The National Institute for Health and Clinical Excellence (NICE) has today issued guidance that doctors should not prescribe four particular drugs as first treatment options for advanced kidney cancer or cancer that has spread around the body.
This decision based on cost-effectiveness, however, contradicts an announcement made by Welsh Health Minister Edwina Hart in January to recommend health boards they make it available for NHS patients.
The drugs – bevacizumab (Avastin), sorafenib (Nexavar), and temsirolimus (Torisel) - have not been approved by NICE as first treatment options for advanced kidney cancer or cancer that has spread around the body.
NICE also rejected the use of sorafenib and sunitinib (Sutent) as secondary treatment options for people with either form of the disease.
However, the drugs have been approved for prescribing in Wales since January and it is understood that people already on them will be allowed to continue if they and their GP choose to.
NICE’s decision will not be popular as it has rejected an appeal made to it by Roche, Wyeth Pharmaceuticals, the James Whale Fund for Kidney Cancer and a joint appeal from the Rarer Cancers Forum and Macmillan Cancer Support.
NICE said Avastin cost £5,982 per patient for the first six-week cycle and £6,117 for subsequent six-week cycles (about £53,000 per patient per year).
Nexavar was £2,980.47 for 112 tablets while Sutent was £3,363 for 30 capsules and Torisel was listed at £620 per vial.
Professor Peter Littlejohns, NICE’s clinical and public health director, said: “We are very aware that renal cancer is a devastating disease for the individual and their family. We recommended the use of sunitinib for first line renal cancer in March 2009, so one of these new treatments is now available.
“The evidence to support the use of the other first and second line treatments isn't strong enough to justify using NHS funds, which could be used for other cancer treatment programmes or in other treatment areas.
“Our advisory committee used the additional flexibility we have recently given them to give special weight to drugs that extend life, at the end of life, but the benefit was still too small set against their cost."
A Welsh Assembly Government spokesperson said: "The Minister expects clinicians in Wales to follow NICE recommendations for the use of these drugs now that the final guidance has been published.
“Patients who have started treatment with one of the drugs not recommended by NICE should be allowed to continue treatment until they or their clinician consider it appropriate to stop.”
Duleep Allirajah, policy manager at Macmillan Cancer Support, said: “We are extremely disappointed by NICE's decision not to make these drugs available to all kidney cancer patients on the NHS. These innovative drugs are proven to significantly improve patients' quality of life and so it is hugely frustrating that despite this, NICE is not allowing patients to access them.”