'Devastating blow' to kidney cancer sufferers

Patients with advanced kidney cancer will be denied four treatments on the NHS under new guidelines published today.

The National Institute for Health and Clinical Excellence (Nice) issued draft guidance rejecting the drugs Sutent (sunitinib), Avastin (bevacizumab), Nexavar (sorafenib) and Torisel (temsirolimus).

Charities expressed outrage at the decision, saying it 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 accepting referrals for people with advanced kidney cancer as around 75 per cent of them "do not gain any real benefit" from interferon.

The only other option was to make patients comfortable in their last months of life.

Broadcaster James Whale, who lost a kidney to cancer in 2000, said the guidance would "mean an early death sentence for many" if it was not revised.

The draft guidance, which is subject to appeal, rejects the drugs, saying they are not cost effective for patients with advanced and/or metastatic kidney cancer.

The medicines do not cure the cancer but extend a person's life by a matter of months.

Patients already on the therapies should continue until they and their doctors consider it appropriate to stop, the guidance said.

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

Of these, around 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.

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.

"Two of the manufacturers have developed proposals which may have the effect of reducing the cost of the drugs. We will be happy to consider these proposals once they have been reviewed and considered suitable for the NHS, by the Department of Health."

Prof Littlejohns said there were no treatments that reliably cured advanced or metastatic kidney cancer.

"The main objective is to relieve physical symptoms and maintain general functions," he said.

"Bevacizumab, sorafenib, sunitinib or temsirolimus have the potential to extend progression-free survival by five to six months, but at a cost of £20,000 - £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."

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 metastatic renal cell 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.

"Sutent produces a remarkable effect on survival for patients. It is now no longer ethical or reasonable for patients to have access to treatment with only interferon."

Mr Whale, who founded the James Whale Fund for Kidney Cancer, said: "The treatment options previously available to us in the kidney cancer community have been limited and inadequate for the majority of patients."

He said the arrival of the drugs had given many families and patients hope for the future.

"I strongly urge Nice to rethink its current draft recommendation," he added.

"If final guidance remains as it currently stands it will certainly mean an early death sentence for many."

Professor Peter Johnson, Cancer Research UK's chief clinician, said: "We are disappointed at Nice's view that although these drugs are clinically effective, their high price means that they are not considered to be value for money for the NHS.

"These drugs have shown a small but definite improvement in an illness where there are few alternative treatments.

"If this decision stands it will be very frustrating for cancer patients and their clinicians.

"This decision once again raises questions about whether Nice's system of appraisal is appropriate for all types of drugs.

"It is often difficult to get unequivocal research data in rarer cancers, such as metastatic kidney cancer, which have a small patient population.

"Although we understand that Nice often has to make difficult decisions, in this case there is a clear separation between what Nice finds to be valuable treatment, and clinical and patient opinion.

"Action is needed to bring these two positions closer together."

Harpal Kumar, chief executive of Cancer Research UK, said: "Possible solutions include looking at the way that pharmaceutical companies are charging the NHS for drugs, and whether appropriate allowances are being made by Nice to compensate for the lack of large scale trials in these areas.

"We also need to ensure that further results are sought and that larger trials, in addition to the nine studies supported by Cancer Research UK, are carried out."



Professor Peter Littlejohns, clinical and public health director at the National Institute for Clinical Excellence, told the BBC today: "I can understand the concern and distress this has caused. We cannot afford all the treatments and therefore decisions should be made using the best evidence.

"We have a very strong ethical framework and I think every patient needs to be taken into account.

"The decision was based on cost effectiveness. We balanced the cost of the drug with the actual length and time of its effectiveness.

"If the drugs were cheaper then the cost effectiveness would be better."

PROMOTED VIDEO
Life and Style
ebookNow available in paperback
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Arts and Entertainment
Stik on the crane as he completed the mural
art
News
Happy in his hat: Pharrell Williams
people
Arts and Entertainment
Stella Gibson is getting closer to catching her killer
tvReview: It's gripping edge-of-the-seat drama, so a curveball can be forgiven at such a late stage
News
i100(More than you think)
News
Phyllis Dorothy James on stage during a reading of her book 'Death Comes to Pemberley' last year
peopleJohn Walsh pays tribute to PD James, who died today
News
peopleExclusive: Maryum and Hana Ali share their stories of the family man behind the boxing gloves
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Austen Lloyd: Commercial / Residential Property - Surrey

    Excellent Salary: Austen Lloyd: SURREY MARKET TOWN - SENIOR PROPERTY SOLICITOR...

