NICE is now backing NHS use of Tecentriq (atezolizumab) with nab-paclitaxel for treating PD L1-positive, triple-negative, advanced breast cancer, following an “improved offer” from drugmaker Roche.

In draft guidelines, the Institute said its earlier rejection has been overturned after the company updated its economic model and agreed to provide a larger discount to the list price of the drug following a deal with NHS England and NHS Improvement.

Tecentriq, given with chemotherapy drug nab-paclitaxel, is the first immunotherapy that specifically targets triple negative breast cancer where tumours have PD-L1 expression of 1% or more.

It is given by injection every two weeks to people who have not had chemotherapy for breast cancer that has spread to other parts of the body and where surgery to remove it is not possible.

The drug works by blocking the activity PD-L1 which is produced in larger amounts on cancerous cells than normal cells, thus helping the person’s own immune cells to attack the cancer.

According to NICE, the evidence suggests that the combination increases the time before the disease worsens by around 2.5 months compared to placebo plus nab-paclitaxel (7.5 months versus 5.0 months respectively).

It also suggests that atezolizumab plus nab-paclitaxel increases overall survival by around 9.5 months (25.0 months versus 15.5 months respectively).

“We are pleased to have been able to work with the company to resolve the issues identified by the committee in our previous draft guidance,” said Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE.

“The committee heard that the availability of a new treatment that increases progression-free survival compared with chemotherapy alone will give hope to patients because it is important to them to be able to maintain a good quality life for as long as possible.”

Professor Peter Johnson, NHS clinical director for cancer said: “As well as ensuring the safety of cancer patients during the pandemic, the NHS is also working hard to make sure that the best care and treatment options are available for them.

“We are delighted that we were able to strike a deal with the company to support NICE’s recommendation for atezolizumab, which will help hundreds of people with breast cancer and their families – it means that patients with triple breast cancer have a significantly better option for treatment.”

“This is a major advance in treatment for triple negative breast cancer, the like of which has not been seen in over 20 years. We are proud to have collaborated with the breast cancer community to ensure that, from now on, people are able to benefit from the first targeted immunotherapy for the disease,” noted Lesley Hugo, Integrated Franchise Lead – Breast Cancer, Roche Products Limited.