Merck’s Keytruda has suffered its second setback with English cost watchdogs in as many months. In final guidance, NICE rejected the drug in patients with locally advanced or metastatic urothelial carcinoma who have had platinum-containing chemotherapy.

The drug had been available via England’s Cancer Drugs Fund following an earlier review while authorities collected more evidence. But last week, the National Institute for Health and Care Excellence said it still couldn’t recommend the drug due to cost-effectiveness uncertainties.

As a result, the Merck immuno-oncology blockbuster will be pulled from the Cancer Drugs Fund. New patients won’t be able to start on the treatment, but those who are already receiving treatment may continue. 

The list price for the treatment is about £5,600 every three weeks, or £11,200 every six weeks.

The decision is particularly disappointing for Keytruda and patients because Keytruda was was the only med among its rivals to score even a Cancer Drugs Fund recommendation in the indication. Roche’s Tecentriq and BMS’ Opdivo each were rejected in bladder cancer in earlier NICE decisions. 

The NICE setback follows another for Keytruda last month. In draft guidance, the agency rejected the combo of Keytruda and Pfizer’s Inlyta in previously untreated kidney cancer patients.