Pfizer’s leading breast cancer candidate Ibrance has been rejected by the UK’s cost effectiveness body on the grounds of its high cost. 

The National Institute of Health and Care Excellence’s (NICE) decision followed its evaluation of Ibrance (palbociclib) in first line hormone receptor positive, human epidermal growth factor receptor 2 (HER2) negative, locally advanced or metastatic cancer.

In this setting, a complete course of Ibrance costs £79,650.

Pfizer had predicted it unlikely for Ibrance to be approved in this setting on the basis of its use as an add-on drug alongside an aromatase inhibitor. In such a setting, NICE evaluates the cost of the entire treatment, including the base therapy and the add-on drug.

Ibrance is prescribed alongside an aromatase inhibitor as a form of ‘two-pronged’ cancer therapy: Ibrance itself inhibits molecules called cyclin dependent kinases – molecules that regulate the cell lifecycle – whilst aromatase inhibitors interfere with the production of a hormone called oestrogen which, in hormone receptor positive breast cancer, can fuel the growth of cancer cells.

Although Ibrance was found to prevent the growth of breast cancer for an average extra 10 months, NICE insisted on more evidence backing the drug’s ability to improve overall survival before it can be deemed cost effective.

“The committee needs more evidence of the drug’s impact on overall survival of people with breast cancer,” said Professor Carole Longson, director of the centre for health technology assessment at NICE. “However, even when allowing for these potential benefits, it was still not enough to make palbociclib cost effective at its current price.

“The committee heard from the patient expert that delaying the progression of their cancer for as long as possible and being able to continue with normal activities, including working, is valued very highly by patients and their families.

“It also heard that by postponing disease progression, palbociclib may reduce the number of people who are exposed to the often unpleasant side effects of chemotherapy, and delay the need for such treatment in others.

“Taking the costs into account, the committee concluded that it could not recommend palbociclib for NHS use at present.”

Thankfully for Pfizer, Ibrance has already reached blockbuster status in the US since its launch in 2015. The drug raked in more than $2 billion Pfizer in 2016.

In the UK, Pfizer could still offer Ibrance at a discounted price as part of a patient access scheme in agreement with the Department of Health. This would give patients access to the drug despite its high price.

NICE is now consulting on the guidance until 24th February, as which point it will offer final guidance on the drug.