[NICE Guidline] Isatuximab with pomalidomide and dexamethasone for treating relapsed and refractory multiple myeloma

NICE|Isatuximab with pomalidomide and dexamethasone for treating relapsed and refractory multiple myeloma | Technology appraisal guidance [TA658]| Published date: 18 November 2020

Evidence-based recommendations on isatuximab (Sarclisa) with pomalidomide and dexamethasone for treating relapsed and refractory multiple myeloma in adults.

Further details are available from NICE

See also:

NICE

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New option for people with difficult-to-treat multiple myeloma is recommended for use in Cancer Drugs Fund by NICE

NICE | November 2020 | New option for people with difficult-to-treat multiple myeloma is recommended for use in Cancer Drugs Fund by NICE

NICE has recommended a new option for people with difficult-to-treat multiple myeloma.

Isatuximab, administered as an intravenous infusion, plus pomalidomide and dexamethasone is recommended for use within the Cancer Drugs Fund as an option for treating relapsed and refractory multiple myeloma in adults.

It will be offered as a treatment option to those people who have had lenalidomide and a proteasome inhibitor, and whose disease has progressed from their last treatment if they have had three previous forms of treatment.

Full details are available from NICE

NICE impact prostate cancer

NICE | November 2020| NICE impact prostate cancer

There have been substantial improvements in the diagnosis and treatment of prostate cancer over the last 20 years and NICE guidance has been key to many of these.

Dr John Graham, consultant oncologist and cancer lead clinician at Taunton and Somerset NHS Foundation Trust

Prostate cancer is the most commonly diagnosed cancer in the UK. In their lifetime 1 in 6 men will be diagnosed. This report from NICE highlights progress made by the health and care system in implementing NICE guidance on prostate cancer.  

Image source: nice.org.uk

Key facts

  • Prostate cancer has a 5 year survival rate of over 95% when diagnosed at stage 1 to 3 compared with other cancers. Although, for the 20 per cent of people diagnosed with stage 4 prostate cancer (metastatic), the 5 year survival rate drops to just 49%.
  • Testing is important to determine the stage of prostate cancer and to make sure the appropriate treatment is offered. Our guideline on prostate cancer says to offer multi-parametric MRI (mpMRI) first for people with suspected clinically localised prostate cancer. The proportion of mpMRIs performed before biopsy is increasing year on year. In 2017 only 37% were performed. This increased to 46% in 2018 and 87% in 2019.

Treatment

  • A range of prostate cancer treatment options are available depending on the stage of cancer. The Predict Prostate patient decision aid is endorsed by us and supports our guideline on prostate cancer. Produced by the University of Cambridge Academic Urology Group, it compares the potential outcomes of different treatment options for people with non-metastatic prostate cancer.
  • The robotic approach to surgery is increasing. In 2019, the proportion of prostatectomies performed robotically rose from 74% in 2017 to 85% in 2019. The benefits of robotic surgery include less blood loss, reduced pain and shorter hospital stays.
  • For people with metastatic hormone-relapsed prostate cancer, we recommended both abiraterone or enzalutamide before chemotherapy and following androgen deprivation therapy. The overall use of these drugs has increased since they were first recommended by us. The use of abiraterone and enzalutamide is measured in defined daily doses (DDDs). DDDs have risen from 350,000 in 2015 to almost 600,000 in 2020.
  • Managing adverse effects of treatment
  • Side effects after treatment for prostate cancer are common. After radiotherapy, 10% of people develop gastrointestinal complications, and after prostatectomy, 9% developed genitourinary complications. Both require further investigation or treatment 2 years after radical treatments.

Full report available from NICE

Summary of the findings or download the full report for more information.

Lancet Oncology: Lung cancer control in the UK hit badly by COVID-19 pandemic #covid19rftlks

Gourd, E. (2020|Lung cancer control in the UK hit badly by COVID-19 pandemic | Lancet Oncology| DOI:https://doi.org/10.1016/S1470-2045(20)30691-4

A news feature in the journal Lancet Oncology highlights the findings of a report from the United Kingdom Lung Cancer Commission. The report reviews the impact of COVID-19 on the lung cancer pathway and explores the opportunities for innovation emerging from the response to the pandemic.

Read the report from the UKLCC COVID-19 Matters A review of the impact of COVID-19 on the lung cancer pathway and opportunities for innovation emerging from the health system response to the pandemic

Lancet article Lung cancer control in the UK hit badly by COVID-19 pandemic

University of Leeds: ‘First of its kind’ lung cancer trial

University of Leeds | November 2020| ‘First of its kind’ lung cancer trial

Scientists from the UK universities of Leeds, Newcastle, Manchester and Glasgow have been awarded funding of £900,000 by Cancer Research UK; the CONCORDE trial will explore the use of new drugs alongside standard radiotherapy in the hope of improving survival for people with advanced non-small cell lung cancer (NSCLC).

