NHS says no to new breast cancer drug Kadcyla


Terminal cancer patient and mother of four Hayley Kalinins says Kadcyla has allowed her to feel "really well"

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A pioneering new breast cancer treatment will not be routinely available in England and Wales, the NHS drugs advisory body NICE is proposing.

The drug - Kadcyla - adds six months of life on average to women dying with an aggressive form of breast cancer.

NICE criticised makers Roche for not setting an affordable price, in its updated draft guidance.

The drug costs £90,000 per patient but Roche said it had offered a lower - undisclosed - price in recent talks.

The two organisations have been in negotiations since the first draft guidance from NICE (the National Institute for Health and Care Excellence), rejecting the drug, was published in April.

Cancer drugs row: A sign of things to come?

There is a real sense of sadness - and anger for that matter - that the new breast cancer drug Kadcyla looks unlikely to be made routinely available on the NHS, something that is obvious from the bitter language being used by both sides.

The decision by England's official NHS advisory body, the National Institute for Health and Care Excellence (NICE), to reject Kadcyla prompted manufacturers Roche to claim the system was "broken".

NICE - not known for its strong use of language - responded by saying it was "really disappointed" in the approach taken by the drugs firm.

Read more analysis from Nick Triggle here

Price row

While this latest guidance is only the final draft version, there tends not to be any major changes when the official recommendations are published - normally a few months after this stage.

The original cost of Kadcyla worked out at £90,000 per patient - that is based on the standard 14 months of treatment.

Roche's Jennifer Cozzone: "NICE is the first organisation to say no to Kadcyla"

Roche said it had offered to lower the price "substantially", but NICE said the new price - which is not being disclosed - made little difference.

Kadcyla is used to treat people with HER2-positive breast cancer that has spread to other parts of the body and cannot be surgically removed.

About a fifth of breast cancer cases are HER2-positive, and it is thought this drug could benefit 1,500 women a year.

It works by seeking out and destroying cancerous cells, attacking them from within.

Its novel action means it is unlikely to cause the side-effects, such as hair loss, seen with many other types of chemotherapy.

Doctor inspecting x-rays For advanced cancer, the aim is remission rather than cure

Kimberley Mawby, 44, who managed to get the drug through a trial at London's Royal Marsden Hospital, described it as "amazing".

She said: "I can have a great life. I don't feel ill, the side-effects are so minimal I lead a really normal life.

"And I know how much it costs but at the end of the day you can't put a price on your life and that's what [Roche] are asking people to do.

"For all the people out there that need this drug, I really believe they should be able to get it"

'Huge blow'

NICE chief executive Sir Andrew Dillon said: "We are really disappointed that Roche were not able to demonstrate more flexibility.

"The company is well aware that we could not have recommended Kadcyla at the price it proposed."

Jennifer Cozzone, head of health economics and pricing at Roche, said: "We're very disappointed with this decision and, frankly, not just for patients who would have had the opportunity to receive Kadcyla with a positive decision.

"Considering Kadcyla is the eighth medicine in a row that NICE has declined to make available to women with advanced breast cancer in the UK, we don't believe this is a question of the price of Kadcyla.

"We believe that this is an issue with how NICE considers medicines in advanced breast cancer."

Sally Greenbrook from Breakthrough Breast Cancer: "It is a brilliant drug but incredibly expensive"

Dr Jayson Dallas, of Roche, added: "NICE's rejection of Kadcyla demonstrates quite simply that their current system is broken, not fit for purpose and in need of a complete overhaul when it comes to advanced cancer."

Mia Rosenblatt, head of policy and campaigns at Breast Cancer Campaign, said the news was a "huge blow".

"It is vital that this is not the end of the line for Kadcyla in respect of NICE approval, and we ask NICE and Roche to urgently revisit their negotiations to find a solution.

"It's not too late to review the cost of the drug," she added.

It means the only way women will be able to get access to the treatment is through the Cancer Drugs Fund, for which their doctors would have to make special requests.

Since April more than 200 women have been given Kadcyla in this way, but the Cancer Drugs Fund is due to end in 2016.

While the guidance applies to England, Wales have said they will follow suit. Officials in Northern Ireland and Scotland are considering the NICE recommendations. None of them currently funds the drug.


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  • rate this

    Comment number 338.

    Justice is one of the four basic principles of medical ethics, which means doing the greatest good for the greatest number of people. The NHS doesn't have a bottomless money pit and uses what it has to try and achieve that.
    Sadly for those who have the very specific indication for this drug, it doesn't help the NHS attain that aim.
    To fund this treatment, another would need to be cut.

  • rate this

    Comment number 337.

    It must be nice in your fluffy bunny world where big companies do everything for the sake of humanity. Unfortunately life doesn't work like that.
    I know a company with a great new drug which will save lots of lives. They'd like you to invest your life savings with a guarantee that you'll lose the whole lot because they plan to give the drug away for free. Interested? No? How surprising!

