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July 2017 decisions news release

Medicines for lung cancer, lymphoma and Crohn’s disease accepted for routine use by NHSScotland

The Scottish Medicines Consortium (SMC) has today (Monday 10 July) published advice accepting three new medicines for routine use by NHSScotland.

Pembrolizumab (Keytruda) for advanced non-small cell lung cancer (NSCLC) was accepted following consideration through SMC’s Patient and Clinician Engagement (PACE) process, for medicines used at the end of life and for very rare conditions. It can delay disease progression and may allow some patients a good quality of life in the context of limited remaining months. Through PACE, patient groups and clinicians shared that there are limited treatment options for these patients and that the side effects of current chemotherapy treatments are often difficult to manage. Pembrolizumab may be better tolerated than current treatments so patients may spend less time in day chemotherapy units. It also provides a treatment option for those patients who are not suitable for chemotherapy and for whom there is currently no alternative.  

Nivolumab (Opdivo) for Hodgkin lymphoma (a cancer of the white blood cells) was also accepted through PACE. Nivolumab is used to treat patients for whom all other treatment options have been exhausted. PACE participants highlighted that patients tend to be extremely debilitated and have poor quality of life. They reported that the response rates seen with nivolumab are unprecedented in such heavily pre-treated patients. Nivolumab rapidly reduces symptoms and may improve patients’ quality of life. It may also provide some younger patients with a ‘bridge’ to stem cell transplant which could be potentially curative. 

Ustekinumab (Stelara) was accepted for the treatment of Crohn’s Disease, a chronic condition that causes inflammation of the digestive system. As well as symptoms such as stomach cramps, diarrhoea, weight loss and fatigue, patients often tend to suffer with anxiety and depression. There is currently no cure for Crohn’s Disease. Ustekinumab offers another treatment option for those patients who do not respond to or are unable to tolerate current treatments. 

The committee was unable to accept selexipag (Uptravi) for pulmonary arterial hypertension after consideration through PACE. While patient groups and clinicians presented a strong case for the medicine, the committee was unable to recommend selexipag as the company’s evidence on the clinical and economic benefits of the medicine when compared to current treatment options was not robust enough. 

Dr Alan MacDonald, chairman of the SMC, said:

“We are pleased to be able to accept these three new medicines for routine use by NHS Scotland. 
“Through PACE the committee heard how pembrolizumab can give patients meaningful extra time with their families, which we know will be welcomed.

“Nivolumab will be a valuable new treatment option for patients with Hodgkin lymphoma, particularly as it may help some towards a transplant which may be curative. 

“For patients with Crohn’s Disease whose condition remains uncontrolled on current treatments, ustekinumab offers a helpful alternative.”

“Unfortunately we were unable to accept selexipag for the treatment of pulmonary arterial hypertension. While a good case was presented through PACE and the committee applied as much flexibility as possible when considering the medicine, the evidence presented by the company on the clinical and economic benefits of selexipag compared to other treatments available was not sufficient for us to accept it for routine use.”