A breast cancer drug and two blood cancer treatments have been recommended for use on the NHS in Scotland.
The latest Scottish Medicines Consortium (SMC) decisions will see a mix of targeted treatments and chemotherapy added to the options available to NHS patients. But a melanoma drug was rejected because it wasn’t deemed cost effective.
‘Good news’ for advanced breast cancer patients
Palbociclib (Ibrance) is one of the newly-approved treatments. It’s a targeted drug that switches off a set of growth signals inside cancer cells.
The SMC said the drug should be made available in combination with hormone treatment for people with a certain type of advanced breast cancer called hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative.
This means the breast cancer cells are fuelled by hormones but do not have the HER2 molecule on their surface.
In December 2017, the SMC approved palbociclib for patients with advanced cancer or cancer that had spread who had not yet received any treatment. This week’s decision makes palbociclib more widely available since it also covers patients who have received prior hormone therapy.
Gregor McNie, Cancer Research UK’s head of external affairs in Scotland, called the announcement “good news” and welcomed the drug company and the SMC working together to make palbociclib available.
He said the decision means “patients with this type of breast cancer who have previously received hormone treatment now have another treatment option available to them”.
Clinical trial results show palbociclib could offer people more time before their disease gets worse compared with existing treatments.
McNie said that breast cancer is currently the most common type of cancer among women in Scotland, and the SMC’s decision will “offer new hope to some patients with this type of disease.”
Palbociclib has been available in England, Wales and Northern Ireland to patients who have not received any prior treatment for their cancer since late 2017, when it was recommended by the National Institute for Health and Care Excellence (NICE).
Following the SMC’s decision this week, NICE are also currently reviewing whether the drug should be recommended for patients who have already received hormone treatment in the rest of the UK.
Combination treatment for myeloma
Another targeted cancer drug, daratumumab (Darzalex), has been recommended for adult patients with multiple myeloma who have had one previous treatment only.
It will be available for people to take with bortezomib (Velcade) and dexamethasone.
This is after clinical trial results showed that adding daratumumab helped patients live around 10 months longer on average than those just taking lenalidomide and dexamethasone, an alternative combination treatment.
Daratumumab with bortezomib and dexamethasone was made available for some NHS patients in the rest of the UK in April.
New chemo for leukaemia
The third recommendation is for a chemotherapy drug called arsenic trioxide in adult patients with newly diagnosed acute promyelocytic leukaemia (APL).
The committee said that the drug should be taken in combination with a group of chemotherapies collectively called all-trans-retinoic acid (ATRA). And treatment should be given with the aim of getting a patient into remission and to stop their cancer coming back.
Results from a phase 3 clinical trial including 263 people showed that the combination was more effective at getting rid of leukaemia cells compared to ATRA and standard chemotherapy and boosted survival.
This approval follows an initial decision from the SMC to reject the drug back in January. The treatment was approved for use on the NHS in the rest of the UK last year.
A final ‘no’
One treatment was rejected for use on the NHS in Scotland – a targeted cancer drug called encorafenib (Braftovi). It’s been trialled in combination with binimetinib (Mektovi) for adults whose advanced melanoma can’t be removed with surgery or has begun to spread to other parts of the body and carries a faulty version of the BRAF gene.
Even though a clinical trial showed the combination could extend the time before these melanomas get worse compared to other targeted drugs taken on their own, the SMC decided not to recommend the treatment in Scotland. It said there wasn’t enough evidence on how the drug should be used in the NHS and whether it would represent value for money.
In January, NICE made this treatment available to the same group of patients in England.
But patients in Scotland with this type of cancer have other combination treatments available on the NHS.
Cristofanilli, M et al. (2016) Fulvestrant plus palbociclib versus fulvestrant plus placebo for treatment of hormone-receptor-positive, HER2-negative metastatic breast cancer that progressed on previous endocrine therapy (PALOMA-3): final analysis of the multicentre, double-blind, phase 3 randomised controlled trial. Lancet Oncol. doi :10.1016/S1470-2045(15)00613-0
Spencer, A et al. (2018) Daratumumab plus bortezomib and dexamethasone versus bortezomib and dexamethasone in relapsed or refractory multiple myeloma: updated analysis of CASTOR. Haematologica. doi: 10.3324/haematol.2018.194118
Platzbecker, U et al. (2017) Improved Outcomes With Retinoic Acid and Arsenic Trioxide Compared With Retinoic Acid and Chemotherapy in Non-High-Risk Acute Promyelocytic Leukemia: Final Results of the Randomized Italian-German APL0406 Trial. J Clin Oncol. doi: 10.1200/JCO.2016.67.1982
Drummer, R et al. (2018) Overall survival in patients with BRAF-mutant melanoma receiving encorafenib plus binimetinib versus vemurafenib or encorafenib (COLUMBUS): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. doi: 10.1016/S1470-2045(18)30497-2