The National Institute for Health and Care Excellence has changed its position on the routine use of Roche's Perjeta to treat a certain form of breast cancer on the NHS in England and Wales.

The Institute has published draft recommendations endorsing the drug's use in combination with Herceptin (trastuzumab) and chemotherapy as an option before surgery in patients with HER2-positive, locally advanced, inflammatory or early stage breast cancer, to shrink the cancer so that it becomes operable.

The decision marks a turnaround from draft guidelines published back in May, which advised that the drug shouldn't be funded because of uncertainties with the economic data presented and over the drug's long-term benefit, largely because of limited trial evidence.

However, Roche subsequently offered a confidential price discount on Perjeta that makes its cost-effective for the NHS, even when taking uncertainties in the evidence highlighted by the committee into account, NICE said.

Professor Carole Longson MBE, director of the centre for health technology assessment at NICE, welcomed the "company's offer to share the long-term financial risks of a positive recommendation for the NHS by providing pertuzumab at a discounted price".

Around 1,400 people in England and Wales would be eligible for treatment with Perjeta annually.

The draft guidance recommends that the maximum number of cycles of treatment should not normally exceed four, the total cost of which is £9,580, without the confidential discount.