A pioneering breast cancer treatment will not be routinely available on the NHS because its price is "too high", a watchdog has ruled.
The National Institute for Health and Care Excellence (Nice) published final draft guidance saying Kadcyla - which can give women dying from an aggressive form of breast cancer extra months of life - was not set at an affordable price.
The manufacturer Roche offered a discount but it was not enough to sway Nice to recommend the drug across England. The move was described as "hugely disappointing" by cancer charities.
The drug will still be available through the Cancer Drugs Fund (CDF) in England for some patients.
Nice said Roche had agreed a "significant" price discount with NHS England to stop the drug being removed from the CDF but a smaller discount had been offered to Nice for the drug's more widespread use.
This means women will need to ask their oncologist to apply to the CDF for funding for Kadcyla.
Without any discount, Kadcyla costs £90,831 per patient, based on a three-weekly dose and an average length of treatment of 14.5 months.
It is licensed for HER2-positive breast cancer and has been shown to extend life by almost six months on average in women who have already tried other treatments, although some patients live much longer.
Nice chief executive Sir Andrew Dillon said: "We recognise that Kadcyla has a place in treating some patients with advanced breast cancer and we have been as flexible as we can in making our recommendation.
"However, the price that the manufacturer is asking the NHS to pay in the long term is too high.
"Despite a growing public campaign for a fair deal on the cost of important new cancer medicines, it is disappointing that there appears to have been no meaningful attempt by Roche to reconsider its price to secure Kadcyla's long-term future in the NHS, outside of the Cancer Drugs Fund."
Dr Caitlin Barrand, assistant director of policy and campaigns at Breast Cancer Now, said it was "hugely disappointing news".
She added: "We simply cannot continue in this way, with highly effective new cancer drugs being held just out of reach for patients in certain areas of the UK.
"It's time that the Prime Minister showed real leadership on this issue. People living with incurable cancer don't have time to lose, and a fairer, more flexible system that enables access to the best treatments available on a routine, UK-wide basis is long overdue."
Samia al Qadhi from Breast Cancer Care, said: "It is absolutely unacceptable that, due to cost, a drug which may give precious extra time with loved ones and improved quality of life to incurable breast cancer patients, is not available for routine use on the NHS.
"Access to best treatment and care for people with incurable breast cancer urgently needs addressing. Although the Cancer Drugs Fund enables access to Kadcyla, the fund is worryingly unstable, causing a huge burden of anxiety for patients."
In England, approximately 800 women with advanced, HER2-positive breast cancer are suitable patients to receive Kadcyla each year, according to Roche.
Deborah Lancaster, director of Roche UK, said: "This announcement comes less than two weeks after Kadcyla was retained on the Cancer Drugs Fund.
"Roche has demonstrated that, when given the opportunity to come to the table with all parties, we can come to an agreement and do the right thing for patients. It is this principle that should be at the heart of our access system moving forward.
"We invest £6.2 billion pounds, and thousands of man hours, in R&D globally every year.
"Roche will continue to invest in delivering life-changing, highly innovative medicines for patients."