Kidney cancer drugs under threat

Sutent was one of the drugs temporarily approved for funding

Doctors may be told to stop prescribing kidney cancer drugs to new patients, just months after funding was agreed.

Health minister Edwina Hart told health boards in January to make Nexavar, Sutent, Avastin and Torisel available despite their use not being approved.

But the National Institute for Clinical Excellence (NICE) has now said the drugs are not cost effective.

Ms Hart is "considering" the guidance and taking advice but said doctors can prescribe the drugs in the meantime.

But earlier a Welsh Assembly Government spokesperson said Ms Hart "expects clinicians in Wales to follow NICE recommendations for the use of these drugs now that the final guidance has been published".

The fact that kidney cancer patients in Wales can access these drugs highlights the inequalities that exist between nations Duleep Allirajah, Macmillan Cancer Support

The spokesperson had added that "patients who have started treatment with one of the drugs not recommended by NICE should be allowed to continue treatment until they or their clinician consider it appropriate to stop."

It follows appeals from Roche, Wyeth Pharmaceuticals, the James Whale Fund for Kidney Cancer and a joint appeal from the Rarer Cancers Forum and Macmillan Cancer Support.

The move by NICE means bevacizumab (Avastin), sorafenib (Nexavar) and temsirolimus (Torisel) have not been approved as first treatment options for advanced kidney cancer or cancer that has spread around the body.

NICE also turned down the use of sorafenib and sunitinib (Sutent) as secondary treatment options for people with either form of the disease.

The organisation said Avastin cost £5,982 per patient for the first six-week cycle and £6,117 for subsequent six-week cycles (about £53,000 per patient per year).

'Devastating disease'

Nexavar is £2,980.47 for 112 tablets while Sutent is £3,363 for 30 capsules and Torisel is listed at £620 per vial.

Professor Peter Littlejohns, clinical and public health director at NICE, said: "We are very aware that renal cancer is a devastating disease for the individual and their family.

"We recommended the use of sunitinib for first line renal cancer in March 2009, so one of these new treatments is now available.

"The evidence to support the use of the other first and second line treatments isn't strong enough to justify using NHS funds, which could be used for other cancer treatment programmes or in other treatment areas."

'Hugely frustrating'

Duleep Allirajah, policy manager at Macmillan Cancer Support, said: "These innovative drugs are proven to significantly improve patients' quality of life and so it is hugely frustrating that despite this, NICE is not allowing patients to access them."

He added: "The fact that kidney cancer patients in Wales can access these drugs highlights the inequalities that exist between nations."

Gwilym Parry, from Pwllheli, who is taking Sutent, said: "It is working for me. I don't see how they can refuse it if it is working. It's an expensive drug but what price life, at the end of the day?"

Ms Hart advised health boards to fund the drugs in January, ahead of expected guidance from NICE in March.

At the time, she said: "I think it is unacceptable for these patients to be kept waiting any longer and I am instructing local health boards to provide these drugs for kidney cancer to appropriate patients with immediate effect."

She said she was including a proviso that each request for funding for the life-prolonging drugs is supported by two cancer specialists and confirmed at the time it was a temporary arrangement.

On Wednesday morning, the assembly government said the advice to doctors was not to prescribe the drugs to new patients.

But in a development, late in the afternoon, a spokeswoman for Ms Hart said she was to take advice from clinicians and for the time being all prescribing of the drugs could continue.

Conservative health spokesman Andrew RT Davies said earlier it was "highly regrettable" the decision came down to cost effectiveness, given the benefits and said it would be a "bitter blow" to many patients.

"Unfortunately the harsh reality is that in this financial climate we're only likely to see more of these decisions being taken throughout the Welsh NHS, due to severe budget constraints," he said.

"Edwina Hart raised kidney cancer patients hopes in January with her big announcement to provide funding - now less than a year later, these hopes have been crushed."

Peter Black, the Liberal Democrat health spokesman said it was "dashing the hopes" of the many with the disease.

"The minister cannot go raising the expectations of kidney cancer patients across Wales to then suddenly take the funding away," he said.