The team of researchers hope that the new drugs will make radiotherapy more effective, increase its ability to eradicate tumour cells and potentially offer new hope to lung cancer patients (Source: University of Leeds)

Full details of the trial are available from the Leeds press release

NIHR: Annual mammographic screening to reduce breast cancer mortality in women from age 40 years: long-term follow-up of the UK Age RCT

In the UK, the NHS Breast Screening Programme offers regular screening to women aged 50–70 years. 

This study recruited 160,921 women aged 39–41 years and randomly assigned one in three of the women to be offered annual mammographic screening from age 40 to 48 years. The women were followed up for occurrence of breast cancer, death from breast cancer and death from all other causes

We found that the women who were offered the screening were 25% less likely to die of breast cancer in the first 10 years in the trial. This mortality reduction was reduced with later follow-up, with a 12% reduction after an average of 23 years. There was no effect of offering screening on death from other causes.

During the early years of the trial, the women offered screening had larger numbers of breast cancers diagnosed, but this excess disappeared after the first National Programme screen. This suggests that there is no overdiagnosis from screening those aged 40–49 years over and above that which already results from screening those aged 50 years or over (Source: NIHR)

Abstract

Background

There remains disagreement on the long-term effect of mammographic screening in women aged 40–49 years.

Objectives

The long-term follow-up of a randomised controlled trial that offered annual mammography to women aged 40–49 years. The estimation of the effect of these mammograms on breast cancer and other-cause mortality, and the effect on incidence, with implications for overdiagnosis.

Design

An individually randomised controlled trial comparing offering annual mammography with offering usual care in those aged 40–48 years, and thus evaluating the effect of annual screening entirely taking place before the age of 50 years. There was follow-up for an average of 23 years for breast cancer incidence, breast cancer death and death from other causes. We analysed the mortality and incidence data by Poisson regression and estimated overdiagnosis formally using Markov process models.

Setting

Twenty-three screening units in England, Wales and Scotland within the NHS Breast Screening Programme.

Participants

Women aged 39–41 years were recruited between 1990 and 1997. After exclusions, a total of 53,883 women were randomised to undergo screening (the intervention group) and 106,953 women were randomised to have usual care (the control group).

Interventions

The intervention group was invited to an annual breast screen with film mammography, two view at first screen and single view thereafter, up to and including the calendar year of their 48th birthday. The control group received no intervention. Both groups were invited to the National Programme from the age of 50 years, when screening is offered to all women in the UK.

Main outcome measures

The main outcome measures were mortality from breast cancers diagnosed during the intervention phase of the trial (i.e. before the first National Programme screen at 50 years), mortality from all breast cancers diagnosed after randomisation, all-cause mortality, mortality from causes other than breast cancer, and the incidence of breast cancer.

Results

There was a statistically significant 25% reduction in mortality from breast cancers diagnosed during the intervention phase at 10 years’ follow-up (relative rate 0.75, 95% confidence interval 0.58 to 0.97; p = 0.03). No reduction was observed thereafter (relative rate 0.98, 95% confidence interval 0.79 to 1.22). Overall, there was a statistically non-significant 12% reduction (relative rate 0.88, 95% confidence interval 0.74 to 1.03; p = 0.1). The absolute benefit remained approximately constant over time, at one death prevented per 1000 women screened. There was no effect of intervention on other-cause mortality (relative rate 1.02, 95% confidence interval 0.97 to 1.07; p = 0.4). The intervention group had a higher incidence of breast cancer than the control group during the intervention phase of the trial, but incidence equalised immediately on the first National Programme screen at the age of 50–52 years.

Limitations

There was 31% average non-compliance with screening and three centres had to cease screening for resource and capacity reasons.

Conclusions

Annual mammographic screening at the age of 40–49 years resulted in a relative reduction in mortality, which was attenuated after 10 years. It is likely that digital mammography with two views at all screens, as practised now, could improve this further. There was no evidence of overdiagnosis in addition to that which already results from the National Programme carried out at later ages.

Full paper is available from NIHR

NICE recommends new chemotherapy-free treatment option for people with untreated chronic lymphocytic leukaemia

NICE | November 2020 | NICE recommends new chemotherapy-free treatment option for people with untreated chronic lymphocytic leukaemia

NICE has recommended a new chemotherapy-free treatment option for people with untreated chronic lymphocytic leukaemia (CLL) in final draft guidance.

