Don’t deny cancer sufferers this drug
Open letter to Alex Neil MSP, Cabinet secretary for health and well-being, the Scottish Government.
We write to express our concern following the decision by the Scottish Medicines Consortium (SMC) not to approve the availability of bevacizumab for women with ovarian cancer in Scotland (your report, 9 October).
Bevacizumab is the first new treatment for ovarian cancer in 15 years and in those at highest risk it can delay the progression of the disease by more than three months and improve survival by more than seven months, compared with chemotherapy alone.
Ovarian cancer is frequently diagnosed late, at an advanced stage, making successful treatment challenging. Approximately 300 women in Scotland could benefit from bevacizumab each year if they were able to access the drug through the NHS, as is the case south of the Border.
Bevacizumab is licensed at 15mg/kg, but evidence from the UK-led ICON7 trial has demonstrated that it is effective when used at half the dose (7.5mg/kg). However, in spite of this and calls from the clinical community, the SMC has stated it cannot recommend its use at 7.5mg/kg as it is outside the licensed indication. This is despite its own analysis showing the lower dose is cost effective. This demonstrates a fatal inflexibility in the SMC process needing urgent attention.
Clinicians in Scotland will only be able to prescribe bevacizumab through the IPTR (individual patient treatment request) process if they can demonstrate their patients are exceptional cases, which will rule out most women. Indeed, to date, no IPTRs for the first line use of bevacizumab have been granted by NHS Greater Glasgow and Clyde or by NHS Lothian. These boards cover around three quarters of the Scottish population. As such, at least 180 ovarian cancer patients have been disadvantaged by being unable to obtain bevacizumab in the ten months since it obtained its licence in this disease.
We urge you and the Scottish Government to act on calls from clinicians and patients to change the remit of the SMC so it can consider the use of this effective treatment at the preferred dose of clinicians (7.5mg/kg).
Louise Bayne Ovacome
(Dr) Ros Glasspool
Consultant medical oncologist
Beatson West of Scotland Cancer Centre
(Prof) Charlie Gourley
Professor and honorary consultant, medical oncology
Edinburgh Cancer Research UK Centre
Target Ovarian Cancer (Dr) Melanie Mackean
Consultant in medical oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh
The Eve Appeal
(Prof) Iain McNeish
Professor of Gynaecological Oncology, Institute of Cancer Sciences, University of Glasgow, Beatson Institute for Cancer Research
(Dr) Fiona Nussey
Consultant in medical oncology, NHS Lothian NHS Trust
(Dr) Nicholas Reed
Consultant clinical oncologist and honorary professor of clinical oncology Gartnavel General Hospital
Ovarian Cancer Action
Yet again the postcode lottery strikes and the sufferers of serious illnesses such as women in Scotland are denied access to Avastin (the trade name of bevacizumab), a drug which can provide some relief to those with advanced stage ovarian cancer, and is available to patients in England.
Admittedly, differences in the provision of expensive drugs between Scotland and England exist across a range of drugs but this is cold comfort to those unfortunates who see patients south of the Border being treated better.
The Scottish Government is usually quick to praise the virtues of the health service in Scotland but this really masks those areas where inferior treatment is being provided.
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