Three cancer drugs cleared for NHS funding in Scotland

Three cancer drugs have been approved for patients on the NHS in Scotland. This includes a drug for some patients with advanced liver cancer, and two drugs that can now be used for children with leukaemia. 

The decisions were hailed as “great news” for people in Scotland who could benefit.

The fresh batch of decisions from the Scottish Medicines Consortium last week included the approval of a targeted liver cancer drug, lenvatinib (Lenvima), for patients with a rare type of liver cancer, called hepatocellular carcinoma.

Patients whose liver cancer cannot be removed surgically or has spread to other parts of the body will be eligible, after the drug was found to be as good as existing treatments at extending survival and to give more patients longer before their disease gets worse. 

The drug will only be used in patients who haven’t yet been treated with any treatment that reaches the tumour via the bloodstream.

Gordon Matheson, Cancer Research UK’s public affairs manager in Scotland, said that the decision means lenvatinib will now be available for some liver cancer patients who have few other options.

“The number of deaths from liver cancer in Scotland has increased over the last 10 years, and lenvatinib has been shown to offer some patients with this type of cancer more time before their disease progresses,” he said.

A new treatment for liver cancer

Lenvatinib is a targeted cancer drug that interferes with signals that help cancer cells grow. It’s used to treat some patients with thyroid or kidney cancer.

A clinical trial involving 954 patients with hepatocellular carincoma compared lenvatinib to another targeted drug called sorafenib (Nexavar). The trial was designed to test if lenvatinib was at least as good as sorafenib.

Patients taking lenvatinib lived for an average of 13.6 months after treatment, compared with 12.3 months for those taking sorafenib. And lenvatinib also doubled the time that patients lived without their cancer getting worse, from 3.7 months in those taking sorafenib to 7.4 months for patients taking lenvatinib.

The most common side effects for those taking lenvatinib were high blood pressure, diarrhoea, decreased appetite and decreased weight.

Lenvatinib was approved for NHS use in England in December 2018 by the National Institute of Health and Care Excellence (NICE).  NICE decisions are also adopted by Wales and Northern Ireland, so lenvatinib should be available for eligible patients there too.

Decisions about which drugs the NHS should pay for in Scotland are made separately by the Scottish Medicines Consortium (SMC).

New options for children with leukaemia

The SMC also approved two drugs for some children and young adults with leukaemia. Both drugs – blinatumomab (Blincyto) and dasatinib (Sprycel) – are already approved to treat adults with the same disease profiles.

Blinatumomab will now be an option for patients over the age of 1 who have a specific type of acute lymphoblastic leukaemia. Patient’s cancer cells would need to test positive for the molecule CD19 and not have a change in their DNA called the Philadelphia chromosome.

The drug will only be available for patients whose cancer has not responded to or come back after at least two treatments or a stem cell transplantation.

Blinatumomab works by bringing leukaemia cells into close contact with immune cells, allowing the immune system to more effectively kill the cancer cells.  In a trial involving 70 children with acute lymphoblastic leukaemia, blinatumomab led to all signs of the disease disappearing in almost 4 in 10 children (39%). It was not compared with any other treatments in the trial.

The most common severe side effects were iron deficiency, low platelet counts and low potassium levels.

The second drug, dasatinib, was given the green light for some children with a type of blood cancer called chronic myeloid leukaemia (CML). The drug is designed for patients whose cancer cells don’t carry the Philadelphia chromosome. 

It will be available to children and young adults in Scotland who have just been diagnosed or who could not use other treatments like imatinib (Glivec), or whose cancer has become resistant to the treatment.

In a trial involving 113 patients under the age of 18, around 8 in 10 patients (78%) who had previous treatment, and around 9 in 10 (93%) patients who hadn’t had previous treatment, were alive without their cancer getting worse 4 years after treatment. The treatment wasn’t compared to any other drugs in the trial. 

“This will be very welcome news for young patients and their families,” said Matheson. 

Both dasatinib and blinatumomab are available on the NHS in England and Wales to treat some adults with leukaemia.