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National Institute of Health and Care Excellence (NICE) on Wednesday published draft guidance for public consultation which does not recommend Novartis’s ribociclib (Kisqali) with fulvestrant for advanced breast cancer.

This recommendation is based on the uncertainties in the clinical evidence, and cost-effectiveness estimates that are much higher than acceptable.

The clinical trial evidence available suggests that the drug combination increases the length of time before the disease progresses. However, there is a lack of evidence around the overall survival benefit as the final trial results are not yet available.

“More data may address the uncertainties in the clinical trial evidence but because ribociclib with fulvestrant does not have the plausible potential to be cost-effective at the offered price, it cannot be recommended for use within the Cancer Drugs Fund (CDF).

NICE last week provisionally approved the use of abemaciclib with fulvestrant for the same indication within the CDF.

The institute also recommends ribociclib used with an aromatase inhibitor for people with previously untreated hormone receptor-positive, HER2-negative, locally advanced or metastatic breast cancer.