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Talazoparib recommended by NICE for advanced breast cancer after initial rejection

The poly ADP-ribose polymerase (PARP) inhibitor talazoparib (brand name Talzenna) has been recommended by the National Institute for Health and Care Excellence (NICE) to treat a type of locally advanced or metastatic breast cancer.

The final draft guidance from NICE recommends talazoparib for the treatment of adults with BRCA 1 or 2 mutated HER2-negative locally advanced or metastatic breast cancer after prior chemotherapy.

Evidence from a clinical trial showed that talazoparib increases how long people live without their cancer getting worse compared with chemotherapy. The trial did not show any difference in how long people live.

NICE originally rejected talazoparib for breast cancer in July 2023, but reversed the decision after the manufacturer Pfizer offered an increased – and confidential – discount to the drug’s price.

The draft guidance states: ‘When considering the condition’s severity and its effect on quality and length of life, the most likely cost-effectiveness estimates for talazoparib are within the range that NICE considers an acceptable use of NHS resources. So talazoparib is recommended.’

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The final guidance is expected to be published on 21 February 2024, and this will make talazoparib the first targeted treatment for this type of advanced breast cancer available in the NHS. This treatment would be instead of chemotherapy.

Current treatments include chemotherapy (mainly taxanes) and best supportive care, and alternative treatment options have been limited.

Helen Knight, director of medicines evaluation at NICE, said: ‘[This] announcement addresses a significant need by giving people with these types of cancer access to an additional treatment. And because talazoparib is taken as a once-daily tablet it means it’s much more convenient for people who would otherwise need to go into hospital for intravenous chemotherapy.

‘Although some uncertainty in the clinical evidence remains, when considering the impact of advanced breast cancer and its effect on quality and length of life, the improved discount from the company means we can now recommend talazoparib for use in the NHS.’

Earlier in January, talazoparib was approved by the European Commission in combination with the androgen receptor blocker enzalutamide in eligible patients with prostate cancer.