demand for healthcare was “about to go through the roof” as baby boomers neared the end of their lives, he said. There had been a 6% increase in emergency admissions in the first quarter of this year.

The Royal College of Surgeons (RCS) said that it was a dangerous move that ranked among the “most severe the modern NHS has ever seen”.

She added: “As the true scale of financial pressure on NHS trusts has become clear over the summer, we are fast finding ourselves in a situation where CCGs are introducing draconian commissioning policies, often flouting Nice [National Institute for Health and Care Excellence] or other clinical guidance, in order to balance the books.

A spokesman for NHS England said: “Major surgery poses much higher risks for severely overweight patients who smoke. So local GP-led clinicalcommissioning groups are entirely right to ensure these patients first get support to lose weight and try and stop smoking before their hip or knee operation. Reducing obesity and cutting smoking not only benefits patients but saves the NHS and taxpayers millions of pounds.

“This does not and cannot mean blanket bans on particular patients such as smokers getting operations, which would be inconsistent with the NHS constitution.

“Vale of York CCG is currently under special measures legal direction, and NHS England is today asking it to review its proposed approach before it takes effect to ensure it is proportionate, clinically reasonable, and consistent with applicable national clinical guidelines.”