Breast Cancer Now has issued an urgent call for the NHS in England to finally make Enhertu available, marking the latest escalation in a two-year campaign against a succession of rejections by the National Institute for Health and Care Excellence (NICE). Claire Rowney, chief executive of the charity, said: “We’re here, once again, asking for Enhertu to be made available for those who need it, and we urgently need to see this happen, now.”
Enhertu (trastuzumab deruxtecan) is an antibody-drug conjugate that targets HER2 proteins on cancer cells, delivering chemotherapy directly to them and also killing nearby cells through a “bystander effect”. It is approved for certain types of metastatic breast cancer — both HER2-positive and HER2-low — and clinical trials such as DESTINY-Breast04 have shown it can significantly increase progression-free and overall survival compared with standard chemotherapy. The Medicines and Healthcare products Regulatory Agency (MHRA) has also approved Enhertu for other solid tumours with HER2-positive mutations, extending its use beyond breast cancer.
The two-year campaign against NICE’s rejection
NICE first issued draft guidance recommending against routine NHS use of Enhertu in September 2023, citing the cost requested by manufacturers AstraZeneca and Daiichi Sankyo as too high relative to the benefits. That was followed by a series of further negative appraisals, culminating in final guidance published on 29 July 2024 that confirmed the refusal. The decision broke a six-year streak in which NICE had approved 21 other breast cancer treatments, and stood in contrast to approvals in Scotland and Northern Ireland, where Enhertu is already available on the NHS. It has also secured European approval.
Breast Cancer Now, alongside patient groups METUPUK and Make2ndsCount, launched the “Enhertu Now” campaign to highlight the distress and desperation of patients denied a potentially life-extending treatment. A petition against the NICE decision gathered more than 300,000 signatures. The campaign has documented cases of women exhausting their savings to pay for Enhertu privately — at a cost of roughly £8,000 per session — while others have considered moving to Scotland to access it on the NHS. Tragically, some women who actively campaigned for the drug’s approval have since died without ever having the chance to benefit from it.
At the heart of the dispute is cost-effectiveness. NICE uses a “severity modifier” to assess treatments for severe diseases, and there have been prolonged debates about how HER2-low metastatic breast cancer is classified within that framework. A single vial of Enhertu costs approximately £1,455, with a full course of treatment estimated at around £118,000. Negotiations between NICE, NHS England and the two drug manufacturers have run for more than two years, with multiple rounds of talks failing to reach a commercial agreement. The Health Secretary, Wes Streeting, has intervened in the discussions, but no deal has yet been struck.
In April 2026, the UK government increased the cost-effectiveness thresholds that NICE uses in its technology appraisals. Breast Cancer Now welcomed the move, urging the manufacturers to resubmit the drug for approval and calling for renewed talks to find a solution. Daiichi Sankyo and AstraZeneca have confirmed that discussions with NICE and NHS England are ongoing, with the aim of securing access for patients in England, Wales and Northern Ireland. The situation remains fluid, but the charity stressed that the delay has already had a profound and tragic impact on patients who cannot afford to wait. “We urgently need to see this happen, now,” Rowney said.