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NICE decision on bowel cancer drugs sparks fury

Avastin and Erbitux not recommended for use on NHS on grounds that they are not cost-effective

The National Institute for Health and Clinical Excellence (NICE) has rejected the NHS use of two targeted therapies for bowel cancer, on the grounds that they are not cost-effective.

The decision by NICEís appraisal committee not to recommend Rocheís Avastin (bevacizumab) and Merck Pharmaceuticalsí Erbitux (cetuximab) has sparked criticism from the industry and charities who say both drugs have been shown to extend life expectancy by four to five months in some patients.

Companies and patient groups are becoming increasingly frustrated at decisions made by the Institute that they believe are based more on cost rather than clinical evidence.

ìAlthough bevacizumab [Avastin] does show some increased benefit over standard treatment, the appraisal committee was not persuaded that it was cost-effective in the treatment of metastatic colorectal cancer,î said NICE deputy chief executive, Andrea Sutcliffe. ìThe evidence available on cetuximab [Erbitux] does not compare it to current standard treatment and we are not able to assess whether it is any better than existing treatments.î

Hilary Whittaker, chief executive of patient organisation, Beating Bowel Cancer, described the decision as a ìscandalî.

ìWe urge NICE to reconsider its decision,î she said. ìWhy should patients in the UK be worse off than patients in the rest of Europe ñ it just doesnít add up.î

Michael Wickham, the chief executive of another patient organisation, Bowel Cancer UK, was also severely critical of NICEís decision. Referring to the recent problems within the health service regarding the restructuring of its IT infrastructure, he commented: ìThe NHS of 2006 is, it seems, content to fund a £10bn overspend on information technology, but not give patients treatments that can help them live longer and better lives.î

In a statement, Roche said it would not be appealing the decision ìdue to some imminent changes in the licensed indications for Avastinî.

ìRoche has recently applied for a licence for the use of Avastin in late stage breast cancer and non small cell lung cancer, and we are investigating imminently the licensing of other uses for this novel treatment in cancer,î the company said.

Roche added that it would make a decision on requesting a further review by NICE for the use of Avastin in late stage colorectal cancer, when it had a ìclearer idea of our likely licence indications in 2007î.

With regard to Erbitux, the UK will now be the only country in Europe to be denied access to a drug which was actually licensed thanks to a British-led clinical study.

ìYet again, we are lagging behind the rest of Europe in terms of access to bowel cancer treatments,î commented Denise Richard, head of the oncology business unit at Merck Pharmaceuticals.

The ruling by NICE overturns a decision made by the All Wales Medicines Strategy Group in June to approve the use of Erbitux, with restrictions, in combination with irinotecan for patients with advanced bowel cancer after failure with irinotecan-including treatments.

Avastin and Erbitux function by targeting a growth factor that stimulates the growth of blood vessels needed by tumours to grow. NICE said the average cost of treating a patient with Avastin was around £16,800, while Erbitux would cost about £11,700, based on doses given during clinical trials.

Bowel cancer is the third most common cancer in the UK, with around 35,000 new cases in the country every year and around 16,000 deaths. Up to 55 per cent of new cases will develop advanced disease, for which the five-year survival rate is only 12 per cent.

30th September 2008

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