The National Institute of Health and Clinical Excellence (NICE) has announced its final decision on whether people with advanced kidney cancer can have access to three controversial new drugs – bevicisumab (Avastin), sorafenib (Nexavar) and temsirolimus (Torisel).
Unlike sunitinib (Sutent), which the Institute approved for advanced kidney cancer patients in February, it decided today that these drugs are currently too expensive for the amount of benefit they bring.
We accept that NICE has a very tricky job to do in assessing the limited available evidence for these drugs. And we recognise the efforts of the drugs’ manufacturers to negotiate pricing schemes that the NHS can afford.
Nevertheless, we’re disappointed and concerned by this decision – for two main reasons.
Sorafenib and temsirolimus – no deal
Firstly, in the case of sorafenib and temsirolimus, the drug manufacturers haven’t managed to negotiate a pricing plan that’s attractive enough for the NHS to fund it. This is somewhat frustrating, especially given the fanfare surrounding the new pricing guidelines announced in January.
The decision not to recommend sorafenib is particularly disappointing, as it will create problems for kidney cancer patients who don’t respond to their initial treatment.
There are no other standard treatment options in this situation, and there is good clinical evidence that sorafenib is effective as a second line treatment, where it can add vital extra months to lives (see, for example, section 4.1.15 of the NICE ruling)
Bevicisumab – perplexing
In the case of bevicisumab, we’re concerned that NICE’s decision appears to go against its own recent recommendations on End of Life care.
As Cancer Research UK’s chief executive, Harpal Kumar, said:
The decision on bevacizumab (Avastin) is bizarre and out with the spirit of the government’s end of life guidance set out last autumn. Basically NICE is saying that, that because bevacizumab can be used for other common cancers, the end of life criteria can’t be used for advanced kidney cancer.
However, NICE has not given approval for use in other cancers in the UK. The decision sends out confusing signals about what NICE is trying to achieve.
What happens next?
We would like to see the manufacturers of these drugs continue to negotiate with NICE to develop affordable pricing schemes. This can’t be the end of the road. It is essential to get these drugs to patients who need them – and of course, data from patients will help settle doubts over the effectiveness of these drugs, and improve how they are used.
But we would also like to see clarification from NICE over its End of Life guidance – both in this instance, and with respect to future appraisals. The guidelines were drawn up to improve access to drugs for patients who need them, and it appears that the opposite has happened here.