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NICE backs breast cancer drugs

Draft guidance recommends aromatose inhibitors for use on the NHS, despite high costs

Aromatose inhibitors should be approved for use in early-stage breast cancer on the NHS alongside the gold-standard treatment, tamoxifen, despite costing ten times more, according to preliminary guidance from the National Institute for Health and Clinical Excellence (NICE).

In its draft guidance, the drug cost-benefit assessment body said trials of the new drugs have shown fewer women on them have a recurrence of cancer than on tamoxifen. Aromatose inhibitors (AIs) work by blocking the natural production of oestrogen, the hormone responsible for several breast cancers.

The guidance will most likely mean a full recommendation in November for AstraZeneca's (AZ) Arimidex (anastrozole), Novartis' Femara (letrozole) and Pfizer's Aromasin (exemestane). Tamoxifen (branded as Nolvadex) is sold by AZ but is now off-patent.

AIs cost about £1,000 per patient per year - approximately ten times the cost of tamoxifen.

ìThis guidance will mean that the 23,000 women diagnosed with early breast cancer each year, plus the many thousands of women currently receiving tamoxifen, will be able to benefit from these life-saving medicines,î said Dr Rakesh Patel, medical leader, breast cancer at AZ. ìThe wealth of AI data demonstrating women are living cancer free for longer and at extremely good value for the NHS are compelling and have made a strong case for the wider use of AIs over tamoxifen.î

Jeremy Hughes, chief executive of charity Breakthrough Breast Cancer, said: ìTamoxifen has already had a big impact on women's lives and these new treatment options will be an important addition to the armoury of therapies available to treat women with the disease.î

He added that NHS trusts should start to make the drug available for some patients on the basis of the draft guidance.

AIs are already available in Scotland for post-menopausal patients after they have been treated with tamoxifen.

NICE said that in the largest trial of Arimidex, after five years, 81.3 per cent of women on the drug were alive and disease-free compared with 79 per cent of those on tamoxifen. In a study of Aromasin, after three years 89 per cent were alive and cancer-free compared with 85.1 per cent of those on tamoxifen.

After two years, 91.2 per cent of women on Femara were alive and cancer-free compared with 89.3 per cent on tamoxifen.

30th September 2008

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