  • rate this

    Comment number 336.

    oops meant 327 - sorry for the typo

  • rate this

    Comment number 335.

    We pluck money out of thin air to send to other countries, yet we can't afford to take care of our own?
    We bring people to England for surgery, yet our own are denied or put on a long waiting list.
    We treat our sick and disabled with contempt, pulling their life line (ESA/DLA) from under them, pushing them to take their own life, taking their dignity.
    There's something wrong with this picture!

  • rate this

    Comment number 334.

    This is being reported incorrectly. The drug is available on the NHS and is routinely given via the cancer drugs fund (England only). The fact it is funded by the CDF is irrelevant to the patient as it's a backend admin thing. NICE is irrelevant and have hardly approved any cancer drugs since CDF. I'm an oncologist. Devolution means Wales/Scot/NI can do it their way and they do- its their choice.

  • rate this

    Comment number 333.

    To add to my post #328 below, Herceptin (which is what Kadcyla really is) is about to go off- patent, so much cheaper biosimilar versions are about to become available. Kadcyla has nothing to do with "Roche recouping its R&D costs" and everything to do with "stealth patent life extension". In a world of finite resources we have to balance cost against benefit. NICE was correct to reject Kadcyla

  • rate this

    Comment number 332.

    #ambrosia. If the pharmaceutical companies are so bad then what's your alternative? So they make a profit - that profit is limited by our own government (google PPRS if you don't believe me). Their shareholders are mainly the companies that provide your pension. Why not nationalise them and the government can fund all the research? Good luck with that.

  • rate this

    Comment number 331.

    People do not have a right to whatever drug they want. The NHS fortunately allows us to communally afford exceptional world class healthcare, but we have become spoilt and expect any drug free of charge at the point of need. This mentality needs to end because resources are finite on this planet and if a company is going to spend billions developing a drug, they should receive fair recompense.

  • rate this

    Comment number 330.

    326 really? NICE is non-political and made similar judgements when there was a Labour government, but don't let facts cloud your prejudice.

  • rate this

    Comment number 329.

    #a_responsibility_to_awe - what a truly ignorant comment!! "How much did developing this drug cost?". You imply that it's peanuts but the truth is it cost millions of dollars. Patent a new blood pressure drug and that cost can be spread across millions of patients. For secondary breast cancer that cost must be spread across a few thousand people in the UK. That's why it costs so much.

  • rate this

    Comment number 328.

    It is worth bearing in mind what Kadcyla is. It is not a new drug at all. It is an existing drug (Herceptin, generic name trastuzumab) with a chemotherapy agent added on. The real biochemistry breakthrough was Herceptin; Kadcyla is not a new breakthrough in any real sense. Other combination regimens (eg Herceptin plus Perjeta) produce an equal survival advantages for less money.

  • rate this

    Comment number 327.

    and this is what the conservatives want .......... two tier health service .... those that can afford health care, and the rest of us do not matter, just like Legal aid, or the lack of it now, if you can afford it you get justice/health .

  • rate this

    Comment number 326.

    I am sure that if my relative could benefit I would want them to have this drug. However, the NHS budget is finite and for it to fund a particular service or drug, it is necessary to decide which service should be stopped to pay for the new service. I would ask those who want to fund this drug, what do you want the NHS to stop doing and are you willing to explain your reasons to those affected?

  • rate this

    Comment number 325.

    236 doug

    someone else with the right idea!

  • rate this

    Comment number 324.

    Cancer drugs are not too expensive, and companies should not be expected it to lower its prices at the cost of its profits. They would not last a year. Most drugs invested in do not make it to market and effectively billions are spent with no financial gain. The reason drugs cost so much is because developing them requires many drugs to first fail, and all that money has to be recouped.

  • rate this

    Comment number 323.

    And yet the Duke and Duchess of Cambridge, gets £4m for a home renovation and the Queen is asking for more cash....???

    Bet the BBC fails to make this an editors pick, talk about a "Gluteus Maximus" backward attitude.

  • rate this

    Comment number 322.

    So you propose rationing treatment based on total tax paid over a patients lifetime? Where do kids and the poor feature in your brave new world? Will there be lots of forms to fill in?

  • rate this

    Comment number 321.

    186. Spindoctor - that'd be why research into prostrate cancer is so lacking then?

  • rate this

    Comment number 320.

    This is just so wrong we spend the lowest amount of money on actual medicines of any developed health service £1:£10 new drugs and rare conditions are bound to be more expensive to treat the funding for drugs must be improved to take this into account

  • rate this

    Comment number 319.

    308. Major Dennis Bloodnok
    If we did not throw money away in overseas aid and cushy benefits for the workshy, feckless and professional breeders
    Demotion to Corporal - how could you overlook that most avaricious of parasites the QE bonus gobbling banker?


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