Availability of Cancer Drugs

Availability of Cancer Drugs

Availability of Cancer Drugs Saw this, which suggests that docetaxel and paclitaxel may be rejected by NICE, despite having been licensed by the Scottish Medicines Consortium last year.

guardian.co.uk/medicine/story/0,1763270,00.html

Also, there’s an interesting article in Private Eye 28 April - 11 May about a 54 year old man diagnosed with an incurable, aggressive brain tumour. His best chance of extending survival is radiotherapy combined with a new drug called Temozolomide. According to the article, this is widely used in other parts of Europe, the US and Australia. He can’t get it.

Although it’s licensed in the UK, NICE has decided it should not be used for newly diagnosed cases of this type of tumour, except in approved clinical studies. It seems that, as it doesn’t work for everyone (well neither does Tamoxifen!), NICE will not change position without more research. The article describes the preliminary finding by NICE as “deeply flawed”.

Ironically, this drug was invented in the UK as a result of funding from Cancer Research UK, yet UK patients can’t have it (unless they are part of a trial) It’s Race for Life season now. I wonder how much money will be raised for CRUK at these races to develop future drugs which UK patients will then be denied by NICE.

I haven’t done any further research to see whether the statements made in the Private Eye article are supported by info on the internet. I’m just summarising what it says.

The Government, NHS managers and NICE seem to deliberately ignore the fact that there will never be a magic bullet that is going to cure each type of cancer, but survival will be improved by small steps - new drugs that work for certain patients, not all patients.

They should get their act together and either accept this and work out how they are going to implement these small improvements, or just come clean and tell cancer patients - sorry, we aren’t going to invest in new drugs that only benefit a small proportion of patients with a particular cancer so don’t expect survival rates to get any better…but they won’t do either of these things because their natural inclination is to carry on being vague and evasive, as we’ve seen with Herceptin.

temozolomide More information about this on:

news.bbc.co.uk/1/hi/health/4739904.stm

I agree - there is an over-cautious officious bureaucratic mindset working here. This government does seem to have a desire to control minutiae. A little more flexibility would do no harm, particularly when other countries have already licenced drugs. And of course there is the increasing anomaly of Britain having three authorities granting licences, so that one region can have a drug prescribed where another cannot.

Desperately poor management skills combined with accountancy over-kill control seem to underlie this.

It would be very ineresting to find out if other chronic illness sufferers have the same problems.

Some thoughts * Scotland approved taxotere/taxol because they considered studies that used AC chemo, not just EC chemo. NICE seems willing only to consider treatments that improve on FEC or E- CMF, since these are standard UK treatments and it argues that AC isn’t. This has big implications because there are lots of trials on chemotherapy regimes than improve on AC chemo because that is the US standard and the drugs companies are mainly interested in impressing the lucrative US market.

* The brain cancer drugs seem to have failed because they cost far more than 30,000 pounds for each ‘quality-adjusted life year.’ I personally found it troubling that they considered telmodar compared both to 30,000 pounds for each QALY and 20,000 pounds per QALY and wonder if they are thinking of raising the cost effectiveness bar.

* The taxotere decision was most frustrating. NICE would not consider at all a study indicating that following FEC100 with taxotere resulted in a cost per QALY of just 8,200 pounds, well below the 30,000 pound threshold (or a 20,000 pound threshold for that matter). They rejected the study because FEC100- taxotere is not a licenced chemotherapy regime. As someone who received taxotere off licence after FEC75 failed to do it for me and has done much better than my prognosis, I am quite disgruntled about this, but I am not sure who is to blame. Did Sanofi-Aventis not get the paperwork on time? Was there no possibility of extending the review until after FEC100- taxotere was licenced? The next review of taxotere isn’t going to be for another three years and I am doubtful that bankrupt PCTs will act without NICE approval.

Thanks Christine This is such interesting data. I am really really concerned at what seems to be another decision by NICE which could seriously affect survival chances for some people with breast cancer. There seems to be something profoundly wrong about systems for drug approval in the UK, and the treatments we get are such a lottery.

I had AC before surgery and then taxotere afterwards. My oncologist told me that though I got this regime proviately i would, under his consultancy have got the same treatment on the NHS (Redbridge PCT) but I don’t know.

I do know that AC failed for me and that I, like Christine, am now doing better than my original prognosis…this may very well be because I was lucky enough to get taxotere.

Does anyone know whether the NICE guidlines under discussion allow for taxotere as neo adjuvant primary treatment or after surgery for those who like me and Chtistine who had another chemo neo adjuvantly which failed?

Jane

AC & EC Chemo Christine, what’s the reason behind US favouring AC and UK favouring EC chemo. Is it cost, clinical effectiveness and/or other factors?

What we desperately need in all this is some top notch investigative, scientific writers to investigate the complete picture with what’s going on in the UK with cancer drugs and tell us the truth. I think it’s a squirming can of maggots that is in desperate need of being opened up and dealt with.

I’m sure we have writers who could do a good job on this, but it would take several years to do and maybe it wouldn’t be very lucrative for them, though I expect they could get plenty of book sales out of it eventually.

A wonderful thought, Daphne But I’m not convinced that anyone (however talented an investigative journalist they are) would be able to get to the bottom of this particular cesspit. I’m afraid that I think the combination of corporate greed, pompous bureaucracy, political cynicism and certain levels of incompetence would conspire to prevent an honest assessment being made.

Or am I just being incredibly cynical?

Anne

E or A? Been told Drs in US get paid more for prescribing/administering this. Some UK Oncs do use A rather than E.

E thought to be less toxic to heart.

I doubt the current NICE appraisal has actually considered the question of anthracycline resistance - one of the problems as I see it with these appraisals is that they treat breast cancer in too general a way when it really is a multi headed beast. Could start arguing that even node positive is far to general a statement , (need to consider how many, other receptor status etc. etc. etc.)

PCTs (or Acute Hospital Trusts) don’t have to have NICE guidance to allow use of the products, but in a climate of financial hardship if such guidance isn’t there it is easy to say no (Taxanes not available to Patients in my area in early BC, I - despite what I say about my insurance company on a regular basis am very grateful they funded taxol for me).

There is the facility to make your views known on the current situation - this is something we all can do (link on th NICE website www.nice.org.uk.

EC probably not prefered on price I doubt that the preference for epirubicin over adriamycin has anything to do with cost. For one thing, adriamycin is such an old drug that it is off patent and a generic variant, doxorubicin, is available if they really wanted to save money. The surprising thing really is why the U.S. still uses adriamycin when it causes such heart problems (the figures from the herceptin trials using AC- taxol show that there was a substantial level of heart damage even in the control group, which didn’t get herceptin), but they must believe that it is more effective, while NICE makes it clear in the taxotere document that they believe FEC is more effective. Or it could be that the U.S. has become somewhat dependent on AC, since all of the treatments developed have been improvements on AC chemo. Part of the problem is that there has never been any work comparing FEC to FAC in effectiveness, so nobody knows which is better.

Cardiotoxicity is a big problem with adriamycin. I have noticed that some doctors in the US seem to be moving towards epirubicin for their her2 positive patients, presumably because they don’t want to put the patients’ hearts at risk and make it impossible for them to herceptin.