'No' in England to pancreatic cancer drug

Editor's note 28th October 2015 -- NICE has confirmed in final guidance that nab-paclitaxel (Abraxane) should not be routinely funded on the NHS in England for pancreatic cancer.

17^th September 2015 - England's health rationing body has confirmed it has decided to say no to the use of nab-paclitaxel (Abraxane) for pancreatic cancer in the NHS.

The final draft guidance by the National Institute for Health and Care Excellence (NICE) follows the decision earlier this month to remove nab-paclitaxel from the Cancer Drugs Fund in England.

It also puts England at odds with the NHS in other parts of the UK.

Nab-paclitaxel was approved by the Scottish Medicines Consortium (SMC) for use in Scotland in February this year and by the All Wales Medicines Strategy Group (AWMSG) for use in Wales in September 2014.

One cancer charity says it is very disappointed by the decision.

Killing cancer cells

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

NICE has now confirmed that the medication, when given with the chemotherapy drug gemcitabine, should not be funded by the NHS for people whose pancreatic cancer has spread and who have not received any other treatments.

'Limited benefits'

The body defended its decision, saying the cost of using nab-paclitaxel, which it costed as £5,035 per patient for a 3 and a half month course of treatment, "is not justified by its limited benefits compared to current treatments".

It also said that information provided by the drug's manufacturer, Celgene, showed that although nab-paclitaxel with gemcitabine was more effective than gemcitabine alone, it resulted in more serious side effects. It said it also caused more side effects than using gemcitabine with another chemotherapy called capecitabine, despite having similar effectiveness.

Side effects

Commenting on the draft guidance in a statement, Sir Andrew Dillon, NICE chief executive, says: "Pancreatic cancer has no obvious warning signs so many people are not diagnosed until their cancer is advanced. Prognosis is poor and without treatment people may live for 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 linked with more side effects.

"When considering the impact of side effects on a patient’s quality of life and the fact that it is also more expensive, nab-paclitaxel cannot be considered an effective use of NHS resources."

Known side-effects of using nab-paclitaxel with gemcitabine include a drop in the number of blood cells causing an increased risk of infection, bleeding problems, tiredness and breathlessness, numbness or tingling in fingers and toes, gastrointestinal problems, aching joints and muscles, tiredness, feeling sick and hair loss.