Patients in England with a specific type of incurable breast cancer can now access a life-extending drug on the NHS, two years after a health body deemed it too expensive. Because nothing says "life-extending" quite like a two-year negotiation over the price tag.
Enhertu can give patients almost seven extra months to live on average - with some living up to three years longer. Women in Scotland have had access since 2023, and it's available in 26 other European countries, which is a fun fact for anyone who enjoys being last to the party.
Charities and patients have campaigned for wider availability since 2024, when the National Institute for Health and Care Excellence (NICE) said Enhertu was not good value for money. From Thursday, doctors in England can prescribe it, with Wales expected to follow shortly, though the guidance doesn't automatically apply to Northern Ireland. Health Secretary Yvette Cooper called the recommendation "life-changing" and a "tribute to the campaigners and charities who never stopped pressing for this."
This decision affects about 1,000 women a year with HER2-low breast cancer. Charity Breast Cancer Now said campaigners' "persistence paid off," but noted thousands have missed out and many have died. Chief executive Claire Rowney said, "Today we can finally say we did it," while adding, "we can't celebrate this momentous decision without remembering the devastating cost of this delay."
Kate Wills, 51, understands that mix of emotions. She has HER2-low metastatic breast cancer that has spread to her bones and lungs, yet nothing about her suggests she is terminally ill. She has a high-powered job, is a wife and mum, and her social media shows a full and happy life - only the occasional medical appointment hints otherwise. Kate said it was "incredibly painful" to know Enhertu could keep her alive longer but she couldn't get it. Hearing it will be available on the NHS, she immediately started crying. "I really can't believe it. I'm so relieved, I'm overjoyed," she said. "It's so hard keeping hope when you have stage four cancer. This gives me enormous hope."
Her son and daughter are in their teens and early 20s, and Kate has been aiming to stay alive long enough for her youngest to finish school. Smiling through tears, she said, "Now I've just dared to dream that I might be around to see them fall in love, to get married." For her, it's bittersweet. Her first thought is for "those women, my friends, who didn't get this in time."
One of those was Jeannie Ambrose, full of life and fight when she spoke to BBC News two years ago at 53. She said, "I'm not ready to die yet. I want to stay alive, I want to keep living. I should be concentrating on enjoying time with my family and friends. I should not be campaigning, using the time I've got left to fight." Jeannie died in January this year. Kate said her friend would be "thrilled but also angry at how long it's taken and how rejected we've felt."
The BBC understands drug companies Daiichi Sankyo and AstraZeneca have not substantially lowered their prices since the drug was first rejected. The reason NICE reversed its decision is largely a trade deal with the USA, where the UK government agreed to spend 25% more on medicines. As part of this, NICE increased how much the NHS will pay for every extra year of good quality life a medication can give - known as a QALY (Quality-Adjusted Life Year). The upper threshold per QALY went from £30,000 to £35,000. At the end of August, NICE also introduced a more nuanced way of measuring a patient's quality of life. These two changes were enough to tip the balance. It is thought patient campaigns for Enhertu - and other drugs - helped too.
Daiichi Sankyo and AstraZeneca welcomed NICE's decision, though the latter called for "strong collaboration" across the healthcare system to ensure "faster, more equitable patient access in the future." Breast Cancer Now's Claire Rowney said, "We are calling on the government, NICE, NHS England and the pharmaceutical industry to work together to fix this broken system, so that people with incurable metastatic breast cancer are not forced to spend precious months and years campaigning for treatments that could give them more time."
Helen Knight, director of medicines evaluation at NICE, said she is pleased a "commercial solution" means the treatment can be made available in England, but added she knows the decision "comes too late for many families." She said, "Our role is important in ensuring NHS spending on new medicines reflects the benefits they deliver while protecting valuable health resources for other essential patient services."
For Kate, the thought of dying before she had to, "when there was a drug that I just could almost reach but couldn't get," was "so incredibly painful." "To know that I can get it now is absolutely everything."