Tuesday, August 22, 2006


The Government's value- for-money watchdog is set to refuse approval for two new bowel cancer drugs, to the fury of patients and cancer charities. Nice, the National Institute for Health and Clinical Excellence (Nice), will recommend today that Avastin and Erbitux are not sufficiently good value to justify NHS prescription. Andrea Sutcliffe, deputy chief executive, said: "Although bevacizumab [Avastin] does show some increased benefit over standard treatment, the [Nice] Appraisal Committee was not persuaded that it was cost-effective in the treatment of metastatic colorectal cancer. "The 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."

The judgment is not final and is open to appeal before guidance is issued in November. But cancer charities are preparing a challenge. They argue that the two drugs work, shrinking tumours and extending life in patients with advanced colon cancer, even if they are not a cure. They are widely available elsewhere, including across most of Europe. Hilary Whittaker, chief executive of Beating Bowel Cancer, said: "We urge Nice to reconsider. Why should patients in the UK be worse off than patients in the rest of Europe?" Michael Wickham, the chief executive of Bowel Cancer UK, said: "The NHS of 2006 is, it seems, content to fund a 10 billion pound overspend on information technology but not to give patients treatments that can help them live longer." Denise Richard, of Merck Pharmaceuticals, which makes Erbitux, said: "The UK is the only country in Europe where Erbitux has been licensed but is not routinely available to patients because the NHS will not fund it."

Bowel cancer is the third-commonest cancer in the UK, with 35,000 new cases every year and 16,000 deaths. More than half the patients will develop cancers that spread, for which the five-year survival rate is only 12 per cent. Avastin and Erbitux are new medicines that work by targeting a growth factor that stimulates the growth of blood vessels needed by tumours to grow. Both are licensed and in trials have shown effectiveness in tumours that are resistant to chemotherapy. Erbitux, used with the traditional drug irinotecan, shrank tumours by half in a quarter of patients and slowed progression of the disease by four months in half of patients. Avastin had similar effects on survival when used with other drugs.

However, the question that Nice has to answer is whether the drugs are cost-effective. Nice measures the cost per life-year saved, with a threshold of effectiveness of about 30,000 pounds. Neither passes this test: Avastin costs between 83,000 and 107,000 pounds, and Erbitux between 39,000 and 69,000. One patient who is taking Erbitux is David Taylor, 54, a journalist who lives in North London. He had colorectal cancer diagnosed in 2004. Treatment with conventional drugs began in January 2005. But the disease progressed and his consultant warned him: "We're running out of drugs."


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