NICE | November 2020 | Pembrolizumab for untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma
Evidence-based recommendations on pembrolizumab (Keytruda) for untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD L1 with a combined positive score (CPS) of 1 or more.
NICE interactive flowchart – Upper aerodigestive tract cancer
Full details are available from NICE
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
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NICE
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NIHR | November 2020| First-line chemotherapy for ovarian cancer given once every three weeks may preserve quality of life
NIHR’s latest evidence feature focuses on research that studied the chemotherapy treatment women with a new diagnosis of ovarian cancer receive, this type of cancer is usually treated every three weeks with chemotherapy containing the medicines carboplatin and paclitaxel. Although a recent Japanese studied reported better outcomes without reducing quality of life for weekly chemotherapy, the researchers behind this study found that patients who received weekly paclitaxel had poorer quality of life during treatment. They were also more likely to have nerve damage that lasted up to 18 months.
Taken together with the lack of progression-free survival benefit, their findings do not support routine use of weekly paclitaxel-containing regimens in the management of newly diagnosed ovarian cancer.
1438 women with ovarian cancer were asked about their quality of life at regular intervals for up to five years after starting treatment. They completed written questionnaires on factors such as emotional well-being, fatigue and nerve pain.
Nine months after patients entered the trial, the researchers found:
Although survival was similar for patients on all treatment plans, well-being data shows a different story. The study suggested weekly schedules were harder for patients to tolerate and caused long-lasting toxicity compared to less frequent chemotherapy.
The researchers believe that three-weekly chemotherapy should remain the standard of care for most newly-diagnosed ovarian cancer patients.
It is not known why paclitaxel causes nerve damage. The researchers in this study believe long-lasting nerve damage and numbness are likely because the total amount of paclitaxel given is higher for people taking weekly treatment (Source: NIHR)
Primary paper:
Blagden, S.P. (2020) et al. Weekly platinum-based chemotherapy versus 3-weekly platinum-based chemotherapy for newly diagnosed ovarian cancer (ICON8): quality-of-life results of a phase 3, randomised, controlled trial| The Lancet Oncology|21|P. 969-977
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
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
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.
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
BMJ (2020) | Mortality due to cancer treatment delay: systematic review and meta-analysis| 371| m4087
A month long delay in treating cancer is associated with increased mortality for seven types of cancer: bladder, breast, colon, rectum, lung, cervical cancer, and head and neck cancer; delays longer than four weeks are even more detrimental.
For surgery, this is a 6-8% increase in the risk of death for every four week delay. This impact is even more marked for some radiotherapy and systemic indications, with a 9% and 13% increased risk of death for definitive head and neck radiotherapy and adjuvant systemic treatment for colorectal cancer, respectively.
The investigators acknowledge that their results reflect the impact of delay on large and expectedly heterogeneous populations with varying risks of recurrence. Therefore, these estimates are best used at a policy and planning level for modelling, rather than for individual risk prediction (Source: Hanna, et al. 2020).
Objective To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways.
Design Systematic review and meta-analysis.
Data sources Published studies in Medline from 1 January 2000 to 10 April 2020.
Eligibility criteria for selecting studies Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck were included. The main outcome measure was the hazard ratio for overall survival for each four week delay for each indication. Delay was measured from diagnosis to first treatment, or from the completion of one treatment to the start of the next. The primary analysis only included high validity studies controlling for major prognostic factors. Hazard ratios were assumed to be log linear in relation to overall survival and were converted to an effect for each four week delay. Pooled effects were estimated using DerSimonian and Laird random effect models.
Results The review included 34 studies for 17 indications (n=1 272 681 patients). No high validity data were found for five of the radiotherapy indications or for cervical cancer surgery. The association between delay and increased mortality was significant (P<0.05) for 13 of 17 indications. Surgery findings were consistent, with a mortality risk for each four week delay of 1.06-1.08 (eg, colectomy 1.06, 95% confidence interval 1.01 to 1.12; breast surgery 1.08, 1.03 to 1.13). Estimates for systemic treatment varied (hazard ratio range 1.01-1.28). Radiotherapy estimates were for radical radiotherapy for head and neck cancer (hazard ratio 1.09, 95% confidence interval 1.05 to 1.14), adjuvant radiotherapy after breast conserving surgery (0.98, 0.88 to 1.09), and cervix cancer adjuvant radiotherapy (1.23, 1.00 to 1.50). A sensitivity analysis of studies that had been excluded because of lack of information on comorbidities or functional status did not change the findings.
Conclusions Cancer treatment delay is a problem in health systems worldwide. The impact of delay on mortality can now be quantified for prioritisation and modelling. Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers. Policies focused on minimising system level delays to cancer treatment initiation could improve population level survival outcomes.
Mortality due to cancer treatment delay: systematic review and meta-analysis
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