August 7, 2008

‘A Devastating Blow to the Kidney Cancer Community’

By Greg Tindle

A WELSH cancer expert has described as "an outrage" plans to deny patients with advanced kidney cancer four types of drug treatment on the NHS.

Under new guidelines the National Institute for Health and Clinical Excellence (Nice) - the Government's medicines watchdog - has turned down the use of the drugs saying they are not cost effective.

Charities have expressed concern at the decision, saying it has left patients only one treatment option - interferon - to which many do not respond.

Professor John Wagstaff, from the South Wales Cancer Institute, said there was "no point" in him now accepting referrals for people with advanced kidney cancer as about 75% of them "do not gain any real benefit" from interferon.

He said the only other option was to make patients comfortable in their last months of life.

The draft guidance, which is subject toappeal, rejects the drugs, saying they are not cost effective for patients with kidney cancer.

The drugs involved are Sutent (sunitinib), Avastin (bevacizumab), Nexavar (sorafenib) and Torisel (temsirolimus).

Every year, up to 7,000 people in the UK are diagnosed with kidney cancer.

Of these, about 1,700 patients will be diagnosed with advanced kidney cancer and at any one time around 3,600 people are living with the advanced form.

Prof Wagstaff, who is an honorary consultant in medical oncology at the South Wales Cancer Institute in Swansea and director of the Wales Cancer Trials Network, said: "The possibility that we clinicians may be prevented from offering Sutent to our patients is an outrage and a devastating blow to the kidney cancer community.

"If this draft guidance is not overturned, there will be no point in me accepting referrals of patients with kidney cancer as three quarters of patients do not gain any real benefit from interferon, leaving only the option of palliative care.

"This decision will mean that the UK will have the poorest survival figures for metastatic renal cell cancer in Europe."

Professor Peter Littlejohns, clinical and public health director at Nice, said: "The decisions Nice has to make are some of the hardest in public life. NHS resources are not limitless and Nice has to decide what treatments represent best value to the patient as well as the NHS. Although these treatments are clinically effective, regrettably, the cost to the NHS is such that they are not a cost- effective use of NHS resources.

He said the four drugs involved in the decision had the potential to extend survival by five to six months, but at a cost of pounds 20,000- pounds 35,000 per patient per year.

"If these treatments were provided on the NHS, other patients would lose out on treatments that are both clinically and cost effective."

A spokesman for the Welsh Assembly Government said: "This is not yet final guidance to the NHS, and we would encourage those with an interest in the appraisal to respond to Nice's consultation by the deadline of August 29."Final guidance is expected from Nice in January 2009."

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