Scots miss out on breast cancer drug ‘withheld’ from NHS use

Health Secretary Shona Robison has announced an overhaul of how new medicines are approved.
Health Secretary Shona Robison has announced an overhaul of how new medicines are approved.
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Scottish women will miss out on a drug that can shrink breast cancer tumours before surgery, which was recently approved for use south of the border.

Campaigners described the move to reject the drug Perjeta for NHS use as “outrageous” and accused the Scottish Medicines Consortium (SMC) of creating “the ultimate postcode lottery” for cancer care.

Despite offers by the drug manufacturer to reduce the price, the regulatory body said it was concerned about the evidence of long-term survival benefits of the medicine.

Professor Jonathan Fox, chair of SMC, said it was “disappointing” to refuse the medicine but the organisation had to consider what was value for money for the whole NHS.

SMC bosses will meet representative from drugs firm Roche to discuss the next step.

The news will come as a blow to breast cancer patients in Scotland, who have also been denied access to the drug Kadcyla which can prolong the lives of people with an aggressive form of breast cancer.

More than 3,400 women in England have accessed both drugs, according to Roche.

First Minister Nicola Sturgeon stepped in earlier this year after nurse Anne Maclean-Chang wrote to her asking for a reform on drug funding as she had been denied access to Kadcyla. NHS Grampian has offered her the treatment on an individual basis.

Nicolas White, head of Scotland at the charity Breast Cancer Care, said: “It is bitterly disappointing that women in Scotland with certain aggressive types of breast cancer will be denied the very drug that could help improve their long-term survival.

“It adds further insult to injury that patients in England, Wales and Northern Ireland receive access to this innovative treatment. In combination with other drugs it may reduce the need for a mastectomy, which can be physically and mentally gruelling.

“It is outrageous that living in Scotland is preventing women with breast cancer getting the treatment they need. This is the ultimate postcode lottery and more must be done to tackle this imbalance in the UK.”

Decisions over which drugs can be used on the NHS continue to generate controversy on both sides of the border.

Prominent restaurant critic and columnist AA Gill described how he was denied access to the lung cancer nivolumab on the NHS in England in his last article before he died on Saturday.

The landmark immunotherapy drug was approved for routine use in Scotland in July, yet it remains out of reach for English and Welsh patients.

Labour health spokesman Anas Sarwar has campaigned for reform over the access to new medicines in Scotland.

He said: “This looks like yet another unfair decision where a drug that can make a real difference to those living and undergoing treatment with cancer is available in other parts of the UK but not in Scotland.

“These cases are becoming more frequent and it is clear the system isn’t working for patients.”

Continual rejection by the SMC could be putting drugs companies off bringing new medicines to Scotland, warned Conservative public health spokesman Miles Briggs.

He said: “This will be a huge blow to breasts cancer patients and their loved ones across Scotland.

“They will understandably be perplexed and angry as to why people going through the same illness elsewhere in the UK can access this drug, but they cannot.

“When the SNP set out on modifying the drugs approval system, it said it would reduce the chances of things like this happening.

“Yet here we are again talking about how Scotland is the only part of the UK where a vital treatment is unavailable.”

An independent review into access to medicines is due be published shortly, carried out by former NHS Fife medical director Dr Brian Montgomery on behalf of the Scottish Government.

It will consider whether the system that considers rare medicines and those which extend life by a few months is working, as well as looking at the whole process of how drugs are approved.

Perjeta was one of four drugs rejected yesterday, including treatments for cystic fibrosis and skin cancer.

However the SMC approved a drug called Jevtana - known as cabazitaxel - for late-stage prostate cancer, which can help patients survive for longer and ease painful side effects.

Prof Fox said: “There are currently very few options for patients at this stage of treatment and as such cabazitaxel represents an advance. Having heard the evidence from patient groups and clinicians through our PACE process, we know this decision will be welcomed.

“It is disappointing that the committee was unable to accept the other medicines considered in November.

“Four of these medicines were considered through our PACE process and, while that gives us additional flexibility in our decision-making for medicines for end of life and very rare conditions, we have to consider value for money and take account of the needs of all patients being treated in NHS Scotland, not only those affected by the condition under consideration.

“We know these decisions will be hard for patient groups and clinicians, particularly those who took part in the PACE meetings.

“However, when we considered all the evidence in front of us, it was not strong enough for us to be able to accept these medicines for routine use.”