20 May 2016 - NICE has today issued draft guidance not recommending pertuzumab (Perjeta, Roche) to treat HER2-positive breast cancer because it is uncertain how the responses to treatment seen in the clinical trials translate into long-term benefits for patients.

Pertuzumab is licensed for use in combination with trastuzumab (Herceptin) and docetaxel before breast cancer surgery to shrink the cancer so that it becomes operable.

The draft guidance looks at pertuzumab used in this way to treat HER2-positive breast cancer that is locally advanced, inflammatory, or early-stage and at high risk of coming back.

The committee concluded that there was a lack of long-term evidence comparing pertuzumab with other treatments used before breast cancer surgery. There was evidence that adding pertuzumab to trastuzumab and docetaxel was more successful at getting rid of cancer in the breast and lymph nodes before surgery but it was very uncertain about the extent to which this would reduce the risk of the disease recurring and result in longer survival..

Pertuzumab costs £2,395 per 420 mg vial (excluding VAT). The total cost of treatment with pertuzumab ranges from £7,185 (3 cycles of treatment) to £16,765 (6 cycles of treatment).

Sir Andrew Dillon, NICE chief executive, said: “In order to be able to recommend pertuzumab as an addition to trastuzumab and chemotherapy, the committee needed to have more evidence of its long-term clinical benefits, particularly its impact on overall survival.

“On the basis of the evidence presented, the committee was very unsure about the extent of these benefits.

“Taking all the uncertainties around the clinical effectiveness of pertuzumab into account, as well as uncertainties with the economic data presented by the company, the committee concluded that it could not recommend the drug for the treatment of HER2-positive breast cancer before surgery as a good use of NHS resources.”

For more details, go to: https://www.nice.org.uk/news/press-and-media/long-term-benefits-of-breast-cancer-drug-pertuzumab-too-uncertain-says-nice-in-draft-guidance