Scotland’s NHS medicines’ gatekeeper has given the green light to two breast cancer treatments, giving the hope of extra time to women whose illness is well advanced.

The Scottish Medicines Consortium (SMC), which issues advice to all Scotland’s NHS boards and its three regional specialist cancer networks, has given the go ahead for patients to be given trastuzumab deruxtecan (brand name Enhertu) and tucatinib (brand name Tukysa). 

They provide specialists with new treatment options for patients with HER2-positive cancer that cannot be removed by surgery or who have secondary incurable breast cancer who’ve already received two or more other treatments specifically for this type of breast cancer.

Trastuzumab deruxtecan, produced by Daiichi Sankyo, is a combination of a targeted drug, trastuzumab, which attaches itself to HER2 proteins to stop breast cancer cell growth and then delivers deruxtecan, a chemotherapy, to kill them.

The SMC decided that, although promising, the evidence for the medicine is not yet complete so is allowing its interim use by Scottish clinicians while further results are gathered.

Tucatinib is a type of targeted therapy known as an oral tyrosine kinase inhibitor (TKI). It is taken in combination with two other medicines, trastuzumab and capecitabine, to control how cells grow and divide. It blocks a specific area of the HER2 gene in cancer cells which stops the cells from growing and spreading.

Chief Executive of the charity Breast Cancer Now, Baroness Delyth Morgan, says the announcements bring hope to patients whose cancers have progressed on existing treatments and who urgently need new, targeted options:

“The SMC’s approval of these treatments marks a significant leap forward for certain women living with incurable HER2-positive secondary breast cancer; availability of the Tukysa combination will provide an important new option for certain people whose breast cancer has spread to the brain, who for too long have faced potentially shorter prognoses and poorer quality of life.

“For women who’ve progressed beyond two or more targeted treatments, access to Enhertu and the Tukysa combination could now give patients more time before their disease progresses and extend their lives, offering them precious extra time with loved ones.”

As part of its consideration of the combined treatment, the SMC convened a patient and clinician engagement (PACE) meeting to gather information from specialists and patient representatives to better understand the potential impact of the new medicine.

SMC chairman, Mark McGregor, said the effect on patients was made clear to them:

“We heard of the heavy symptom burden for patients living with HER2-positive breast cancer. Trastuzumab deruxtecan may be a useful additional treatment but as the evidence considered was limited, the committee decided to accept its use subject to reassessment once further evidence is available.

“Trastuzumab deruxtecan and tucatinib may provide patients with additional treatment options that have the potential to slow disease progression and control the symptoms of this aggressive form of breast cancer.”

SMC published advice allowing a total of four medicines to be prescribed by NHS clinicians in Scotland.

The green light was also given to osimertinib (Tagrisso) by AstraZeneca UK Ltd for first-line treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor mutations; and to tralokinumab (Adtralza), which is a monoclonal antibody treatment from LEO Pharma for moderate-to-severe atopic dermatitis (atopic eczema) in adult patients who are candidates for systemic therapy.

The latter is the first approved biologic to specifically target IL-13 cytokine, a chemical behind inflammation and other symptoms of the condition.

 

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