One kidney cancer treatment and two lung cancer drugs have been recommended for use on the NHS in Scotland.
The decision from the Scottish Medicines Consortium (SMC) adds new immunotherapies and a targeted drug to the list of available treatments for some patients.
Gordon Matheson, Cancer Research UK’s public affairs manager in Scotland, called the three approvals “great news for patients”.
The SMC’s decisions come after clinical trial evidence showed each treatment offered value for money for the NHS in Scotland.
Immunotherapy for advanced kidney cancer
Nivolumab (Opdivo) is an immunotherapy that stops cancer cells from ‘switching off’ important immune cells, called T-cells. This boosts the immune system’s ability to attack and kill cancer cells.
In combination with another drug, ipilimumab (Yervoy), nivolumab will be available for adults with kidney cancer who have not received any treatment beforehand and are at a medium to low likelihood of doing well on treatment – so called intermediate or poor risk disease.
“Nivolumab with ipilimumab provides a new option for kidney cancer patients with advanced disease. Clinical trial evidence suggests this drug combination could significantly extend some patients’ survival compared to existing treatment options,” said Matheson.
In the clinical trial, the drug was compared against the targeted drug sunitinib (Sutent), which is the current standard treatment in Scotland.
847 patients whose kidney cancer was deemed intermediate or poor risk were assigned to receive either nivolumab with ipilimumab or sunitinib. 75 in 100 treated with the combo of immune-boosting drugs cruk were alive 18 months after treatment, compared with 60 in 100 for sunitinib.
The most common side effects experienced by both groups of patients were tiredness, diarrhoea and itchy skin, but this was less common in those who had the immunotherapy.
Targeted therapy for lung cancer
Anaplastic lymphoma kinase (ALK) is a gene that can be faulty in some lung cancers. The faulty gene can cause the cancer cells to grow, and brigatinib (Alunbrig) – one of the newly-approved drugs – blocks these growth signals.
This treatment is now available on the NHS in Scotland for patients whose non small cell lung cancers carry the faulty ALK gene. These patients must also have already received treatment with crizotinib (Xalkori), the standard treatment for this kind of lung cancer.
222 patients were involved in a trial of the drug, of which 112 were randomly assigned to a lower dosage of brigatinib, and 110 patients to a higher dosage.
The lower dosage was found to produce a response, ranging from no disease progression to the cancer completely disappearing, in around 50 of the 112 individuals. Whereas the higher dose produced a response in around 55 of the 110 individuals.
The lower dosage completely eradicated the tumour in one patient, and the higher dose completely eradicated the tumours of four patients. The side effects of the two doses did not significantly vary in severity.
The SMC’s decision recommends the drug is used at the higher dosage.
Immunotherapy accepted for inoperable lung cancer
Durvalumab is the second immune-boosting drug to receive approval in the latest batch of decisions from the SMC.
A clinical trial involving 709 people, with 473 receiving durvalumab and the rest receiving a dummy drug (placebo), showed the drug can hold some lung cancers at bay.
Those who took durvalumab lived 16.8 months on average before their cancer got worse, compared with 5.6 months for those taking the placebo.
Around 44 in 100 people treated with the immunotherapy had not seen their disease get worse 18 months after treatment, compared with around 27 in 100 people who took the placebo.
Reported side effects did not differ greatly between groups. Lung infections (pneumonia) and a reduced number of red blood cells (anaemia), which can cause fatigue, were some of the most common side effects reported from both groups.
Specifically, this drug works against tumour cells that have PD-L1 molecules on their surface. And it has been approved for treating non-small cell lung cancer (NSCLC) in patients whose disease has not worsened on chemoradiotherapy treatment.
Matheson added: “Survival rates in Scotland are currently low for lung cancers. These two medicines provide new treatment options for some patients with non-small lung cancer who have already received other treatments.”
The three approvals bring Scotland in line with the NHS in England, Wales and Northern Ireland, which follow decisions by the National Institute of health and Care Excellence (NICE).
Patient Access Schemes (PAS), which provide discounts on the cost of the medicines thereby imporving their cost-effectiveness for NHS Scotland, were taken into account when accepting each of the treatments.
Nivolumab (Opdivo®) is accepted for use within NHS Scotland (2019). SMC: Final appraisal document
Brigatinib (Alunbrig®) is accepted for use within NHS Scotland (2019). SMC: Final appraisal document
Durvalumab (Imfinzi®) is accepted for use within NHS Scotland (2019). SMC: Final appraisal document