Three cancer drugs approved for NHS use in Scotland

3 new cancer drugs have been given the go-ahead by the Scottish Medicines Consortium (SMC) for routine use in Scotland, but a fourth has been rejected.

The approved drugs are:

• Atezolizumab (Tecentriq) for adults with non small cell lung cancer that has spread to another part of their body;
• Osimertinib (Tagrisso) for adults whose non small cell lung cancer tests positive for a faulty version of a molecule called EGFR;
• Pembrolizumab (Keytruda) for patients aged 3 years or older with classical Hodgkin lymphoma, a cancer of the white blood cells, that has come back or doesn’t respond to treatment.

Scott Muir, the vice-chairman of the consortium, said he was pleased to be able to accept their use for the NHS in Scotland.

The rejected drug, selpercatinib (Retevno), was being considered for adults with a type of advanced non small cell lung cancer.

“We were unable to accept selpercatinib as the evidence provided by the company was not strong enough to satisfy the committee of its cost effectiveness,” said Muir.

Personalising lung cancer treatment

David Ferguson, public affairs manager for Cancer Research UK in Scotland, said the acceptance of the 2 lung cancer drugs “will be warmly welcomed by patients and their families”.

Whilst both approved to treat lung cancer, the drugs, atezolizumab and osimertinib, work in different ways and are only to be used in people with particular types of lung cancer.

Atezolizumab is a type of immunotherapy. It works by blocking a molecule that’s often found on cancer cells – called PD-L1 – from interacting with immune cells and stopping them from working properly, boosting the immune system’s ability to attack cancer cells.

It has been approved for use in patients who are diagnosed with non small cell lung cancer when it has already spread to other parts of their body and has a lot of PD-L1. In a phase 3 study, treatment with atezolizumab improved overall survival when compared with chemotherapy in this subgroup of patients.

The majority of patients are diagnosed at an advanced stage of the disease, which is associated with extremely poor survival and limited options, so a new treatment option is vitally needed.

Atezolizumab is also easier to tolerate, administer and requires less time spent in hospital than the current treatment option of chemotherapy.

Osimertinib treats cancer in a different way. It’s a targeted treatment designed to be effective against cancers that test positive for a faulty version of a molecule called EGFR.

The drug has been approved for patients who have had surgery to remove non small cell lung cancer that tests positive for EGFR, as there is currently a high risk of the disease returning after surgery.

In a phase 3 clinical trial, osimertinib significantly increased the amount of time patients lived for without their cancer coming back compared with a dummy drug (placebo).

The SMC also noted that osimertinib is an oral medicine that is likely to be better tolerated than other treatment options.

“Both drugs improve overall survival for non-small cell lung cancer. They showed significant potential in clinical trials as the first treatment option for some aggressive forms of lung cancer.

“Targeted drugs like these are expanding our options to treat cancer and helping more people survive cancer,” said Ferguson.

A new option for Hodgkin lymphoma

Pembrolizumab has been approved for the treatment of patients aged 3 or older with Hodgkin lymphoma whose cancer has come back or when other treatment options have failed.

The drug is another type of immunotherapy that binds to a molecule called PD-1 on T cells, preventing the cancer from switching off immune cells and allowing them to fight the disease.

In a phase 3 study, pembrolizumab stopped patients’ cancer from getting worse for longer than those being treated with brentuximab vedotin, one of the treatments currently used to treat Hodgkin lymphoma.

The SMC also noted that current treatments can be very intensive, with serious side effects, and the new drug offers a more convenient treatment option that is likely to make the treatment more tolerable for patients and their families.

“Pembrolizumab will provide another treatment for patients living with Hodgkin lymphoma that is generally well tolerated,” said Ferguson.

Not cost-effective

Selpercatinib was being considered as a treatment for adults with a type of advanced non small cell lung cancer that have a change in a gene called RET.

After careful consideration, SMC has not recommended selpercatinib to treat these patients because the evidence provided by the company that produces the drug was not strong enough to satisfy the committee that it offers value for money to NHS Scotland.

This was despite the SMC using a more flexible approach in their assessment, as it is for a rare condition where patients are likely to have a life expectancy of less than3 years with currently available treatments.

If a patient’s healthcare professional thinks a particular patient would benefit from the drug, they can still make a request to prescribe selpercatinib. All Scottish health boards have procedures in place to consider these requests.

Drug decisions for the NHS in England are made through the National Institute for Health and Care Excellence (NICE), which usually leads to adoption in Wales and Northern Ireland as well.