Another potentially life-extending drug combination for some people with advanced breast cancer will now be available on the Cancer Drugs Fund (CDF) following Pfizer’s Ibrance with fulvestrant’s approval by NICE in final guidance.
The guidance recommends palbociclib (also called Ibrance and made by Pfizer) with fulvestrant as an option for people with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, advanced breast cancer who have already had endocrine therapy.
Palbociclib joins two other NICE-approved drugs – ribociclib and abemaciclib – as an option at this stage of the treatment pathway. Taken once-daily in pill form, palbociclib is a type of drug called a cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor. These work by inhibiting proteins in cancer cells, thereby preventing the cells from dividing and growing.
The treatment could be an option for up to 3,300 women who have already had endocrine treatment and where exemestane plus everolimus would be the most appropriate alternative to a CDK 4/6 inhibitor.
The committee heard from patients that they value improvements in progression-free survival and want to delay chemotherapy for as long as possible. They also heard that the different side effects of each of the CDK4/6 inhibitors mean that people would like to have a range of treatment options available to them.
Clinical trial evidence suggests that compared with fulvestrant alone, palbociclib with fulvestrant increases the length of time before the disease progresses. However, it is not known whether palbociclib increases the length of time people live, because the final trial results are not available yet.
Although the cost-effectiveness estimates were very uncertain, the committee considered that palbociclib with fulvestrant has the potential to be cost-effective. They therefore recommended it for use on the CDF in order to allow more evidence to be collected to address the uncertainties around overall survival and cost-effectiveness.
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Meindert Boysen, Director of the NICE Centre for Health Technology Evaluation, said: “The committee heard that treatments that can delay the need for chemotherapy, improve quality of life and extend how long people live in better health are important and would be welcomed. Palbociclib provides people with an alternative where NICE has already recommended two other drugs.
“We are pleased therefore that the company has agreed a managed access agreement that will allow palbociclib to be made available within the Cancer Drugs Fund as a further treatment option for people with this type of breast cancer.”
Minister for Innovation Nicola Blackwood said: “We are determined to find ways to save as many lives as possible, and to do our best to stop cancer from taking people from their family and friends far too soon.
“This latest development is another great example of the work the health community and research is doing to improve patients access to cancer treatments.
“This Government will always help the NHS reach its full potential and innovative drugs like this is proof that the UK continues to be the world-leading destination for revolutionary healthcare.”
Blake Dark, NHS Commercial Medicines Director, said: “This targeted treatment has the potential to make a real difference to the quality of life for people with breast cancer, not only extending survival, but significantly delaying the need for chemotherapy.
“The NHS worked closely with the manufacturer of the treatment, Pfizer, to reach an agreement meaning that it will be available to patients immediately while further evidence is to be collected.”
Palbociclib with fulvestrant is already available to NHS patients in England following publication of NICE’s draft recommendation in November.