The National Institute for Health and Clinical Excellence (NICE) does not recommend lapatinib (Tyverb, GlaxoSmithKline) or trastuzumab (Herceptin, Roche) with aromatase inhibitors for a particular type and stage of breast cancer. This is because it is unclear how much either drug can improve overall survival compared to existing treatments and they do not appear to represent value for money for the NHS.
The healthcare guidance body, NICE, is currently developing guidance for the NHS on the use of lapatinib or trastuzumab specifically as first line treatment options to delay the growth of advanced breast cancer that has spread to other parts of the body (metastatic disease), and which reacts with the hormones oestrogen or progesterone and has high levels of a protein called HER2 on the surface of its cells. Once published, the guidance will only advise on the use of these drugs alongside aromatase inhibitors (a type of hormone therapy).
This final appraisal determination (FAD) follows a public consultation in February on NICE’s provisional recommendations. The FAD proposes that these drugs are not recommended for use with aromatase inhibitors for this particular type and stage of breast cancer. If women are already receiving either option when the final guidance is published, then they should be able to continue treatment until they and their doctors consider it appropriate to stop.
Sir Andrew Dillon, Chief Executive of NICE said: Having reviewed the available evidence, our committee of experts has found that while both lapatinib and trastuzumab can reduce the growth and further spread of metastatic breast cancer tumours when taken alongside the aromatase inhibitors letrozole and anastrozole, the extent to which these treatments can improve overall survival appears to be small or difficult to quantify.
Until final guidance is issued, NHS bodies should continue to make decisions locally on the funding of specific treatments.
NICE hopes to publish final guidance for the NHS in June 2012.