Scotland U-turn on Lymphoma Medication

Nicky Broyd

October 08, 2019

NHS Scotland overturned its February rejection of axicabtagene ciloleucel (Yescarta, Kite/Gilead) for lymphoma and the drug was one of several treatments approved for cancers.

The CAR T-cell therapy was considered again through the Scottish Medicines Consortium (SMC)'s Patient and Clinician Engagement (PACE) process for end of life and rare conditions.

In February, the SMC cited uncertainty in the company’s evidence around axicabtagene ciloleucel's long-term benefits and cost effectiveness.

In a statement, SMC Chairman Dr Alan MacDonald said: "We know there are currently limited treatment options for those with this stage of lymphoma. Axicabtagene ciloleucel offers an innovative and potentially life extending treatment for those with this condition, and we hope our decision will benefit them, their families and carers."

The decision was welcomed in a statement by Stephen Scowcroft, director of operations and external affairs, Lymphoma Action: "This is further good news for people affected by lymphoma as it means there is wider access to CAR T- cell therapy in Scotland. It is important for people affected by DLBCL [Diffuse large B-cell lymphoma] and particularly significant for people affected by primary mediastinal B-cell lymphoma, for whom CAR T-cell therapy would not otherwise be available in Scotland."

Metastatic Non-squamous Non-small Cell Lung Cancer (NSCLC)

Another drug rejected in February as a first-line treatment for advanced lung cancer gained approval this month through the PACE process for NSCLC.

Pembrolizumab (Keytruda, Merck, Sharp & Dohme) was accepted for use in combination with chemotherapy.

Dr MacDonald said that for people with NSCLC "pembrolizumab can extend life expectancy giving patients the chance of some valuable extra time with their families in the context of this incurable illness".

The Roy Castle Lung Castle Foundation said it was "delighted" with the decision. In a statement, it said: "It means that now more patients with NSCLC can access this beneficial treatment option, which offers another way to live well with lung cancer for longer.

"We see this as a huge step forward. Scotland has had one of the highest rates of lung cancer in the world and approximately nine out of ten patients with lung cancer have NSCLC."

Early Stage Breast Cancer

Triptorelin acetate (Decapeptyl SR, Ipsen) was accepted for the treatment of early stage breast cancer.

Dr MacDonald said: "We know from patient groups and clinicians that triptorelin acetate will be a welcome additional treatment option for those with early stage breast cancer at high risk of recurrence."

However, pertuzumab (Perjeta, Roche) was rejected for the adjuvant treatment of early stage breast cancer despite the PACE process.

Dr MacDonald said: "While the PACE process gives committee members additional flexibility in their decision making, we were unable to accept pertuzumab (Perjeta) for the treatment of early stage breast cancer as the company’s evidence around its clinical and economic benefits was not sufficient."

Early Stage Prostate Cancer

The SMC turned down enzalutamide (Xtandi, Astellas) for the treatment of early stage prostate cancer, again despite use of PACE.

Dr MacDonald said: "This was because of uncertainties in the company’s evidence about the benefits of using enzalutamide at this point in treatment."

Severe Plaque Psoriasis

Risankizumab (Skyrizi, AbbVie) was accepted for the treatment of moderate to severe plaque psoriasis as an additional treatment option, including where other treatments have not been effective or caused side effects.

Dr MacDonald said: "Plaque psoriasis is a condition for which additional treatment options are required, so our decision on risankizumab will be helpful to those for whom previous treatments have been unsuccessful."

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