Writing in the December issue of BJU International, Professor Eisen, from the University of Cambridge, points out that although NICE has put its findings out for consultation, its provisional decision is that sunitinib, sorafenib, temsirolimus and interferon plus bevacizumab are too costly.
A further review is due to be carried out in January 2009, but Professor Eisen fears that NICE - which advises the UK Department of Health - may confirm its provisional advice that none of these treatments should be provided by the UK’s National Health Service.
“We had hoped that NICE would approve at least one of these drugs, as they represent a major breakthrough and there are no suitable alternatives for the large majority of the 4,000 or so patients who might be considered for these drugs in the UK” says Professor Eisen.
“Given that sunitinib was investigated as a first line option, it seemed most likely that it would be approved.
“Our hopes were dashed when NICE released its consultation document. It said that although the four drugs they looked at were clinically effective, they were not cost-effective.”
Professor Eisen says that about one in ten patients benefit significantly from existing drugs to activate the immune system, leaving the other 90 per cent with no benefits, just a range of unpleasant side effects, including flu-like symptoms and depression.
He points out that a number of very effective treatments have been developed in the last three years, but he fears that when NICE issues its final recommendations next spring the hopes of UK clinicians and patients could be well and truly dashed.
For example sunitinib has already been adopted in advanced Western countries as the first-line therapy for patients who show no indication that they will react adversely to the drug.
However, Professor Eisen stresses that although the data on these new drugs is extremely encouraging, and represents the first major breakthrough in advanced kidney cancer in the last 25 years, none of them will cure the condition. But they can extend a patient’s life. In the case of sunitinib, some patients have had their life expectancy doubled, giving them an extra year.
Professor Eisen says that the predicted outcome of the NICE consultation is depressing for a number of reasons.
“First, if an intervention which doubles progression-free and overall survival in a disease where nothing else works is deemed to be cost-ineffective, the chances of introducing any new cancer medication must be deemed remote. The prospect is that patients treated within the UK National Health Service must wait until therapies are off-patent and therefore become cheaper.
“Second, the NICE cost-effectiveness analysis is at variance with other cost-effectiveness analyses conducted in the USA, Sweden and other countries. In the media furore that greeted NICE’s provisional decision there is no indication that the significant differences between the cost-effectiveness analyses from the UK and elsewhere had caused any pause for thought among the authorities.
“Third, the very great variability of the natural history of kidney cell carcinoma was not considered by NICE. From what we know of these medications already, a minority of patients can benefit very significantly.
“Finally, no provision is made for the importance of gaining even a few months of extra life for patients, despite the fact that these benefits are deemed to be extremely important by all patient groups.”
Professor Eisen concludes that if the NHS is ever to introduce the benefits of novel targeted therapies, except in a very few circumstances such as herceptin in breast cancer, it must reconsider its assessment methods.
“Most doctors accept that however many resources are put into healthcare there will always be a need to ration new and expensive treatments” he says. “Equally, this realisation is spreading to all Western countries and NICE is being closely watched as a forerunner of control mechanisms elsewhere.
“The stark differences in options available for patients in the NHS and most other Western countries suggest that no internationally agreed model is possible at present. The development of an internationally validated tool to assess cost-effectiveness would allow for reliable comparisons of healthcare provision in different countries. Embedding the cost-effectiveness analyses into the pivotal clinical trials would reduce the unacceptable delays in reaching even a provisional decision for patients within the NHS.
“Condemning these kidney cancer patients to toxic, barely effective 20-year old treatment should not be an acceptable option.”
Annette Whibley | alfa
Investigators may unlock mystery of how staph cells dodge the body's immune system
22.09.2017 | Cedars-Sinai Medical Center
Monitoring the heart's mitochondria to predict cardiac arrest?
21.09.2017 | Boston Children's Hospital
Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.
A warming planet
Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.
The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...
Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...
Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!
When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...
For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.
Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...
19.09.2017 | Event News
12.09.2017 | Event News
06.09.2017 | Event News
22.09.2017 | Life Sciences
22.09.2017 | Medical Engineering
22.09.2017 | Physics and Astronomy