Increased discount prompts NICE to recommend Roche's Perjeta after surgery for early breast cancer

The National Institute for Health and Care Excellence issued draft guidance Friday recommending Roche's Perjeta (pertuzumab) for treating early HER2-positive breast cancer in patients whose disease has spread to their lymph nodes. Last year, the agency had provisionally rejected Perjeta in this setting, arguing that "uncertainty" over its clinical effectiveness suggested the drug might not be cost-effective.

However, NICE noted that Roche has since "proposed an improved discount" to the price of Perjeta, and also submitted a revised economic analysis that only included patients whose disease spread to their lymph nodes, whereas the previous draft guidance had also included those who cannot undergo hormonal therapy. Moreover, NICE said the new analysis used the independent appraisal committee's lower estimates of how long the benefit of treatment with Perjeta will last.  

Meindert Boysen, director of the Centre for Health Technology Assessment at NICE, stated "we're pleased that we've been able to work with the company to address the uncertainties of [Perjeta] as a treatment for early HER2-positive breast cancer." He added that Roche's "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." Final guidance is expected to be published in March.

Perjeta was approved in Europe last year for use in combination with Herceptin (trastuzumab) and chemotherapy for the post-surgery treatment of adults with HER2-positive early breast cancer at high risk of recurrence. NICE already recommends the drug, in combination with Herceptin and chemotherapy, for treating early HER2-positive breast cancer before surgery. The agency also recommends it for HER2-positive breast cancer that has either come back in the breast following initial treatment or has metastasised.

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