The National Institute for Health and Care Excellence says it is looking to Roche to ensure a new treatment for advanced breast cancer with significant unmet need is cost-effective.

The cost watchdog published draft guidelines rejecting the PD-L1 inhibitor Tecentriq (atezolizumab) for breast cancer that has spread to other parts of the body, ruling that based on current evidence it is too expensive for NHS use.

Tecentriq given with the chemotherapy agent 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 to people who have not had prior chemotherapy for metastatic disease and where surgery to remove the tumour is not possible.

Evidence indicates that the combination extends progression free survival by around 2.5 months compared to placebo plus nab-paclitaxel (7.5 months versus 5.0 months respectively), and increases overall survival by around 9.5 months (25.0 months versus 15.5 months respectively).

However, NICE noted that the company did not submit any trial data directly comparing atezolizumab plus nab-paclitaxel with other treatments currently used at this stage, and the committee felt its analysis indirectly comparing these treatments was "unreliable and lacked validity".

When using nab-paclitaxel as a proxy for current treatment in the NHS, NICE’s independent committee could not recommend atezolizumab plus nab-paclitaxel as a cost-effective use of NHS resources, even after applying end-of-life criteria, it added.

Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said the Institute is "committed to working with the company to try to resolve the issues identified by the committee. In the meantime, I would encourage anyone with an interest in this topic to give us their feedback on this draft guidance.”

The cost of a course of treatment with atezolizumab is £39,981 based on treatment for 7.5 months at its full list price but the company offered the NHS a confidential discount.

An estimated 2000 people in England have triple negative breast cancer, of whom around 600 people would be eligible for treatment with atezolizumab and nab-paclitaxel.