The recommendation of venetoclax plus obinutuzumab is set to benefit more than 1,000 people each year. The new fixed 12-month chemotherapy-free treatment will be offered to people with CLL who have not received any prior treatments.

CLL, a type of cancer that affects white blood cells, is the most common of the chronic leukaemias and accounts for around 30% of all leukaemias affecting adults. In England there were 3,157 new cases of CLL in 2017.

Venetoclax plus obinutuzumab will be offered as a first-line treatment to people with CLL, with certain genetic abnormalities (such as a 17p deletion or TP53 mutation). For those without a 17p deletion or TP53 mutation, venetoclax plus obinutuzumab will be offered to those people with untreated CLL for whom fludarabine plus cyclophosphamide and rituximab (FCR) or bendamustine plus rituximab (BR) is unsuitable.

NICE has also recommended venetoclax plus obinutuzumab as a new treatment option via the Cancer Drugs Fund, for people with untreated CLL without a 17p deletion or TP53 mutation for whom FCR or BR is suitable. This is so more evidence can be gathered on its cost effectiveness in this group (Source: NICE).

Full news story is available from NICE

[NICE Guideline] COVID-19 rapid guideline: delivery of systemic anticancer treatments #covid19rftlks

NICE| Updated 9 November 2020|COVID-19 rapid guideline: delivery of systemic anticancer treatments [NG161]

The purpose of this guideline is to maximise the safety of patients with cancer and make the best use of NHS resources during the COVID-19 pandemic, while protecting staff from infection. It will also enable services to match the capacity for cancer treatment to patient needs if services become limited because of the COVID-19 pandemic.

On 9 November 2020, we removed the option to defer treatments that prevent long-term complications, and amended guidance on treatments suitable for home delivery.

This guideline focuses on what you need to stop or start doing during the pandemic. Follow the usual professional guidelines, standards and laws (including those on equalities, safeguarding, communication and mental capacity), as described in making decisions using NICE guidelines.

This guideline is for:

  • health and care practitioners
  • health and care staff involved in planning and delivering services
  • commissioners

The recommendations bring together

  • existing national and international guidance and policies
  • advice from specialists working in the NHS from across the UK. These include people with expertise and experience of treating patients for the specific health conditions covered by the guidance during the current COVID-19 pandemic.

This guideline links to a table of NHS England interim treatment regimens during the COVID-19 pandemic. Check the table for updates.

Full details from NICE

ICR: What are the biggest issues in drug discovery and development?

Institute of Cancer Research | November 2020 | What are the biggest issues in drug discovery and development?

A panel of academic and industry experts have called on the NHS to pay less for drugs used to treat cancer. The summit held last summer by the Institute of Cancer Research (ICR) brought leading organisations from across the academic, charity, pharmaceutical and medical sectors.

The Summer Summit brought together experts from 16 leading academic institutions, charities, stakeholder groups and pharmaceutical companies and calls for a ‘variable pricing’ model based on the benefits they deliver to patients. The peer organistaions that participated in the summit, reached consensus and they identify several measures that will improve the current system of developing drugs, these are some of the solutions proposed to some of the biggest issues in drug discovery and development.

  • Increasing incentives to discover and develop innovative treatments
  • Enabling companies to work together more easily
  • Flexible pricing for new medicines
  • Improving the creation and use of biomarker tests
  • New indicators of effectiveness to speed up clinical trials

The stakeholders at the summit also developed a nine point plan looking at practical recommendations to improve access to new cancer treatment.

The fuull blog post is available from The Institute of Cancer Research

The list of consensus statements is available from The Institute of Cancer Research

See also:

BMJ NHS should vary price it pays for cancer drugs to improve access, say experts

Cochrane: How effective are initiatives that aim to speed up the diagnosis of brain tumours?

Cochrane Library | November 2020| How effective are initiatives that aim to speed up the diagnosis of brain tumours?

A recent Cochrane review has reviewed the question: How effective are initiatives that aim to speed up the diagnosis of brain tumours?

The review covers evidence that was available to January 2020, the reviewers identified d 115 studies that investigated the diagnosis of brain tumours, but as these did not meet all of their inclusion criteria, they were excluded. We found no studies with information about the cost of initiatives.

What this means
Currently, there is no evidence from good quality studies to inform patients, health professionals, or service planners about how to reduce the time to diagnosis of brain tumours. Nor is there any information on the cost of these initiatives. This review highlights the need for research in this area.

See also Cohrane overview

Review available from Cochrane