October 2015 decisions news release
The Scottish Medicines Consortium (SMC), which reviews newly licensed medicines, has today published advice accepting six new medicines for routine use by NHSScotland.
Four of these medicines, trastuzumab (Herceptin) for stomach cancer, radium 223 (Xofigo) and abiraterone (Zytiga) for prostate cancer, and nintedanib (Ofev) for idiopathic pulmonary fibrosis (a long term disease of the lungs) were accepted after consideration under the SMC’s PACE (Patient and Clinician Engagement) process, which aims to improve patient access to new medicines for the treatment of end of life and very rare conditions.
The committee was unable to recommend everolimus (Afinitor) for breast cancer, which was also considered under the PACE process.
Trastuzumab is used to treat some types of gastric cancer. During the PACE meeting participants highlighted that there are currently no other treatment options for patients and that trastuzumab can improve overall survival and progression-free survival and is well tolerated. Trastuzumab was also considered under SMC’s decision making process for medicines to treat extremely rare (ultra orphan) conditions.
Radium 223 is used to treat men with prostate cancer which has spread to the bones. Patient groups and clinicians who participated in the PACE meeting spoke of the significant improvement in overall survival radium 223 can offer patients, highlighting that it can reduce the risk of spinal cord compression and fractures.
A second prostate cancer medicine, abiraterone (Zytiga) was also accepted following consideration by an Independent Review Panel (IRP) convened by SMC. This submission related to its use at an early stage in the treatment pathway for prostate cancer. SMC has previously accepted abiraterone for restricted use in patients who have already had chemotherapy.
Nintedanib (Ofev) is used to treat idiopathic pulmonary fibrosis, a long term disease of the lungs where collagen and fibrous tissue builds up. Through PACE, patient groups and clinicians highlighted that nintedanib works differently to other treatments and may be an another treatment option for patients.
Ciclosporin eye drops (Ikervis) are used to treat severe keratitis, an inflammation of the cornea caused by dry eye disease. Patients currently have limited treatment options to reduce damage to the cornea, so ciclosporin fulfils an unmet need.
The committee also accepted insulin degludec / liraglutide (Xultophy) for diabetes.
The committee was unable to recommend everolimus for breast cancer for routine use by NHSScotland due to uncertainties surrounding the overall clinical benefit the medicine would provide for patients at the end of their lives. During the PACE meeting patients highlighted that everolimus has the ability to delay chemotherapy. However, the uncertainties around clinical benefits meant that the committee was concerned everolimus may not be an effective use of NHS resources.
Professor Jonathan Fox, chair of SMC, said:
“We are pleased to be able to accept these six medicines for routine use by NHS Scotland, four of them through our PACE process. Effective treatments for idiopathic pulmonary fibrosis are limited, and we know patients will welcome the advice on medicines for prostate cancer and stomach cancer. This brings the number of medicines accepted through PACE to 23.
“It is disappointing we were not able to recommend everolimus for the treatment of breast cancer. The patient groups and clinicians who took part in the PACE meeting provided a powerful input to the committee’s deliberations about this medicine. However, uncertainty about the clinical benefits of everolimus meant we were unable to accept it. We know this decision will be disappointing to both patients and clinicians as we understand the devastating impact of breast cancer.”