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Cancer Drugs Fund axes 25 treatments from list

But fund overall receives a financial boost

Jo Carlowe

Tuesday, 13 January 2015

Some drugs are to be removed from the Cancer Drugs Fund, causing consternation from cancer charities.

The CDF published the outcome of its review yesterday. The steps were introduced to curb rising costs and prevent the CDF from soaring over budget. Funding will cease for 25 treatments, including those use to treat breast, bowel and prostate cancer.

The CDF review will create projected savings of approximately £80 million.

According to NHS England, had action not been taken, the Fund is projected to have grown to around £420 million next year, necessitating offsetting cuts in other aspects of cancer treatment such as radiotherapy, cancer diagnoses, cancer surgery, and NHS services for other patient groups.

The budget for the CDF will grow from £200 million in 2013/14, to £280 million in 2014/15, and an estimated £340 million from April 2015. This represents a total increase of 70% since August 2014.

A national panel – comprising oncologists, pharmacists and patient representatives – independently reviewed the drug indications currently available through the CDF, plus new applications. They carried out a detailed assessment of the evidence, looking at clinical benefit, survival and quality of life, the toxicity and safety of the treatment, the level of unmet need and the median cost per patient. In cases where the high cost of a drug would lead to its exclusion from CDF, manufacturers were given an opportunity to reduce prices.

In conclusion, 59 of the 84 most effective currently approved indications of drugs will rollover into the CDF next year, ‘creating headroom for new drug indications that will be funded for the first time’. These are Panitumumab, a treatment for bowel cancer; Ibrutinib, a treatment for Mantle cell lymphoma, a type of non-Hodgkin lymphoma; and Ibrutinib for use in chronic lymphocytic leukaemia (CLL).

Following these changes, four important patient protections are in place:

  • Any patient currently receiving a drug through the CDF will continue to receive it, regardless of whether it remains in the CDF.
  • Drugs which are the only therapy for the cancer in question will remain available through the CDF.
  • If the CDF panel removes a drug for a particular indication, some patients may instead be able to receive it in another line of therapy or receive an alternative CDF approved drug.
  • Clinicians can apply for their patient to receive a drug not available through the CDF on an exceptional basis.

Commenting, Professor Peter Clark, Chair of the Cancer Drugs Fund (CDF) and a practising oncologist, said: “We have been through a robust, evidence-based process to ensure the drugs available offer the best clinical benefit, getting the most for patients from every pound.

“There were drugs that did not offer sufficient clinical benefit so we simply cannot go on funding those. There were others that offered some benefit but were costly and I am pleased that a number of pharmaceutical firms worked with us to make prices more affordable, saving millions of pounds that can now be reinvested in other treatments.

“These are difficult decisions, but if we don’t prioritise the drugs that offer the best value, many people could miss out on promising, more effective treatments that are in the pipeline.”

Among the drugs to be removed are three breast cancer drugs: Everolimus (Afinitor), Eribulin (Halaven) and Lapatinib (Tyverb).

Breast Cancer Care say the decision will deny ‘thousands of patients…the chance of improved quality of life and extra time with their loved-ones.’

“This news is devastating for them,” said Breast Cancer Care chief executive.

“The Cancer Drugs Fund is falling apart when there is still no long-term solution in place. While it is good that another three breast cancer drugs remain on the list and budget for the Cancer Drugs Fund will grow, the priority now must be to urgently find a sustainable system that works. Without this, cancer patients will continue to be denied access to vital treatment - they deserve better than this.”

Treatments for advanced bowel cancer have also been effected, including the removal of Afilbercept (Zaltrap) from the CDF.

Mark Flannagan, chief executive of the charity Beating Bowel Cancer, described this as “bad news for bowel cancer patients”.

“It’s likely that 65% of patients with advanced bowel cancer face the probability of an earlier death by being refused innovative treatments that were available before.

“These changes are a backward step in treatment for advanced bowel cancer. Doctors will be forced to tell their patients there are treatments that can prolong their lives but they will no longer be available.“

While Owen Sharp, chief executive of Prostate Cancer UK described the announcement as “another symptom of a drug appraisal system in meltdown,” following the decision to remove the prostate cancer drug cabazitaxel from the fund. 

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