Breast cancer patients and campaigners will be hugely disappointed with news this morning that Roche’s Kadcyla will not be routinely available on the National Health Service in England and Wales.

The National Institute for Health and Care Excellence has published final draft guidance rejecting the use of Kadcyla (trastuzumab-emtansine) for patients as the first and only targeted chemotherapy for secondary HER2-positive breast cancer, because of its high price tag - around £90,000 per course (list price).

Although Roche has offered a discount, NICE’s independent Appraisal Committee found that it did not reduce the price enough to make it cost-effective for the NHS, despite using the specially extended range for so-called end-of-life medicines.

“We recognise that Kadcyla has a place in treating some patients with advanced breast cancer and we have been as flexible as we can in making our recommendation. However, the price that the manufacturer is asking the NHS to pay in the long-term is too high,” said Andrew Dillon, the Institute’s chief executive.

Patients in England will still be able to access Kadcyla in England through the country’s Cancer Drugs Fund, after a significant price cut offered by Roche secured its stay of execution. However, in a stark reminder of the UK’s current postcode lottery of care, patients in Wales - who had been getting access after support from the All Wales Medicines Strategy Group pending NICE’s ruling - and those in Scotland will be now be barred from treatment.

“We simply cannot continue in this way, with highly effective new cancer drugs being held just out of reach for patients in certain areas of the UK,” said Caitlin Barrand, assistant director of Policy & Campaigns at UK charity Breast Cancer Now. “It’s time that the Prime Minister showed real leadership on this issue…a fairer, more flexible system that enables access to the best treatments available on a routine, UK-wide basis is long overdue.”

More than 42,000 people signed a petition (organised by Breast Cancer Now) asking Roche to lower the price of Kadcyla to ensure its continued availability on the CDF and, while it ultimately had no effect on the drugmaker’s decision to lower the price (which had already been decided), the level of support shows the strong public feeling over the issue of costly cancer drugs. 

NICE said a different, smaller discount had been offered by Roche for its Kadcyla appraisal, but that had not received any further offers from the drugs giant. “Despite a growing public campaign for a fair deal on the cost of important new cancer medicines, it is disappointing that there appears to have been no meaningful attempt by Roche to reconsider its price to secure Kadcyla’s long-term future in the NHS, outside of the Cancer Drugs Fund,” Dillon said.

A confused system

In a statement, Roche said that its main priority is ensuring that patients in the UK can benefit from innovative, life-changing medicines that are standard of care across Europe. “Our concern with this NICE FAD on Kadcyla is that it highlights the confusion at the heart of our drug access system and destroys patients’ faith in the system that is supposed to ensure they have access to the treatments they need”.

“We need a unified approach and, moving forward, it is imperative that we work together to build a pragmatic, flexible and sustainable system for assessing medicines that prioritises clinical value. Only then will we be able to ensure the best outcomes for people with cancer in the UK,” the firm stressed.