What has SMC said?
The Scottish Medicines Consortium (SMC) has not recommended pembrolizumab, for treating adults with gastric and gastro-oesophageal junction adenocarcinoma (types of cancer of the stomach and junction between the oesophagus and the stomach). Pembrolizumab is used together with trastuzumab and chemotherapy to treat patients who have not had treatment for their cancer yet and where the cancer:
- Is locally advanced and can’t be removed by surgery (is unresectable) or
- Has spread to other parts of the body (is metastatic) and
- Has a type of protein called PD-L1 on it with a CPS of 1 or more (CPS is a score which measures the level of PD-L1 on the cancer cells) and
- Has a protein called HER2 on the surface of the cancer cells (is HER2-positive).
This document summarises the SMC decision and what it means for patients.
You can find more detailed information about the SMC assessment of pembrolizumab by looking at the SMC Detailed Advice Document (SMC2644).
What does SMC's decision mean for patients?
Pembrolizumab for use as described above should not normally be prescribed on the NHS in Scotland. Your healthcare professional should talk with you about other treatment options.
If your healthcare professional thinks you would benefit from it, they can make a request to prescribe pembrolizumab. All health boards have procedures in place to consider these requests.
You can find more information about making decisions about your treatment in this booklet called: Medicines in Scotland: What’s the right treatment for me?
More about SMC's decision
SMC was unable to accept pembrolizumab as described above for routine use. The evidence from the company about the benefits the medicine offers when compared to current treatments was not strong enough to justify the additional cost of the medicine. In addition, the company's evidence of the medicine’s value for money was not strong enough. This was despite using a more flexible approach* in the assessment, as it is for a condition where patients taking current treatments are likely to live less than 3 years.
How does SMC make its decision?
SMC carefully considers every new medicine to make sure it benefits patients and is likely to be a good use of NHS resources.
To do this SMC studies the following:
- Evidence from the company about how well the medicine works compared with current treatments available in Scotland, in relation to how much they will cost to buy and use to treat patients.
- Information from patient groups about the potential impact of the medicine on patients and carers.
- Advice from healthcare professionals about any benefits of the new medicine compared to current treatment, along with how the new medicine is likely to be used.
When SMC assesses a medicine it takes account of the needs of all patients in NHSScotland, not only those who may be treated with the medicine.
You can find out more about how SMC decides here: htps://www.scottishmedicines.org.uk/how-we-decide/
More information and support
The organisation below can provide more information and support for people with oesophageal cancer and their families. SMC is not responsible for the content of any information provided by external organisations.
OCHRE
https://www.ochrecharity.org.uk
0800 822 3370
You can find out more about pembrolizumab (Keytruda®) in the Patient Information Leaflet (PIL) by searching for the medicine name on the Medicines and Healthcare products Regulatory Agency (MHRA) website.
https://products.mhra.gov.uk/