The National Institute for Health and Care Excellence is backing routine NHS funding for Pfizer's Ibrance and Novartis' Kisqali to treat certain forms of breast cancer, after the firms agreed a reduced price under the new process for appraising medicines.
The cost watchdog said that the undisclosed discounts have enabled it to recommend the drugs as new options for people with hormone receptor (HR) positive, human epidermal growth factor receptor 2 (HER2) negative locally advanced or secondary breast cancer in final draft guidelines, “despite uncertainties about how long they extend overall survival”.
Both Kisqali (ribociclib) and Ibrance (palbociclib) are both CDK 4/6 inhibitors designed to slow disease progression, given once-daily alongside an aromatase inhibitor, which itself blocks the production of the hormone oestrogen to prevent it from fuelling the cancer.
NICE’s appraisal committee found that both drugs stalled the growth of cancer for an extra 10 months on average, and that this effect would likely result in some improvement in overall survival, though the exact magnitude of this could not be determined from current clinical trials.
Dr Alistair Ring, consultant medical oncologist at The Royal Marsden, London, called the decision to allow NHS use of these therapies “a breakthrough moment for the advanced breast cancer community in England and Wales.”
Also commenting on the decision, Professor Nicholas Turner, Professor of Molecular Oncology at The Institute of Cancer Research, London, and consultant medical oncologist at The Royal Marsden, and one of the clinical experts on the NICE panels for both drugs, said: “I’m delighted that NICE and the manufacturers have managed to come to an agreement over the price and economic modelling of palbociclib and ribociclib, so that many more women can access this much-needed new type of treatment on the NHS.”
Kisqali was approved in Europe back in August. “Under the new NICE process, this is the first time a cancer medicine has been funded so soon after being licensed – showing that the system can work to bring innovation earlier, to benefit patients and the NHS,” said Barak Palatchi, General Manager of Novartis Oncology UK & Ireland.
However, Professor Paul Workman, chief executive of The ICR, expressed frustration that NHS approval of Ibrance “was such a long, drawn-out process,” given that it received regulatory approval in November last year and was subsequently turned down by NICE for being too costly.
“We need NICE to work together with industry on a new process for evaluation where companies are encouraged to come forward with their best price much earlier in discussions. The current system is taking too long and prices still remain high,” he said.
It is estimated that around 8,000 people in England would be eligible for treatment with either palbociclib or ribociclib.