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A life-extending breast cancer drug will not be routinely offered on the NHS in England and Wales, despite repeated pleas and negotiations.

The final guidelines from NICE say the price tag per patient - £90,000 at full cost - is not tenable.

Manufacturer Roche says it offered a discount - the same one it used to cut a deal with the Cancer Drugs Fund.

Women in England will still be able to get Kadcyla through this fund for now.

Price row

Kadcyla can add about six months of life to those with incurable disease.

It is used to treat people with HER2-positive breast cancer that has spread to other parts of the body and cannot be surgically removed.

Roche recently agreed an undisclosed, reduced price for Kadcyla with NHS England to stop the drug being taken off the Cancer Drugs Fund - a special fund set up by the government to help people in England access costly cancer drugs that are not routinely available on the NHS.

But this fund is due to end in March 2016. The government says a replacement is likely to be brought in from April 2016, although there are no details yet.

Any person currently receiving the treatment can continue until they and their doctor consider it appropriate to stop.

Charities are concerned that more breast cancer patients could miss out on getting Kadcyla (trastuzumab-emtansine) in the near future if no deal is reached between those holding the purse strings of the NHS and the drug manufacturer.

Stand-off

NICE says the price of Kadcyla is too high to justify for general use against its clinical merits and its decision is now final - although it will keep the guidance under review as new research becomes available.

Roche says it would be willing to return to the negotiating table with NICE.

Sally Greenbrook, of Breast Cancer Now, said patients were the ones who would ultimately suffer unless the treatment was made available.

"Women in England who could benefit from Kadcyla are covered - for now - by the Cancer Drugs Fund, but with just months until the new Fund is introduced, we're yet to be convinced that the proposals will improve the outlook for breast cancer patients.

"We'll do all we can to ensure that reform of the Fund leads to positive change but given that the plans include using similar thresholds to those used by NICE, and no mention of pricing negotiations, we're concerned that the new Fund will fail to improve on the existing one and may make matters worse."

Kadcyla is not available on the NHS in Scotland.