Breast cancer drug approved for use in Scotland, though concerns remain about patients getting the drug across the UK

Scotland has become the first part of the UK to make a drug routinely available on the NHS that can extend the lives of women with an aggressive form of breast cancer.

Kadcyla was approved by the Scottish Medicines Consortium (SMC), which assesses drugs for use by the health service in Scotland, in a decision welcomed by charities and doctors. 

But the move has highlighted differences in health policy between the UK nations and has led to calls for access for patients in England. 

The National Institute for Health and Care Excellence (NICE) had previously decided that the drug is too expensive for routine use in England, but patients can currently receive it through the Cancer Drugs Fund.

“We’re pleased that the SMC has recommended Kadcyla,” said Gregor McNie, Cancer Research UK’s senior public affairs manager in Scotland. “It’s great news that this life extending drug will be made available for some breast cancer patients in Scotland.”

More than 4,600 women are diagnosed with breast cancer in Scotland each year, with the disease responsible for about 1,000 deaths annually.

Up to 118 women each year with a form of the disease known as HER2-positive breast cancer could now benefit from Kadcyla, which can extend life by up to 6 months.

The SMC had previously rejected the drug based on cost-effectiveness. But the SMC chairman Dr Alan MacDonald said the drug – also known as trastuzumab emtansine – had been approved after its manufacturers offered a discount.

He said: “I am pleased we were able to accept this new medicine for routine use in NHS Scotland. From the valuable testimonies given by patient groups and clinicians at our meeting, we know that trastuzumab emtansine will be welcomed by patients and their families for the treatment of breast cancer.

“We were able to accept trastuzumab emtansine on resubmission because the company offered an improved Patient Access Scheme (PAS), a confidential discount that improves the cost effectiveness of a medicine.”

Last month NICE announced plans to introduce a further hurdle to drug approval that will cost more than £20 million a year, known as a budget test, a move expected to disproportionately affect cancer treatments. 

“The differences in access to drugs across the UK is a problem that could be increased by the new budget test,” said Sara Bainbridge, Cancer Research UK’s policy manager.  

“We hope that the drug company who make Kadcyla will work in partnership with NHS England and NICE to make this drug routinely available for patients in England too.” 

A further decision from NICE on the routine use of Kadcyla is expected soon. 

Professor David Cameron, director of cancer services at NHS Lothian, said: “I am delighted that this medicine is recommended to be made available on the NHS for Scottish patients who can benefit from it.

“It has been fought for by many, and especially the patients themselves. This decision represents a step forward in cancer care for Scotland.”

Cancer Research UK’s Gregor McNie also acknowledged the difficult job done by the SMC, but said that changes could be made for the future. “Dr Brian Montgomery’s recent review made some positive recommendations on how the SMC could improve its decision-making – it’s important that these changes are made a reality for patients as soon as possible,” he said.