October 2022 decisions news release
The Scottish Medicines Consortium (SMC), which advises on newly-licensed medicines for use by NHSScotland, has today (Monday 10 October) published advice on new medicines for six different conditions.
Pembrolizumab (Keytruda®) was accepted as a treatment option for three different types of cancers:
It was accepted for the treatment of some patients with renal cell carcinoma, the most common type of kidney cancer in adults. It will be used following surgery to remove an affected kidney to help prevent recurrence of the cancer. The committee heard from patient groups who highlighted the stress and anxiety patients face as they are monitored for spread of the disease after surgery. Pembrolizumab is the first targeted treatment to be made available for patients after surgery to help stop the cancer coming back.
The committee also approved pembrolizumab for the treatment of triple negative breast cancer alongside chemotherapy. The medicine was accepted through the Patient and Clinician Engagement (PACE) process which is used for end of life and rare conditions. Triple negative breast cancer is particularly aggressive and typically affects younger women. The committee heard powerful testimony through PACE from women who highlighted the importance of extending their lives for as long as possible to let them spend more time with their families. Pembrolizumab, in combination with chemotherapy, could significantly delay disease progression and prolong survival in this setting.
Pembrolizumab was also accepted for use through the PACE process, in combination with lenvatinib, for the treatment of advanced or recurrent womb cancer (endometrial carcinoma). Pembrolizumab in combination with lenvatinib may increase survival time for patients, allowing more time with loved ones, and may improve quality of life by reducing the symptom burden.
The committee accepted ozanimod (Zeposia®) for the treatment of ulcerative colitis, a chronic inflammatory bowel disease characterised by remissions and flare ups. Symptoms include abdominal pain, diarrhoea, intestinal bleeding and fatigue which can impact on patients’ ability to work, care for family and on their social life. Ozanimod offers a new treatment option that can be taken orally by patients at home.
Filgotinib (Jyseleca®) was accepted for use in some patients with moderate rheumatoid arthritis, a chronic autoimmune disease that causes joint inflammation and pain, swelling and stiffness. Filgotinib can improve the signs and symptoms of rheumatoid arthritis. It has previously been accepted for use in patients with severe rheumatoid arthritis and its use can now be extended to those with moderate disease.
The committee was unable to accept defatted powder of Arachis hypogaea L., semen (peanuts) (Palforzia®), a desensitisation treatment for children with peanut allergy as there was uncertainty around its cost-effectiveness.
SMC Chair Mark MacGregor said: “Pembrolizumab will provide a treatment option to potentially prevent or delay recurrence of kidney cancer after surgery. It will also help reduce the worry for patients and their families caused by the threat of recurrence of the disease.
“Pembrolizumab will help delay the progression of triple negative breast cancer and improve quality of life for patients. While only providing a modest increase in survival, it allows them to live independently for longer and give them more time with their loved ones.
“Pembrolizumab will also offer the same opportunity to patients with womb cancer. We know that improved quality of life, symptom management and even small extensions in duration of life are of huge importance to patients and families.
“Patients with inflammatory bowel disease have their lives detrimentally altered by the condition. Ozanimod offers a treatment option that may reduce the time spent receiving treatment in hospital and allow them to be more independent. The addition of another treatment option may delay or avoid surgery for some patients.
“Rheumatoid arthritis is a chronic condition that has a significant impact on the day to day lives of patients. Filgotinib will offer another treatment option to improve symptoms for some patients and the opportunity of increased mobility.
“The committee was unable to accept Arachis hypogaea L., semen (peanuts) (Palforzia®), a desensitisation treatment for peanut allergy as the evidence provided by the company was not strong enough to satisfy the committee. The company’s proposed use of the medicine was not supported by the clinical evidence provided, leaving significant uncertainty that it offers value for money for NHSScotland.”