Lung cancer cell. Credit: LRI EM Unit
The Scottish Medicines Consortium (SMC) has recommended three drugs for people with cancer in Scotland.
The latest SMC decisions will provide new treatment options for some adults with non small cell lung cancer (NSCLC), multiple myeloma and a rare type of lymphoma.
Marion O’Neill, Cancer Research UK’s senior external affairs spokesperson in Scotland said the decisions would be “welcome news” for patients and their families in Scotland.
Rare blood cancer treatment approved
Brentuximab vedotin sticks to the surface of lymphoma cells called CD30, delivering a dose of chemotherapy directly to the cancer. The drug will now be an initial treatment option for some people with systemic anaplastic large cell lymphoma (ALCL).
When you have lymphoma, some of your white blood cells (lymphocytes) don’t work properly. They start to divide constantly but don’t develop fully, meaning they can’t fight infection as normal white blood cells do.
Anaplastic large cell lymphoma is a type of non- Hodgkin lymphoma that develops from white blood cells called T cells. Under a microscope, the cancerous cells in ALCL look large, undeveloped and very abnormal (or “anaplastic’). Systemic ALCL affects multiple regions of the body.
Current treatment for people with systemic ALCL is a combination of chemotherapy drugs including cyclophosphamide, doxorubicin and prednisone – also known as CHP.
Clinical trial data suggests that combining brentuximab vedotin with CHP could give people with this rare form of cancer more time before their disease progresses and help them live longer. This new decision means that the drug combination will be available for use on the NHS in Scotland as a treatment option for patients whose cancer has been previously untreated.
“This drug performed well in treating anaplastic large cell lymphoma, a rare form of non-Hodgkin lymphoma which can grow very quickly,” said O’Neill. “Kinder treatment options are needed for this type of blood cancer and this drug can be given without the need for long hospital stays. That means less disruption to patients’ day-to-day lives, giving them more time to do the things they love.”
Targeted therapy for non small cell lung cancer
The SMC has also approved the use of entrectinib as a to treat some adults with advanced non small cell lung cancer (NSCLC). It will now be an option for people whose cancer test positive for a particular DNA change in the ROS1 gene and who haven’t been treated with therapies that target this change (such as crizotinib).
This ROS1 mutation is present in approximately 1-2% of non small cell lung cancers. In advising on the decision, patient and clinicians said that there were limited treatment options for people with this type of cancer, exposing a clear unmet need.
O’Neill said the decision to offer entrectinib on the NHS was “great news for people in Scotland”.
Entrectinib is a targeted cancer drug that works to block signals instructing cells to grow. Entrectinib is one of an innovative new group of drugs that was designed to target specific changes in cancer cell’s DNA rather than where the cancer is growing in the body.
It was approved for NHS use in England last year to target cancers that have a specific genetic change known as a NTRK fusion, but it’s also been trialled as a treatment for ROS1-positive non small cell lung cancer.
Results from a phase 2 study submitted to the SMC revealed that 72% of people with a ROS1-positive cancer had responded to the drug in some way. The trial did not compare the drug with any exisiting treatments.
Entrectinib was found to be a well-tolerated oral treatment that can be taken at home. and experts acknowledged that patients who respond to entrectinib could see reduced symptoms and improved duration and quality of life.
New treatment combo for some adults with myeloma
In the third cancer decision of the month, the SMC approved the use of daratumumab as part of a combination treatment for some adults with myeloma.
Myeloma is a type of blood cancer that develops from cells in the bone marrow. Between 2015 and 2017, there were approximately 5,800 new cases of myeloma each year in the UK.
O’Neill said that treatment options for myeloma, especially for those patients who have had a relapse, have previously been limited. The latest decision will help to change that, adding a treatment option for people who’ve already had one prior therapy.
Daratumumab works by helping the immune system recognise myeloma cells and destroying them. It will be offered in combination with two other drugs – dexamethasone and either lenalidomide (Revlimib) or bortezomib.
In a clinical trial, adding daratumumab to bortezomib and dexamethasone substantially increased the time patients had before their their cancer got worse.
After a median follow up of 7.4 months, only 27% of people taking daratumumab with bortezomib and dexamethasone had seen their cancer get worse, compared to 49% of the patients in the control group, taking just bortezomib and dexamethasone.
This combination was made available to people with multiple myeloma in England on the NHS in March 2019.
“Daratumumab’s approval by the SMC gives people with myeloma, especially those who have relapsed once, more targeted treatment which should improve their quality of life and give them more time to spend with their loved ones,” says O’Neill.
Palumbo, M.D et al (2016) Daratumumab, bortezomib, and dexamethasone for Multiple Myeloma. New England Journal of Medicine. DOI: 10.1056/NEJMoa1606038
Brentuximab vedotin (Adcetris) for previously untreated systemic anaplastic large cell lymphoma – Scottish Medicines Consortium
Entrectinib (Rozlytrek) as monotherapy for the treatment of adult patients with ROS1-positive, advanced non-small cell lung cancer (NSCLC) not previously treated with ROS1 inhibitors – Scottish Medicines Consortium