Available breast cancer medications


Available breast cancer medications

Ø Who decides whether to use novel cancer medications on the NHS?

The National Institute for Health and Care Excellence (NICE) is the organisation in England that decides which new medications will be made available through the National Health Service. Normally, Wales and Northern Ireland adhere to NICE rulings. The Scottish Medicines Consortium (SMC) in Scotland decides which new medications will be made available through the Scottish National Health Service (NHS). For every new breast cancer medicine, Breast Cancer Now provides input into both processes to make sure the patient voice is heard clearly at every turn.

 What medicines have already received approval for 2022?


     Trastuzumab and capecitabine, tucatinib (Tukysa)

Both NICE and the SMC approved the use of the targeted medication tucatinib in combination with trastuzumab and capecitabine at the start of this year. It can be used after two or more additional therapies for HER2-positive breast cancer. This treatment is for HER2 positive, locally progressed, or secondary breast cancer. It represents a significant improvement in treatment options, especially for eligible individuals whose breast cancer has progressed to the brain.

          Chemotherapy combined with pembrolizumab (Keytruda)

In May, we celebrated Pembrolizumab's NICE approval as a chemotherapy and immunotherapy combo drug (paclitaxel or nab-paclitaxel). It is appropriate for patients with locally advanced or secondary breast cancer that is triple negative, has an elevated level of the protein PD-L1, and who have not previously undergone chemotherapy for their secondary or locally advanced breast cancer.

This treatment, in which we are participating, is currently being evaluated by the SMC. In the fall of 2022, a decision is anticipated.

      Abemaciclib, the primary treatment for breast cancer (Verzenios)

For select patients with hormone-receptor-positive, HER2 negative primary breast cancer, whose breast cancer is lymph node-positive, NICE authorised abemaciclib for routine use on the NHS alongside hormone therapy after surgery. An estimated 4,000 people will be qualified for this treatment per year. We are awaiting the dates for the SMC's appraisal after it was submitted.

If you have used this treatment and would be willing to share your experience with us in order to inform our efforts to ensure that it is also accepted for use on the Scottish National Health Service, please do so.


 What is scheduled for the remainder of 2022?

Here, we focus on a few of the medications that are presently being evaluated, and we anticipate that decisions about their application to the NHS will be made later this year. The NICE and SMC schedules may include new medications, and the timings are only estimates.

Ø Secondary breast cancer medications


       Saquinuzumab emtansine (Trodelvy)

We appreciate your support of the Time For Trodelvy initiative. In March 2022, the SMC approved the use of sacituzumab govitecan for the Scottish National Health Service. Tragically, NICE rejected it provisionally in April 2022. To guarantee that this decision is overturned, we have been working hard with our patient advocates and supporters. We'll keep you updated as we anticipate announcing the final decision in July.

In the interim, we have confirmation from the pharmaceutical industry that they will continue to welcome new qualified patients into their pre-reimbursement access programme. We advise patients to discuss this with their treatment team as a healthcare professional must submit any requests to Gilead.

      Combined alpelisib (Piqray) and fulvestrant

Following a provisional denial in April, we anticipate NICE will make a definitive determination regarding the use of alpelisib with fulvestrant in July. This is the first specific therapy for some patients with PIK3CA mutations, which are thought to occur in 30–40% of oestrogen receptor-positive, HER2-negative breast tumours. We're expecting the SMC's timeframe for when it will be evaluated.

     Deruxtecan trastuzumab (Enhertu)

For HER2-positive breast cancer that cannot be surgically removed or secondary breast cancer after two or more prior treatments for HER2-positive breast cancer, trastuzumab deruxtecan is already accessible on the NHS. In a recent clinical trial, the medication was compared to trastuzumab emtansine (Kadcyla) in order to determine if it should be used earlier in the course of the disease or after one or more prior therapies for HER2 positivity. Timelines for the SMC will be set after the decision, which is anticipated around the end of this year.

       Lbrance (palbociclib) with fulvestrant

NICE approved the use of palbociclib with fulvestrant under the Cancer Drugs Fund in 2019. (CDF). While more information is gathered, the CDF permits NICE to provisionally approve promising medicines. After this period of data gathering, NICE reviews the treatment and decides whether or not to utilise it on the NHS. This has previously happened for related drugs like ribociclib (Kisqali) and abemaciclib (Verzenios), and a new review is being done to see whether palbociclib with fulvestrant can be made regularly accessible. A decision is anticipated in the fall of 2022.


Ø Primary Breast cancer drugs

       Olaparib (Lynparza)

After surgery and chemotherapy, olaparib is being evaluated by NICE as an adjuvant therapy for high-risk, HER2 negative, BRCA positive primary breast cancer. A choice is anticipated before the year is over.

For eligible patients, AstraZeneca has launched an early access programme for olaparib, and we advise patients to discuss this with their treatment team as any requests to AstraZeneca must be made by a healthcare professional.

       Pembrolizumab (Keytruda)

In some patients with primary triple-negative breast cancer, pembrolizumab is now being evaluated by NICE in combination with chemotherapy prior to surgery and again after surgery on its own. This year's choice is anticipated to be made public in the fall.

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