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#EnhertuEmergency: HCPs in the UK call for NHS access to Enhertu for HER2-low breast cancer patients

28.05.2024 | Insight

#EnhertuEmergency: HCPs in the UK call for NHS access to Enhertu for HER2-low breast cancer patients

The National Institute for Health and Care Excellence (NICE) published its final draft guidance on Enhertu in March, deciding not to recommend the use of the cancer drug for HER2-low breast cancer on the basis that it is not “a cost-effective use of NHS resources”. Enhertu, jointly developed and commercialised by AstraZeneca and Daiichi Sankyo, is approved in the US for several types of cancer including HER2+ metastatic breast cancer, HER2+ advanced stomach cancer as well as HER2-low metastatic breast cancer.

The decision is reminiscent of NICE’s rejection of Lynparza (Olaparib) for use in metastatic prostate and breast cancer based on cost-effectiveness in September 2022. Seven months later, after scores of healthcare professionals (HCPs) took to X to demand #OlaparibNow, NICE recommended it as a “clinically and cost-effective option”.

NICE’s decision to not recommend Enhertu has also generated a lot of conversation both online and in the media, with major news outlets highlighting the reaction from patients living with incurable breast cancer. But what do HCPs in the UK think about NICE’s recommendation?

HCPs overwhelmingly negative about Enhertu’s rejection in the UK

UK HCPs online are overwhelmingly negative towards the decision to not recommend Enhertu for NHS use in England. 95% of HCP posts about NICE’s rejection expressed anger, frustration and sadness at the decision. 

Much of this emotive language comes from patients, whose voices were amplified by HCPs sharing their posts, often adding their own thoughts and experiences. Over half (53%) of the HCP posts about the decision were reposts; HCPs frequently share posts from Breast Cancer Now as well as from breast cancer patients such as teacher Kate Rackham who described the rejection as her “worst nightmare”.

HCPs also share posts from those who have family members living with breast cancer; a nurse shared one person’s argument that “If the treatment exists it’s wrong to only offer it to certain people!!”.

While patients’ opinions are having a profound impact on the HCP conversation, so too are prominent patient advocacy groups. Two thirds (67%) of all HCP posts advocate for their followers to sign Breast Cancer Now’s petition to make Enhertu available on the NHS.

The petition, which has received a quarter of a million signatures at the time of writing, is often accompanied by the hashtag #EnhertuEmergency. The hashtag was used in over a hundred HCP posts discussing Enhertu in the UK between March and May 2024. This goes some way to show there is considerable agreement between HCPs, patients and patient advocacy groups.

HCPs’ negativity towards NICE’s rejection of Enhertu is consistent across England and Scotland

There is also a broad consensus among HCPs across the UK geographically. While NICE’s rejection only impacts patients in England, HCPs in both England and Scotland express their support for Enhertu’s approval. Robert Hunter, a doctor in Glasgow, posted on X that “patients with terminal breast cancer in England will be denied access to new treatment that has already been approved in Scotland”. Four other HCPs from across the UK discussed “inequities” in breast cancer patients accessing life-extending drugs.

This coalition of HCPs from across the UK suggests that NICE’s rejection of Enhertu is not just a point of contention for HCPs in England, but something that HCPs around the UK largely agree on.

Potential challenges for AstraZeneca, Daiichi Sankyo

Despite the groundswell of positive opinion towards Enhertu as a treatment option, there are reputational risks for AstraZeneca and Daiichi Sankyo related to NICE’s decision not to recommend Enhertu. While HCPs online generally saw NICE’s recommendation as the main roadblock for patients getting Enhertu on the NHS, there are still concerning signs for its manufacturers. 

Almost half of the posts made by UK HCPs (49.6%) tagged AstraZeneca.These posts call for the manufacturer to “sit around the table” with NICE. Similarly, the most-shared post by HCPs called on “@NICEComms, @NHSEngland, @ASTRAZENECAUK and @DaiichiSankyoUK to make the life-extending drug, Enhertu available on the NHS”.

The only post which was positive about Enhertu’s rejection came from a medical oncologist. He suggested it was “crazy the price certain countries pay for drugs”, and that he does not want drugs to be provided “at any price”.

While this view is not yet one that is expressed widely among UK HCPs in the online conversation, there is a chance that it will become more prevalent the longer that Enhertu is unavailable to patients living with incurable breast cancer. Changes in HCP attitudes can have a profound impact on market access strategy; by actively tracking the online HCP conversation and conducting early listening you can stay informed and shape your approach accordingly.

Conclusion

Using CREATION Pinpoint, the online conversations of HCPs in the UK on X were collected from March 2024 to May 2024. During this period, 79 HCPs in the UK published 137 posts about the rejection of Enhertu for HER2-low breast cancer. These posts were then analysed for sentiment, to determine what HCPs feel about this development.

By conducting thorough social listening, understanding HCP sentiments online can help guide and inform market access decisions. Within the online HCP conversation in the UK, there is a clear desire for NICE to facilitate access to Enhertu for women living with incurable breast cancer. To find out more about how you can identify and understand HCPs in your market and therapy area, follow CREATION.co on LinkedIn or get in touch for a chat.

 

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Meet the Author

Cameron Bassindale


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