Immunotherapy drug too costly for head and neck cancer

In collaboration with the Press Association
PET Scan head and neck for nasopharynx carcinoma (via Wikimedia Commons CC-BY-SA)

An immunotherapy drug is too expensive to be given to NHS patients with head and neck cancers in England, according to the NHS drugs watchdog.

In draft guidance, the National Institute for Health and Care Excellence (NICE) said it could not recommend nivolumab (Opdivo) for the treatment of advanced head and neck cancer.

"Nivolumab is an expensive drug but it is also the only treatment shown in a phase III trial to improve survival for this group of patients."  Professor Kevin Harrington, from The Institute of Cancer Research, London

“Since this is not NICE’s final decision on nivolumab we would urge the drug company and NHS England to get round the table, working in partnership, to make this drug available for patients in England,” said Sara Bainbridge, Cancer Research UK’s policy manager. 

NICE has previously recommended the drug for treatment of other cancer types, but in this case the decision was that the high cost outweighs its benefits.

NICE approves treatments based on the years of good quality of life added by a drug versus its cost. It usually approves drugs which cost less than £30,000 for each additional year of quality life.

But at the current price, NICE expects nivolumab to cost double that for each year. 

Every year around 10,000 people in the UK are diagnosed with head and neck cancer, and treating a single patient with nivolumab would cost around £5,700 per month, according to estimates.

The drug is already approved for treating melanoma skin cancer on the NHS and NICE is reconsidering a previous decision to reject its use for lung cancer patients.

And, last month, NICE said more evidence of how well the drug worked for Hodgkin lymphoma, a blood cancer, was needed before it could recommend nivolumab for patients.

Professor Kevin Harrington, from The Institute of Cancer Research, London, who led the UK arm of a phase III trial with nivolumab, said: "It is disappointing and frustrating that today's decision means doctors will not be able to offer this game-changing immunotherapy to patients with advanced head and neck cancer.

"Once it has relapsed or spread, the disease is extremely difficult to treat and options, including surgery and radiotherapy, are very limited.

"Nivolumab is an expensive drug but it is also the only treatment shown in a phase III trial to improve survival for this group of patients and it did so without worsening patients' quality of life, and with fewer side-effects than other options.”

The trial involved 361 patients who were either treated with nivolumab or one of three different types of chemotherapy. After one year, 36% of the nivolumab group were still alive compared with 17% of the chemotherapy group.

Professor Carole Longson, director of the health technology evaluation centre at NICE, said: "The additional costs of nivolumab were considered to be very high in relation to its benefit to be recommended for routine NHS use at present."