New batch of treatment decisions for NHS Scotland

The Scottish Medicines Consortium (SMC) has made decisions on five new cancer treatments, including a personalised blood cancer immunotherapy.

Axicabtagene ciloleucel (Yescarta), a CAR T cell therapy, has been approved for some adults with aggressive forms of blood cancer. Gordon Matheson, Cancer Research UK’s public affairs manager in Scotland, has described the decision as “fantastic news”.

And Yescarta isn’t the only immunotherapy recommended for NHS use. A new combination treatment for non small cell lung cancer will also be available to some patients in Scotland.

The remaining decisions included drugs for breast and prostate cancer.

Yes for Yescarta

Yescarta has been approved for adults with two types of aggressive non-Hodgkin lymphoma who’ve already had two or more different types of treatment.

The treatment involves taking a patient’s own immune cells and modifying them in a lab. These are then given back to the patient, where they find and kill cancer cells.

In a clinical trial of 101 people who took Yescarta, 8 in 10 people saw their disease respond to the therapy and half of these people were cancer free six months after treatment. But the drug also led to serious side effects in over half of patients.

Yescarta is the second CAR T cell therapy to be recommended by the SMC for patients with a type of blood cancer called diffuse large B cell lympoma (DLBCL), after Kymriah was accepted last month.

Yescarta can also be used to treat patients with another type of lymphoma called primary mediastinal B cell lymphoma.

“It’s really great news for patients and their families that new treatments are now available for those who might have few other options,” said Matheson.

Lung cancer immunotherapy approved

Pembrolizumab has also been approved for some patients with non small cell lung cancer that’s spread to other parts of the body.

The drug will be used in combination with pemetrexed and platinum chemotherapy to treat adults whose tumours don’t test positive for faulty versions of two molecules, called EGFR and ALK, and who have not received previous treatment for their disease.

Clinical trial results, published in May this year, showed around 69 in 100 patients who received pembrolizumab with pemetrexed and platinum chemotherapy were alive 12 months after starting treatment, compared to 49 in 100 taking standard treatment alone. 

Severe sides effects were similar in both groups, the most common being nausea and tiredness.

The new combined therapy is already available on the NHS in England for some patients with non small cell lung cancer.

The SMC’s decision restricts availability in Scotland to patients whose tumours have low levels of a molecule called PD-L1. It’s the first time these patients, who have limited options, have had access to immunotherapy treatment.  

Patients in Scotland whose tumours have high levels of PD-L1 can already access treatment with pembrolizumab alone, thanks to a previous SMC decision.

Other approvals and rejections

The SMC also approved the hormone therapy triptorelin acetate (Decapeptyl) for some women with early stage breast cancer. The drug, which is already used to treat prostate cancer, will be combined with other hormone therapies to treat premenopausal women who’ve already had chemotherapy but are at high risk of their cancer coming back.

The SMC rejected the use of an immunotherapy drug, pertuzumab (Perjeta), for early stage breast cancer following initial treatment. This was because they weren’t convinced the drug added significant clinical benefit or offered good value for money.

The hormone therapy enzalutamide (Xtandi) for early stage prostate cancer was also rejected due to concerns over the cost-effectiveness of the drug.