Cancer Drug Fund succumbs to cuts

Sixteen medicines spanning 25 indications have been culled from the silo budget

The government’s flagship silo fund for new oncology medicines has buckled under the financial pressure of paying for expensive new cancer drugs, and has announce it will cut 16 medicines with 25 indications from its funding stream.

The Cancer Drugs Fund (CDF) was set up as a £50 million investment for new cancer drugs not recommended by NICE, or under appraisal by the watchdog in October 2010.

From March 2011, this was extended to be a £200 million pot that would be paid out each year until April 2014.

Such was the positive response from doctors, patients and the media, the government decided in September 2013 that the Fund would run until 2016.

But in August 2014, the government said it would be extending the Fund’s finances from £200 million per year to £280 million per year, up until March 2016.

But in a new funding pledge, NHS England said it would in fact pay out even more to an estimated £340 million in its final year.

The CDF was originally set up to fund drugs regardless of their cost. But now NHS England has said that despite the increase in investment, it can simply no longer afford to pay for all of the medicines it has been for the past four years.

NHS England, which is responsible for the specialist commission budget that pays for the CDF, says there would be around a £100m overspend on the CDF this year alone and it cannot pay for 84 medicines currently on its list.

Given this, the government has this week decided to cut 16 cancer drugs that span 25 indications (see below for the full list) from the CDF, a process it has deemed ‘de-listing’.

But whilst these have been removed, there still remain 36 medicines with 53 licences still being funded by the CDF.

This also includes three new treatments that will be added to the list from 12 March, namely: Amgen’s Vectibix (panitumumab) for bowel cancer and Janssen’s Imbruvica (ibrutinib) for Mantle cell lymphoma (a type of non-Hodgkin lymphoma) and chronic lymphocytic leukaemia, bringing the total number of drugs that will be available through the fund to 62 from April.

Professor Peter Clark, chair of the Cancer Drugs Fund and a practising oncologist, said: “We have been through a robust, evidence-based process to ensure the drugs available offer the best clinical benefit, getting the most for patients from every pound.

“There were drugs that did not offer sufficient clinical benefit so we simply cannot go on funding those. There were others that offered some benefit but were costly and I am pleased that a number of pharmaceutical firms worked with us to make prices more affordable, saving millions of pounds that can now be reinvested in other treatments.

“These are difficult decisions, but if we don’t prioritise the drugs that offer the best value, many people could miss out on promising, more effective treatments that are in the pipeline.”

A full list of the 16 drugs and 25 licences to be de-listed from 12 March 2015 are:

  • Sanofi’s Zaltrap (aflibercept): second line treatment for metastatic colorectal cancer.
  • Sanofi’s Jevtana (cabazitaxel): for the treatment of castrate-resistant metastatic prostate cancer.
  • Napp’s Levact (bendamustine): refractory low grade lymphoma.
  • Roche’s Avastin (bevacizumab): first line treatment of advanced colorectal cancer with a single agent of chemotherapy; first line treatment of advanced colorectal cancer with combination chemotherapy; and second line treatment epithelial ovarian, fallopian or primary peritoneal cancer.
  • Takeda’s: Velcade (bortezomib): for relapsed multiple myeloma; and relapsed Waldenstrom’s Macroglobulinaemia.
  • Pfizer’s Bosulif (bosutinib): for refractory blast crisis Chronic Myeloid Leukaemia (CML); and blast crisis CML where there is no intolerance to treatments.
  • Merck KGaA’s Erbitux (cetuximab): for the second or third line treatment of metastatic colorectal cancer.
  • Bristol-Myers Squibb’s Sprycel (dasatinib): for treatment of lymphoid blast crisis chronic myeloid leukaemia.
  • Eisai’s Halaven (eribulin): for treatment of advanced breast cancer.
  • Novartis’ Afinitor (everolimus): for treatment of advanced breast cancer; treatment of well differentiated pancreatic neuroendocrine carcinomas; and metastatic renal cell carcinoma.
  • GlaxoSmithKline’s Tyverb (lapatinib): treatment of advanced breast cancer.
  • GlaxoSmithKline’s Arzerra (ofatumumab): treatment of chronic lymphocytic leukaemia.
  • GlaxoSmithKline’s Votrient (pazopanib): treatment of advanced non-adipocytic soft tissue sarcoma.
  • Janssen’s Caelyx (Pegylated Liposomal Doxorubicin (PLD)): treatment of named sarcomas.
  • Lilly’s Alimta (pemetrexed): maintenance treatment of advanced non-squamous non-small cell lung cancer; and second line treatment of advanced non-squamous non-small cell lung cancer.
  • Bayer’s Stivarga (regorafenib) patients with advanced gastro-intestinal stromal tumours (GIST).
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