In its final appraisal document, which was released on 15 February 2019, NICE recommended that pertuzumab with intravenous trastuzumab and chemotherapy (docetaxel) is recommended for the adjuvant treatment of human epidermal growth factor receptor 2 positive (HER2+) early stage breast cancer in adults with lymph-node-positive disease and provided that Roche sticks to the promised discounts on its originator pertuzumab, Perjeta.

In its final appraisal document NICE states that Roche has offered the UK’s National Health Service a discount on Perjeta, which has a UK list price of GBP 2,395 for a 420 mg vial.

NICE does not indicate how much the discount on Perjeta might be. However, it does say that when the discount on the price of Perjeta, together with a weighted discount for biosimilar intravenous trastuzumab are taken into consideration, the ‘cost-effectiveness estimate is comfortably below GBP 20,000 per quality-adjusted life year (QALY) gained’. The GBP 20,000 threshold is NICE’s typical cost-effectiveness threshold and it is for this reason that the institute says that it has recommended adjuvant pertuzumab for HER2+ early stage breast cancer in people with lymph-node-positive disease.

This latest recommendation overturns NICE’s August 2018 appraisal, which did not recommend Perjeta, with biosimilar trastuzumab and chemotherapy, for treatment of breast cancer. This was because, although the institute said that biosimilar trastuzumab would lower the cost of treatment, it was concerned that the treatment still might not be cost-effective.

To date, there are no biosimilars of pertuzumab. Companies working on biosimilars or non-originator biologicals of pertuzumab include Iran-based CinnaGen, Taiwanese company JHL Biotech, India-based Mabpharm, Australian biotech NeuClone and China-based Shanghai Henlius Biotech.

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