Patient groups react to Cancer Drugs Fund cuts

Charities representing cancer patients in the UK have reacted angrily to the de-listing of treatments from the Cancer Drugs Fund (CDF), calling the decision a “step backwards.”

At the same time, there is a clamour of voices arguing that the Fund was only ever a temporary measure and an alternative process should be sought to provide access to expensive new therapies that while clinically effective and are deemed too expensive by the National Institute for Health and Care Excellence (NICE).

The announcement on Monday that the number of cancer therapies supported by the CDF will drop from 84 to 59 in a bid to slash £80m of its annual costs, with number of bowel and blood cancer drugs affected by the decision.

Professor Chris Bunce, research director at Leukaemia & Lymphoma Research, said that the de-listing of five blood cancer drugs across eight separate indications was concerning as many of them prolong survival and provide a good quality of life for diseases that can have devastating symptoms.

He singled out for particular concern the de-listing of Janssen’s Velcade (bortezomib) for mantle cell lymphoma, Waldenstrom’s macroglobulinaemia and multiple myeloma, a view echoed by blood cancer specialist Dr Andrew Chantry of Royal Hallamshire Hospital in Sheffield, who said: “Many patients respond extremely well to bortezomib and may well not respond nearly as well to other myeloma drugs.”

“This will shorten their lives and hasten the return of considerable suffering and often lead to a terminal decline,” he added.

“In many cases, patient populations for the drug indication are very small, so the total cost burden to the NHS is actually relatively low,” continued Bunce, although he welcomed additions to the CDF such as Janssen/Pharmacyclics’ Imbruvica (ibrutinib) for mantle cell lymphoma and chronic lymphocytic leukaemia.

Meanwhile, the news that Roche’s Avastin (bevacizumab) will be de-listed for first-line colorectal cancer therapy – along with other changes – has been greeted with consternation by the Beating Bowel Cancer charity.

“This is bad news for bowel cancer patients,” said the group’s chief executive Mark Flanagan. “It’s likely that 65 per cent of patients with advanced bowel cancer face the probability of an earlier death by being refused innovative treatments that were available before.”

Many commentators have questioned the process by which the decision to remove drugs from the CDF was taken, which reportedly included a ‘Dragon’s den-like’ series of 10-minute presentations in which companies tried to keep their medicines on the list, and patient groups are incensed they were not consulted beforehand.

‘More harm than good’

Meanwhile, Karl Claxton, professor of health economics at the University of York, writes in New Scientist magazine that the CDF has done more harm than good to the NHS and has been primarily a benefit to pharma companies “who have been able to sell their drugs to the NHS at unrealistic prices.”

He believes that the funding for the CDF – set at £280 million in 2014/15 and predicted to rise to £340 million from April 2015 – could have supported greater improvements in health, across a range of diseases, if it had been made available to the wider NHS.

Where there does seem to be agreement is that the CDF is flawed, and a more fundamental reform of the way new drugs are funded on the NHS is needed, although few are offering suggestions of practical alternatives.

“We all agree we need to see a longer term sustainable solution that ensures future patients get clinically effective cancer treatments that their doctors want to prescribe to their patients,” said Flanagan.

The Association of the British Pharmaceutical Industry (ABPI) chief executive Stephen Whitehead described the CDF as “a sticking plaster” and insisted the solution to the issue “remains the urgent reform of NICE which will ensure that the right patients get the right medicines at the right time whatever their condition.”

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