Faster access to cancer drugs

Patients getting faster access to cancer drugs as NICE approves three quarters of the Cancer Drugs Fund | NICE

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Liver cancer drug, sorafenib has been approved for routine NHS use, marking three quarters of the way through the Cancer Drugs Fund (CDF) without a negative decision.

NICE has recommended sorafenib, also known as Nexavar, made by Bayer to be routinely available for some patients on the NHS.

Sorafenib is one of the 24 drugs NICE was asked to appraise from the CDF, and all have been approved so far for routine NHS use.

Its positive recommendation means that NICE is three quarters of the way through the CDF with 18 drugs now approved.

Companies, like Bayer have provided discounts and in some cases additional evidence meaning the drugs can be considered as cost effective for routine NHS.

Read the full news story here

NICE set to approve trastuzumab emtansine for breast cancer

The NHS in England will soon be able to routinely fund the use of trastuzumab emtansine for people with certain categories of breast cancer, the National Institute for Health and Care Excellence (NICE) has announced in new draft guidance | OnMedica

NICE’s decision means that, by late summer, more than a thousand women and men could benefit from the drug.

HER2-positive breast cancer accounts for about a fifth of the roughly 41,500 women and 300 men who are diagnosed with breast cancer each year in England, but HER2-positive tumours are typically more aggressive than other types of breast cancer. The targeted treatment trastuzumab (Herceptin) is only effective for this type of breast cancer. Trastuzumab emtansine (Kadcyla) is licensed for the treatment of locally advanced or metastatic HER2-positive breast cancer, after trastuzumab and a taxane, taken either in combination or separately.

Currently, trastuzumab emtansine – which at full list price costs about £90,000 per patient – is only available on the NHS through the Cancer Drugs Fund (CDF). But NICE revealed yesterday afternoon that the drug’s manufacturer Roche had agreed a new commercial access arrangement with NHS England. When NICE factored this confidential agreement into a new clinical and cost-effectiveness analysis, also applying end-of-life criteria, it concluded that it can now recommend the drug as cost effective for routine use on the NHS.

New chemotherapy approach offers breast cancer patients a better quality of life

The chemotherapy drug capecitabine gives patients a better quality of life and is as effective at preventing breast cancer from returning as the alternative regimen called CMF, when given following epirubicin. | ScienceDaily | Cancer Research UK

Around 4,400 patients on the TACT2 clinical trial were treated with the chemotherapy drug epirubicin followed by either capecitabine or CMF, after surgery.

Researchers at The Institute of Cancer Research, London, and the Cancer Research UK Edinburgh Centre found that capecitabine resulted in patients experiencing fewer side effects and having a better quality of life, and it was as effective at preventing cancer’s return as CMF.

Most patients experienced some side effects regardless of the treatment they were given. But those taking CMF were more likely to experience severe side effects including early menopause, nausea, infection, thrombosis, and anemia.

During the trial, patients were followed up after 12, 18 and 24 months, and then yearly for at least 10 years, to see if their cancer had returned and to monitor side effects. More than 85 per cent of patients did not experience their cancer returning for at least five years.

More detail at

Link to the research:

Cameron, D., et al.  Accelerated versus standard epirubicin followed by cyclophosphamide, methotrexate, and fluorouracil or capecitabine as adjuvant therapy for breast cancer in the randomised UK TACT2 trial (CRUK/05/19): a multicentre, phase 3, open-label, randomised, controlled trial. The Lancet Oncology.

Cancer experts condemn cancer drug decision

Expert cancer clinicians have condemned a preliminary decision by the National Institute for Health and Care Excellence (NICE) not to approve use of the drug nivolumab (Opdivo) for the treatment of head and neck cancer on the NHS | OnMedica

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NICE has today issued new draft guidance which does not recommend nivolumab in this way, saying that it is not cost-effective.

Nivolumab is administered intravenously every two weeks and the drug works by blocking a protein on the surface of cells known as PD-L1, which reduces the activity of the body’s immune cells. There is more PD-L1 on cancerous cells which stops the immune system from attacking the tumour.

NICE said the anticipated marketing authorisation for nivolumab was for treating squamous cell carcinoma of the head and neck which has progressed during or after platinum-based chemotherapy.

The watchdog found that the evidence showed a significant improvement in overall survival rates in the short term after nivolumab. However, its value for money was considerably above that which is usually a cost-effective use of NHS resources.

Read the full commentary here

NICE draft guidance is available here

Understanding GP attitudes to cancer preventing drugs

A study by Cancer Research UK concludes that GPs want more support when offering drugs that lower the risk of certain cancers. It finds that GPs are more comfortable to discuss drugs, and more willing to prescribe or recommend drugs when they are supported by secondary care clinicians. Cancer Research UK

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Understanding GP attitudes to cancer preventing drugs is aimed at increasing understanding GP attitudes towards offering the use of tamoxifen and aspirin to lower the risk of cancer, or prevent cancer. This is an area where there is little research around clinician attitudes and knowledge.

The study surveyed 1,007 GPs from across the UK. It found nearly half of GPs were unaware of the potential benefits of tamoxifen to prevent breast cancer among women with a clear family history of the disease who are therefore at higher risk.

The study also showed that more needs to be done to promote the evidence and guidance on chemoprevention. The research suggests that ensuring evidence based chemoprevention is routinely discussed with and offered to the people who may benefit should be a priority across the UK.

Executive summary: Understanding GP Attitudes to Cancer Preventing Drugs 

Full report: Understanding GP Attitudes to Cancer Preventing Drugs

Estimated generic prices of cancer medicines deemed cost-ineffective in England

Hill, A. et al. (2017) BMJ Open. 7:e011965

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Image source: Neil Webb – Wellcome Images // CC BY-NC-ND 4.0

Objectives: The aim of this study was to estimate lowest possible treatment costs for four novel cancer drugs, hypothesising that generic manufacturing could significantly reduce treatment costs.

Conclusions: Our findings demonstrate that affordable drug treatment costs are possible for novel cancer drugs, suggesting that new therapeutic options can be made available to patients and doctors worldwide. Assessing treatment cost estimations alongside cost-effectiveness evaluations is an important area of future research.

Read the full abstract and article here

Value in cancer drug spending: assessing the clinical risks and benefits from a decade’s worth of innovation

Salas-Vega, S. & Mossialos, E. LSE Health & Social Care Blog. Published online: 5 January 2017

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Image source: LSE

To shed light on the clinical risks and benefits from new cancer medicines, we took a narrative synthesis approach to review regulatory assessments of the impact on overall survival, quality of life, and safety from all cancer medicines newly licensed in the US and EU between 2003-2013. For this, two researchers evaluated appraisals from English (National Institute of Health and Care Excellence, NICE), French (Haute Autorité de Santé, HAS) and Australian (Pharmaceutical Benefits Advisory Committee, PBAC) health technology assessment (HTA) agencies that were published through May 2015.

We find that while most new cancer drugs approved between 2003 and 2013 extended overall survival or improved the quality of life of cancer patients, their clinical benefits vary widely. Improvements in overall survival and quality of life also often come at the cost of safety, and there are reasons to question whether claims of clinical benefits have been matched by those observed in real-world settings.