Analysis reveals most common Cancer Drugs Fund applications

In collaboration with the Press Association

New figures have revealed which drugs attracted the most applications to England's £200m Cancer Drugs Fund.

The fund was set up in 2010 to allow local health authorities to buy cancer drugs that have not been recommended by the National Institute for Health and Clinical Excellence (NICE).

Figures from April 2011 to January 2012 showed that bevacizumab (Avastin) had the greatest number of applications for funding, followed by cetuximab (Erbitux) and abiraterone (Zytiga).

The latter was third in the league table despite only gaining an EU license in September 2011. It was developed at The Institute of Cancer Research with support from Cancer Research UK and others.

National Cancer Director, Professor Sir Mike Richards, presented the data at the National Cancer Action Team's (NCAT) network development programme (NDP) meeting in London.

There were 1,975 requests for bevacizumab and 1,029 for cetuximab during the first 10 months of the fund, during which time a total of 8,557 applications were received.

Both drugs have been licensed in the EU, but cetuximab and bevacizumab recently failed to win backing for use as an initial treatment for advanced bowel cancer when NICE ruled the drugs were not a cost-effective use of NHS resources.

Bevacizumab has also been deemed not cost-effective for use in advanced breast cancer on the NHS, while cetuximab is considered not cost-effective for treatment of patients with squamous cell cancer of the head and neck that has come back and/or spread.

Professor Richards said abiraterone was "interesting in many ways", noting that it was the third most requested drug, with 940 applications to date, despite its relatively recent approval in the EU.

A final decision is still to be made by NICE regarding abiraterone's use in the NHS to treat prostate cancer, although draft guidance suggested its current price tag would be too high to justify its use.

Other drugs that received a high number of applications under the Cancer Drugs Fund included lapatinib (Tyverb), rituximab (MabThera) and everolimus (Afinitor).

Professor Adrian Newland, chair of London New Cancer Drugs Group welcomed the analysis.

"This confirms how the Cancer Drugs Fund has been helpful in getting clinically effective drugs to patients, but we're starting to realise that the way these drugs are used in normal practice is rather different from how they're used in the setting of carefully controlled clinical trials," he said

Professor Newland said data from networks across London showed that 10 per cent of the patients allocated drugs through the scheme do not receive them and, of those that do, about a third of the designated cycles of treatment are not given.

"We do not know the reasons for this and it could be for a variety of reasons," such as patients becoming sicker or having other complicating conditions, or not tolerating the drugs as well as the carefully selected patients on clinical trials, he explained

"So we need to keep monitoring the way the fund works in practice to make sure it's doing the best by patients."

He also sounded a warning about new and potentially expensive drugs in the pipeline.

"It will also be crucial to monitor how new drugs affect the fund, which is due to run until 2014. For example, abiraterone - a new and potentially exciting prostate cancer drug - has shot up the listings, and is now our third most prescribed drug despite only being available in London since December. It costs about £3,000 per month per patient, and can extend life by years in some cases," he added.

"With other expensive treatments in the pipeline, such as the newly licensed skin cancer drug vemurafenib, we need to make sure we manage our resources so we that we can continue to make new and effective drugs available to our patients as they become available.

At the NCAT meeting, Professor Richards also highlighted the forthcoming national chemotherapy audit, which aims to collect information on all patients taking chemotherapy in the UK.

"We do want to collect information on those patients chemotherapy through the Cancer Drugs Fund and link that through the cancer registry data and see what the outcomes are for those patients," he said.

Copyright Press Association 2012