AstraZeneca’s Truqap (capivasertib) has been approved for use by the National Health Service (NHS) in England and Wales, providing a new targeted therapy option that significantly increases progression-free survival (PFS) in breast cancer patients.
National Institute for Health and Care Excellence (NICE), the spending watchdog for the NHS, has recommended the drug to be used in combination with AstraZeneca’s already-marketed breast cancer drug Faslodex (fulvestrant). Adults with hormone receptor (HR)-positive HER2-negative breast cancer that has one or more PIK3CA, AKT1 or PTEN gene alterations and is locally advanced or metastatic are eligible for the therapy.
NICE estimates around 1,100 patients will be able to take the new twice-a-day tablet, with London’s Institute of Cancer Research (ICR) forecasting that the combo therapy will eventually benefit around 3,000 a year.
Truqap will likely become a key revenue driver for AstraZeneca. The drug is forecast to reach blockbuster status by 2027, whilst 2031 global sales are expected to hit nearly $2bn, as per GlobalData’s Pharma Intelligence Centre. As well as the UK, Truqap is also approved in the US, the European Union (EU), and Japan, amongst others.
GlobalData is the parent company of Pharmaceutical Technology.
The HR-positive HER2-negative breast cancer drug market also includes Pfizer’s Ibrance (palbociclib), Eli Lilly’s Verzenio (abemaciclib), and Novartis’ Kisqali (ribociclib).
Breast cancer is the most common cancer in the UK, affecting one in seven women. Treatments have progressed over the past few decades, meaning 75% of patients survive for 10 years or more after diagnosis. HR-positive HER2-negative breast cancer is the most common type of breast cancer.
Results from the Phase III CAPItello-291 trial (NCT04305496) showed that Truqap doubled the time it took for cancer to progress in 708 women with HR-positive HER2-negative breast cancer patients. The median PFS was 7.3 months in those who received Truqap and Faslodex, compared to 3.1 months in patients who received hormone therapy alone.
The NHS availability of Truqap is a ‘triumph’ according to Professor Kristian Helin, chief executive of ICR.
"This announcement is a triumph that will improve treatment for these patients with the most common type of advanced breast cancer. Around half of patients with this kind of breast cancer have mutations in one or more of the genes and for these patients, Truqap can halt disease progression. I’m delighted that access to the drug is being expanded to NHS patients in England and Wales who are in desperate need of better options,” Professor Helin commented.
Patients with advanced HR-positive HER-2 negative breast cancer in the UK are currently offered the option to continue Faslodex or chemotherapy. Faslodex on its own is often ineffective and chemotherapy carries side effects, the ICR stated.
“People with advanced breast cancer would value treatments like [Truqap] that can be given when limited options exist and because it may delay the need for chemotherapy and its associated side-effects,” NICE’s director of medicines evaluation Helen Knight said.
Truqap works by inhibiting all three isoforms of the AKT protein. AKT kinases enable cancer cell growth and multiplication. NICE said that whilst there have been no clinical trials directly comparing the new combo therapy to existing approved regimens, indirect comparisons suggest non-inferiority.
The recommendation by NICE represents a U-turn after the agency initially rejected the therapy due to uncertainties over its cost-effectiveness.
Breast Cancer Now’s chief executive Claire Rowney said this meant “patients faced unnecessary delays in accessing” the treatment.
She added that “NHS England must now put in place prompt genetic testing to ensure those eligible to receive [Truqap] without further delay.”
