Pancreatic cancer drug rejected in England

30^th December 2014 -- The NHS in England is being advised not to fund a new pancreatic cancer drug that's already available to patients in Wales and in England through the Cancer Drugs Fund.

In draft guidance, the National Institute for Health and Care Excellence (NICE) says that although nab-paclitaxel (Abraxane) is more effective than a current treatment, it is more expensive and causes more side effects.

The drug isn't yet available in Scotland.

One cancer charity says it is 'extremely disappointed and frustrated' at the decision by NICE.

'Limited benefits'

Pancreatic cancer can develop without causing any symptoms in the early stages, and may not be diagnosed until it is more advanced, and has spread or metastasised to other parts of the body.

NICE draft guidance doesn't recommend nab-paclitaxel given with gemcitabine for previously untreated metastatic pancreatic cancer, because its "limited benefits compared to current treatments do not justify its cost".

Nab-paclitaxel is a variation of the chemotherapy drug paclitaxel and works by blocking cell division and killing cancer cells.

People newly diagnosed with pancreatic cancer are usually offered a combination treatment called FOLFIRINOX. However, this can cause serious side effects and is not suitable for everyone.

Other options include gemcitabine on its own or combined with capecitabine.

The information NICE assessed showed that FOLFIRINOX is likely to be more effective than nab-paclitaxel with gemcitabine.

Nab-paclitaxel with gemcitabine was more effective than gemcitabine alone, but resulted in more serious side effects.

It caused more side effects than gemcitabine with capecitabine, but was just as effective.

Decision 'hard to accept'

In a statement, NICE chief executive Sir Andrew Dillon says: "In the early stages, pancreatic cancer doesn't usually cause any symptoms, which can make it difficult to recognise and means that many people are not diagnosed until the cancer is very advanced. Without treatment, survival may be only 2 to 6 months. Unfortunately the development of new treatments for pancreatic cancer has been very limited in recent years.

"Although nab-paclitaxel is more effective than one of the treatment options currently available, it is associated with more side effects and is also more expensive."

Reacting to the draft guidance Alex Ford, chief executive of Pancreatic Cancer UK says: "We are extremely disappointed and frustrated at this negative decision, which prevents a new drug with proven survival benefits – 2 months on average although in some cases significantly more - from being made routinely available to eligible patients.

"It is a decision that is hard to accept given that the average survival time from diagnosis for a metastatic pancreatic cancer patient is between just 2 – 6 months; that pancreatic cancer has the worst survival rates of any of the 21 most common cancers at less than 4%; that those rates have remained virtually unchanged for 40 years; and that Abraxane is the first real advance in treatment terms for almost 20 years."

Until final guidance is issued, local NHS bodies in England have to make their own funding decisions.

Ms Ford says: "This decision by NICE means it is now absolutely vital that Abraxane is retained on the Cancer Drugs Fund (CDF) as an alternative way for patients in England to access the treatment."