Title: Trastuzumab deruxtecan for treating HER2-positive unresectable or metastatic breast cancer after trastuzumab and a taxane [ID3909]
Funder: Department of Health and Social Care

Abstract: Breast cancer arises from the tissues of the ducts or lobules of the breast. Metastatic breast cancer is when the cancer has spread beyond the breast and nearby lymph nodes to other organs in the body. Unresectable means that the cancer cannot be removed by surgery. Human epidermal growth factor receptor 2 (HER2) is a receptor for a growth factor which occurs naturally in the body. When human epidermal growth factor attaches itself to HER2 receptors on breast cancer cells, it can stimulate the cells to divide and grow. Some breast cancer cells have more HER2 receptors or extra copies of the HER2 gene than others. In this case, the tumour is described as being HER2-positive._x000D_ _x000D_ In 2017, there were 46,109 new diagnoses of breast cancer in England. [1] There were approximately 3,900 cases of breast cancer in stage IV in the UK in 2018 according to the National Cancer Registration and Analysis Service.[2] In 2017 in England, there were 10,219 deaths from breast cancer.[3] It is estimated that approximately 15-20% of women with breast cancer will have HER2-positive tumours. [4]_x000D_ _x000D_ Current treatments for advanced breast cancer aim to relieve symptoms, prolong survival and maintain a good quality of life while managing adverse events. Treatment depends on whether the cancer cells have particular receptors (hormone receptor status or HER2 status), the extent of the disease and previous treatments._x000D_ _x000D_ For people with HER2-positive unresectable or metastatic breast cancer who have not had previous anti-HER2 treatment or chemotherapy for their metastatic disease, NICE technology appraisal guidance 509 recommends pertuzumab with trastuzumab and docetaxel as first line treatment. NICE technology appraisal guidance 34 recommends trastuzumab with paclitaxel as an option for people with tumours expressing HER2 who have not received chemotherapy for metastatic breast cancer and in whom anthracycline is not appropriate. For disease that has progressed after trastuzumab and a taxane, NICE technology appraisal guidance 458 recommends trastuzumab emtansine as an option for treating HER2-positive unresectable, locally advanced or metastatic breast cancer._x000D_ _x000D_ References_x000D_ 1. Office for National Statistics. Cancer registration statistics, England 2017. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/cancerregistrationstatisticscancerregistrationstatisticsengland Accessed October 2021_x000D_ 2. National Cancer Registration and Analysis Service (NCRAS). Stage breakdown by CCG 2016. London: Public Health England, 2018. Available from: http://www.ncin.org.uk/view?rid=3604 Accessed October 2021_x000D_ 3. Office for National Statistics. Death Registrations Summary Statistics, England and Wales, 2017. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/deathregistrationssummarytablesenglandandwalesreferencetables Accessed October 2021_x000D_ 4. Macmillan Cancer Support Receptors for HER2. Available from https://www.macmillan.org.uk/cancer-information-and-support/breastcancer/receptors-for-breast-cancer Accessed October 2021

Lay abstract: To appraise the clinical and cost effectiveness of trastuzumab deruxtecan within its marketing authorisation for HER2-positive unresectable or metastatic breast cancer after trastuzumab and a taxane.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: CANCER AND NEOPLASMS