Guidance on the use of taxanes for the treatment of breast cancer was issued on June 16 by the National Institute for Clinical Excellence (NICE). It recommends that both docetaxel (Taxotere) and paclitaxel (Taxol) should be available for the treatment of advanced breast cancer when initial cytotoxic chemotherapy (including anthracycline) has failed or is inappropriate.
The NICE also recommends that the use of taxanes for first-line treatment of advanced breast cancer and for adjuvant treatment of early breast cancer should be limited to clinical trials.
According to the guidance, the choice of taxane for individual patients should take into account evidence from clinical trials (which it summarises). It says that both drugs are clinically effective for the treatment of anthracycline-resistant advanced breast cancer but that more randomised clinical trial evidence is available for docetaxel than for paclitaxel. The guidance says that the side effect profile in individual patients may differ between the two products.
The NICE guidance on use of taxanes in breast cancer was due to be published in May. However, the guidance originally only recommended the use of docetaxel (and not paclitaxel) and an appeal against the guidance was lodged. (Recommendations for use of taxanes in ovarian cancer were published at that time [PJ, May 13, p716].) The NICE appeal committee upheld the appeal, made by Bristol Myers Squibb Pharmaceuticals (manufacturer of paclitaxel) and the charity Cancer Bacup, that due weight had not been given to the evidence submitted with regard to the use of paclitaxel in breast cancer. Following re-appraisal, new guidance was drafted recommending the use of both taxanes for breast cancer. A second appeal by Aventis Pharma (manufacturer of docetaxel) was not upheld and, as a result, the guidance was published on June 16. While both companies welcomed the publication, Aventis said: "We regret, however, that the guidance is incompletely drafted and does not show the full extent of the differences between the two taxanes reviewed which clearly favours docetaxel as a treatment of choice for patients."
NICE has estimated that the additional cost to the National Health Service of using taxanes in breast cancer will be £16m per year. This is based on an extra cost of £4,000 per patient, compared with conventional drug treatments, for an estimated 4,000 patients. At present, 1,000 patients receive taxane treatment for breast cancer. The Department of Health said in a press statement on June 16 that health authorities had already received funding which would enable them to implement the NICE recommendations "through the additional allocation of £600m made following the budget".
The guidance is available on the NICE website (www.nice.org.uk).