NHS Scotland's July 2019 Funding Decisions

Nicky Broyd

July 08, 2019

The Scottish Medicines Consortium (SMC) has this month approved new drugs for advanced breast cancer, multiple myeloma, and metastatic melanoma.

Advanced Breast Cancer

The Patient and Clinician Engagement (PACE) process played a role in acceptance of palbociclib (Ibrance, Pfizer) used in combination with fulvestrant (Faslodex, AstraZeneca) for advanced, incurable breast cancer.

PACE is used for rare conditions and end of life care.

Palbociclib can slow disease progression extending survival time by some months.

SMC Chairman Dr Alan MacDonald said: "We know from our PACE meeting that having additional time to spend with family and friends is important to those with advanced breast cancer, and we hope our decision on palbociclib will be of value to them."

Multiple Myeloma

PACE was also used to reach a positive decision on daratumumab (Darzalex, Janssen-Cilag) for another incurable condition, multiple myeloma.

Daratumumab's use in a combination treatment regimen can extend the time before disease progression and help reduce the risk of certain complications, including bone fractures and renal impairment.

Dr MacDonald said: "Patients with multiple myeloma have to deal with a significant symptom burden in addition to coming to terms with reduced life expectancy. Our decision on daratumumab offers additional time before the disease relapses."

Acute Promyelocytic Leukaemia (APL)

Arsenic trioxide (Trisenox, Teva Pharma) was approved, in combination with tretinoin, for the treatment of acute promyelocytic leukaemia (APL).

The SMC accepted patient group submissions highlighting sometimes intolerable side effects with current chemotherapy treatment. The new therapy can also be life-extending.

Dr MacDonald said: "For those with acute promyelocytic leukaemia (APL), arsenic trioxide offers a treatment that is easier to tolerate and may help improve survival rates."

Metastatic Melanoma

Encorafenib (Braftovi, Pierre Fabre) was rejected for treatment of metastatic melanoma despite PACE submissions.

Encorafenib is used in combination with binimetinib (Mektovi, Pierre Fabre) in cases with a specific 'BRAF' gene mutation.

Dr MacDonald said: "Although the PACE process gives our committee members additional flexibility in their decision making, they were unable to accept encorafenib for the treatment of metastatic melanoma as the company’s evidence around its cost effectiveness when compared with other treatment options was not strong enough."

Complex Perianal Fistulas

Also rejected was the stem cell therapy darvadstrocel (Alofisel, Takeda) for complex perianal fistulas in adult patients with Crohn's disease.

Dr MacDonald said: "This was because of uncertainties in the company’s evidence about the medicine’s long-term benefits."

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