NHS England recently announced its plan to delist 7 hematologic cancer agents indicated for 12 different types of cancer, bringing the total unavailable cancer indications to 25. The NHS however clarified that patients who have already begun treatment with any of these agents may continue treatment even after the delisting, which is scheduled to take effect on November 4, 2015, in anticipation of an amended system of drug provision due in April 2016.
Diana Jupp, Director of Patient Experience at Bloodwise, the UK’s biggest blood cancer charity, said, “Today’s announcement will remove the only hope of effective treatment for many blood cancer patients. The existing system for approving new cancer drugs is clearly failing patients. Many blood cancer patients will be left in limbo until a long term solution is put in place next year. For some this will be too late. These drugs have been recognised as being clinically effective, yet patients in England will be denied access purely because the current system is broken. The Cancer Taskforce recently published its recommendations for improving cancer care to comparable levels of the rest of Europe. Ensuring that patients have access to the best drugs available is surely a key part of this.”
While a new drug provision system in 2016 may produce substantial benefits nationwide, a good number of the drugs due to be delisted have been many patients’ only hope for symptom alleviation and inhibition of disease progression. For example, Brentuximab entered the Cancer Drugs Fund only in January 2015. It was met with strong support from clinicians and disease experts as a treatment for two indications, but the NHS has still decided to remove them.
Dr. Graham Collins, member of the Bloodwise Medical Advisory Panel and Consultant Haematologist at Oxford University Hospitals, said, “Brentuximab is the most effective single agent we have for relapsed anaplastic lymphoma. The delisting of this drug means it is likely that patients in England will die if they are not able to access this treatment – it’s hugely detrimental to patients with this rare but life threatening disease. This drug has also become the standard of care in England for treating relapsed Hodgkin lymphoma following an autologous stem cell transplant, or for those failing two lines of treatment not suitable for a stem cell transplant. The de-listing of this treatment will make it harder for patients to receive curative treatment, inevitably making a cure a more difficult goal.”
The blood cancer drugs set to be removed from the CDF, and their indications are as follows:
- Bendamustine for the treatment of chronic lymphocytic leukaemia
- Bendamustine for the treatment of relapsed mantle cell non-Hodgkin lymphoma
- Bosutinib for the treatment of refractory chronic phase chronic myeloid leukaemia
- Bosutinib for the treatment of refractory accelerated phase chronic myeloid leukaemia
- Bosutinib for the treatment of accelerated phase chronic myeloid leukaemia
- Brentuximab for the treatment of refractory systemic anaplastic lymphoma
- Brentuximab for the treatment of relapsed or refractory CD30+ Hodgkin lymphoma
- Dasatinib for the treatment of Philadelphia chromosome positive (Ph+) acute lymphoblastic leukaemia
- Ibrutinib for the treatment of relapsed/refractory chronic lymphocytic leukaemia
- Ibrutinib for the treatment of relapsed/refractory mantle cell lymphoma
- Lenalidomide for the second line treatment of multiple myeloma
- Pomalidomide for the treatment of relapsed and refractory multiple myeloma
The CDF was first established five years ago as a temporary initiative to provide, on a case-to-case basis, cancer patients with access to drugs that are still under-evaluated or had been rejected by the National Institute of Health and Care Excellence (NICE). Drugs indicated for blood cancers are proportionally over-represented on the list of drugs only available to patients through the CDF, which is due for review in March 2016 to make room for a more permanent and extensive system.