    Recruitment Genius: Graduate Programme - Online Location Services Business

    Negotiable: Recruitment Genius: What do you want to do with your career? Do yo...

    Recruitment Genius: Senior QC Scientist

    Negotiable: Recruitment Genius: This company is a leading expert in immunoassa...

    Recruitment Genius: Development Scientist

    Negotiable: Recruitment Genius: A Development Scientist is required to join a ...

    Day In a Page

    Homeless Veterans Christmas Appeal: ‘We give them hope. They come to us when no one else can help’

    Christmas Appeal

    Meet the charity giving homeless veterans hope – and who they turn to when no one else can help
    Should doctors and patients learn to plan humane, happier endings rather than trying to prolong life?

    Is it always right to try to prolong life?

    Most of us would prefer to die in our own beds, with our families beside us. But, as a GP, Margaret McCartney sees too many end their days in a medicalised battle
    Thomas Cook's outgoing boss Harriet Green got by on four hours sleep a night - is that what it takes for women to get to the top?

    What does it take for women to get to the top?

    Thomas Cook's outgoing boss Harriet Green got by on four hours sleep a night and told women they had to do more if they wanted to get on
    Christmas jumper craze: Inside the UK factory behind this year's multicultural must-have

    Knitting pretty: British Christmas Jumpers

    Simmy Richman visits Jack Masters, the company behind this year's multicultural must-have
    Radio 4 to broadcast 10-hour War and Peace on New Year's Day as Controller warns of cuts

    Just what you need on a New Year hangover...

    Radio 4 to broadcast 10-hour adaptation of War and Peace on first day of 2015
    Christmas 2014: 10 best educational toys

    Learn and play: 10 best educational toys

    Of course you want them to have fun, but even better if they can learn at the same time
    Cameron, Miliband and Clegg join forces for Homeless Veterans campaign

    Cameron, Miliband and Clegg join forces for Homeless Veterans campaign

    It's in all our interests to look after servicemen and women who fall on hard times, say party leaders
    Millionaire Sol Campbell wades into wealthy backlash against Labour's mansion tax

    Sol Campbell cries foul at Labour's mansion tax

    The former England defender joins Myleene Klass, Griff Rhys Jones and Melvyn Bragg in criticising proposals
    Nicolas Sarkozy returns: The ex-President is preparing to fight for the leadership of France's main opposition party – but will he win big enough?

    Sarkozy returns

    The ex-President is preparing to fight for the leadership of France's main opposition party – but will he win big enough?
    Is the criticism of Ed Miliband a coded form of anti-Semitism?

    Is the criticism of Miliband anti-Semitic?

    Attacks on the Labour leader have coalesced around a sense that he is different, weird, a man apart. But is the criticism more sinister?
    Ouija boards are the must-have gift this Christmas, fuelled by a schlock horror film

    Ouija boards are the must-have festive gift

    Simon Usborne explores the appeal - and mysteries - of a century-old parlour game
    There's a Good Girl exhibition: How female creatives are changing the way women are portrayed in advertising

    In pictures: There's a Good Girl exhibition

    The new exhibition reveals how female creatives are changing the way women are portrayed in advertising
    UK firm Biscuiteers is giving cookies a makeover - from advent calendars to doll's houses

    UK firm Biscuiteers is giving cookies a makeover

    It worked with cupcakes, doughnuts and macarons so no wonder someone decided to revamp the humble biscuit
    Can SkySaga capture the Minecraft magic?

    Can SkySaga capture the Minecraft magic?

    It's no surprise that the building game born in Sweden in 2009 and now played by millions, has imitators keen to construct their own mega money-spinner
    The King's School is way ahead of the pack when it comes to using the latest classroom technology

    Staying connected: The King's School

    The school in Cambridgeshire is ahead of the pack when it comes to using the latest classroom technology. Richard Garner discovers how teachers and pupils stay connected