Two skin cancer treatments get the green light for NHS Scotland

Cancer Research UK

skin_cancer_em_hero.jpg

Skin cancer cells under an electron microscope.

Credit: LRI EM Unit. 

An immunotherapy and a targeted cancer drug were among the latest batch of NHS approvals from the Scottish Medicines Consortium (SMC). 

Cemiplimab (Libtayo) will provide a new treatment option for advanced melanoma, while the immunotherapy drug encorafenib (Braftovi) will be used to treat some people with a type of non melanoma skin cancer

“These latest decisions are great news for people affected by these two types of skin cancer in Scotland.”Marion O’Neill, head of external affairs in the devolved nations

Five cancer drugs were reviewed in total, with a third drug approved for some children with lymphoma or solid tumours. Plerixafor (Mozobil) can now be used before a stem cell transplant to help stimulate stem cells to enter the blood.

Immunotherapy option for non melanoma skin cancer

Cemiplimab works by reawakening the immune system. It blocks molecules on the surface of tumour cells that can switch off immune cells.  

What are 'checkpoint' immunotherapy drugs?

It will provide a new treatment option for people with a type of non melanoma skin cancer – squamous cell skin cancer – which makes up around 1 in 5 skin cancers. 

The immunotherapy drug will be available to adults with squamous cell skin cancer that’s spread either to deeper layers of the skin or nearby lymph nodes (locally advanced), or to other parts of the body. 

According to the SMC it’s rare for this type of cancer to spread, with less than 1 in 20 patients’ cancer advancing in this way. But once the cancer has begun to spread there are no other licensed treatments available, although some patients may be treated with chemotherapy. 

“Patients told the SMC there was a need for an alternative to chemotherapy that could improve their quality of life,” said O’Neill. 

So far trials have been relatively small and haven’t compared the drug to chemotherapy, but 44% of patients responded to cemplimab in the latest phase 2 clinical trial

“Clinical trial data suggested cemiplimab could be effective for many patients,” said O’Neill. “But the evidence wasn’t that clear – especially about the long-term effect of the treatment, including whether it helped patients live longer.”

Because of these limitations of the data, cemplimab has been accepted for NHS use on an interim basis, with the decision due to be reviewed once more information becomes available.  

O’Neill said the latest decision showed the value of this relatively new approval option for the SMC, which allows patients in Scotland access to promising new drugs while more evidence is collected on their long-term impact. 

Cemplimab was added to NHS England’s Cancer Drugs Fund in July 2019. Medicines in the Cancer Drugs Fund are usually available to eligible patients in England, Wales and Northern Ireland. 

New treatment combo for advanced melanoma

A second treatment, encorafenib, was approved to treat adults with melanoma that either can’t be removed with surgery or that’s spread to other areas of the body, in combination with the targeted drug binimetinib. 

The drug combination will only be an option for people whose melanoma has a particular DNA fault in a gene called BRAF. The decision reverses a previous recommendation by the SMC.

The drug combo increased the time it took for people’s cancer to get significantly bigger compared to targeted treatments that inhibit BRAF, like vemurafenib. 

People taking encorafenib and binimetinib lived without their cancer growing for 14.9 months on average, compared with 7.3 months for those taking vemunrafenib in the latest clinical trial

O’Neill said it was “good news” to see the SMC has approved the combination, adding that it may cause fewer side effects compared to some existing treatments. The combination was approved for NHS use in England in January 2019. 

Myeloma and prostate cancer drugs rejected

But it wasn’t all good news from the SMC this month, as 2 cancer drugs were rejected for NHS use. 

The targeted cancer drug daratumumab (Darzalex) was being considered as a new treatment option for people who have been newly diagnosed with multiple myeloma and can’t have a stem cell transplant. 

And apalutamide (Erleada), which is used to treat prostate cancer that hasn’t spread but continues to grow even when testosterone levels have been reduced to very low levels, was also rejected for NHS use. 

The SMC wasn’t able to make a recommendation on either drug because the manufacturers chose not to submit evidence. However, the option remains open for the manufacturers to submit evidence and for the SMC to produce advice at a later date.

“We urge the SMC and the drugs’ manufacturers to work together so that these treatments can be made available for people in Scotland in the future,” said O’Neill. 

References

SMC (2020) Cemiplimab [SMC2216]

SMC (2020) Encorafenib [SMC2238]

SMC (2020) Plerixafor [SMC2249]

SMC (2020) Daratumumab [SMC2269]

SMC (2020) Apalutamide [SMC2269]