A melanoma cell. Credit: Dr Erik Sahai.
The National Institute for Health and Care Excellence (NICE) has recommended the use of the immunotherapy drug pembrolizumab (Keytruda) for some adults in England with a type of advanced melanoma skin cancer.
The drug will now be routinely available on the NHS to adults with stage 3 melanoma that’s spread to the lymph nodes and who have undergone surgery.
Until recently, patients’ only option was close monitoring after surgery, with other treatment options still very limited.
Current evidence shows that around 75% of people who take pembrolizumab after surgery do not have their cancer come back within a year of their treatment – a significant improvement on current standards.
Matt Sample, policy manager at Cancer Research UK, said: “This is good news for people who’ve had surgery for this type of skin cancer. Clinical trials have shown that pembrolizumab can reduce the risk of reoccurrence, meaning it has the potential of reducing the worries these people might have about their cancer returning.”
A need to prevent cancer from coming back
Melanoma is the 5th most common cancer in the UK, and around 7% of cases are diagnosed at stage 3. Around half the number of people diagnosed at this stage will survive their cancer for 5 years or more.
Cancer returning after treatment can significantly reduce chances of survival. As around 60 to 70% of these patients will have their cancer come back after surgery within 5 years, there has been a great need to develop new treatments that can prevent this.
“Fear of recurrence of cancer is also a huge emotional burden for patients and families and in particular for the growing population of melanoma patients who are diagnosed at a younger age, with the majority of their life ahead of them,” said Susanna Daniels, chief executive of Melanoma Focus.
Current evidence from a phase 3 clinical trial shows that around 75% of people who take pembrolizumab after surgery do not have their cancer come back within a year of their treatment.
As the trial is still ongoing to collect more data, the drug was previously only available through the Cancer Drugs Fund, which helps provide access to promising medicines while further evidence is gathered on its clinical and cost-effectiveness.
Whilst evidence now shows that pembrolizumab can prolong the amount of time someone can have before their cancer comes back, there is still not enough data to know whether the drug improves overall survival.
Despite this uncertainty, NICE believes that the benefit shown by the drug means it is still likely to be cost-effective, and so have approved it for routine use.
“I am delighted for patients that NICE have recognised the value this treatment adds for people with stage 3 melanoma by reducing the likelihood of recurrence, and that it will now be available on a routine basis,” added Daniels.
Pembrolizumab is an immunotherapy that aims to boost the immune system’s ability to recognise and kill cancer cells. It works by blocking a molecule found on immune cells – called PD-1 – from talking to cancer cells.
NICE decisions are usually adopted in Wales and Northern Ireland as well, so the decision is likely to affect patients in all 3 nations. Scotland has a separate process for reviewing drugs.
Malcolm Needham May 5, 2022
Diagnosed with squemous cell carcanoma and after 4 surgeries to try to remove it, i am now due to start immunotherapy next week using pembolixumab. How is the drug infused, is it a normal iv line into the arm or a more permanent line into a vein in the neck? Hoping this will sort it!!
Jacob Smith May 6, 2022
Thanks for your comment. We’re sorry to hear about your diagnosis.
Pembrolizumab is given as an infusion over about 30 minutes into a vein. It can be given into a peripheral intravenous (IV) line in the arm using a small tube called a cannula. But this may depend on how easy it is to get access to a good enough vein- sometimes this can be tricky.
If inserting a cannula is an ongoing problem, a central line (a long flexible tube that ends up in a central vein in your chest) might be needed. These can stay in place for longer. There are different sorts of central lines, the type that goes in the neck are usually for short term treatments, so if needed, another type is more likely to be used. But a central line might not be necessary.
I hope that’s helpful,
Shannon Draisey January 20, 2022
Really happy to see this and I really hope that more research will be undertaken for immunotherapy options to be offered to patients with other types of cancer such as brain cancer.
Jemima Key December 28, 2021
This is brilliant news!!!
My partner has recently had 1 biopsy and 2 surgeries to remove melanoma and 30 lymphnodes, 7 of which had cancer in them. He is due to start immunotherapy in the new year. So this article has proved to be very informative for us.
Keep up the fantastic work!
Nicola December 28, 2021
Is this for malignant melanoma ? My husband died 16 years ago when I was 40 , he was 46. 14 months and two days from when I saw a mole had gone bad on his back . Xmas eve , saw gp, New Years eve had first op to cut out .
Would be amazing if some people are saved from this now
Harry Jenkins January 4, 2022
Thank you for getting in touch, and I’m very sorry to hear about your husband. This drug is indeed for people with malignant melanoma, in situations where it has advanced and more treatment is required after surgery. Current evidence shows that it could significantly reduce the likelihood of these people’s cancer from coming back, which is of course wonderful news.
Harry, Cancer Research UK