NHS offers first drug targeting advanced breast cancers driven by BRCA gene mutations

Talazoparib (Talzenna) will become the NHS’s first targeted treatment for advanced breast cancers caused by mutations to BRCA genes, after a recommendation by the National Institute for Health and Care Excellence (NICE).

NICE estimates that around 300 people in England will benefit from the new treatment, which will be offered to them instead of chemotherapy. Clinical trial results suggest that it can stop their cancers growing for longer

The decision was made after Pfizer, the company that makes talazoparib, offered the drug to the NHS at a discount. NICE had originally chosen not to recommend it because of cost concerns.

What are BRCA genes?

Everyone has BRCA (BReast CAncer) genes, which usually work to stop cells multiplying in ways that can lead to cancer. A very small group of people (around 1 person in every 450), have different versions of these genes. These changes, which can be inherited, make BRCA genes less able to stop cells from growing out of control, increasing the risk of certain cancers.

Since our researchers helped discover BRCA genes in the 1990s, doctors have been able to use treatments like talazoparib to target common features of cancers caused by BRCA mutations. The first of these “PARP inhibitor” drugs, olaparib, was also developed by a team of our scientists.

Drugs like olaparib are already available for early-stage breast cancers. NICE’s decision on talazoparib means these breakthroughs can now also help people with more advanced disease.

A targeted drug for advanced breast cancers

Talazoparib is recommended for advanced breast cancers with cells that don’t have receptors for a protein called HER2, which can be effectively targeted by other drugs. HER2 negative breast cancers, including triple negative breast cancers, don’t have as many treatment options.

Advanced breast cancers have grown or spread to the point that they cannot be cured, so the aim of treatment is to help people live longer with a good quality of life. This is done differently for different HER2 negative cancers, but treatments often involve giving chemotherapy directly into people’s veins.

Patient experts told the NICE committee that this can be difficult and tiring. They also explained that people receiving chemotherapy need to spend lots of time in hospital, which makes it harder for them to lead normal lives.

By contrast, people who have advanced HER2 negative breast cancers and BRCA mutations can take talazoparib at home in the form of a daily pill.

How effective is talazoparib?

The NICE committee based their recommendation on evidence from the EMBRACA trial, which compared talazoparib to alternative therapies chosen by physicians in different countries. Although it didn’t improve overall survival, talazoparib kept trial participants’ cancers from growing or having a bigger impact on their health for longer than other treatments.

Doctors and patients told NICE that these results show talazoparib could help people live “as normal a life as possible for as long as possible”.

In most cases, the NHS will offer talazoparib to people who have already been treated with at least one other breast cancer drug. It can be used as people’s first treatment when the other available options are not suitable.

NICE decisions apply to England and are usually adopted in Wales and Northern Ireland. Scotland has a different process for deciding which drugs can be used on the NHS.