Scottish Medicines Consortium October 2019 decisions news release

Medicines which can be used to treat lymphoma, lung cancer, breast cancer and psoriasis have today (Monday 7 October) been accepted by the Scottish Medicines Consortium (SMC) for use by NHSScotland.

Axicabtagene ciloleucel (Yescarta) for lymphoma (a type of blood cancer) was accepted following consideration through SMC’s Patient and Clinician Engagement (PACE) process, which is used for medicines to treat end of life and very rare conditions. This is a new type of medicine called CAR-T cell therapy. It uses the patient’s own immune cells (T-cells) to destroy the cancer cells. The patient’s T-cells are removed and modified in the laboratory to create CAR-T cells. These cells are then infused back into the patient where they bind to and kill the cancer cells. PACE participants spoke of how there are limited treatment options for this condition. Axicabtagene ciloleucel could potentially offer long-term disease control and may be life extending for some patients.

Pembrolizumab (Keytruda) for metastatic non-squamous non-small cell lung cancer (NSCLC) was also accepted following consideration through PACE. In the PACE meeting, patient groups and clinicians highlighted the devastating impact of this condition , with a usual life expectancy of less than a year, and multiple symptoms including breathlessness, chest pain and weight loss. Pembrolizumab, when added to chemotherapy, can control symptoms, meaning patients are likely to remain well and live longer.

Triptorelin acetate (Decapeptyl SR) was accepted for the treatment of early stage breast cancer. This medicine offers another treatment option for those at high risk of recurrence.

The committee also accepted risankizumab (Skyrizi) for the treatment of moderate to severe plaque psoriasis (a condition which causes red, scaly patches on the skin) in adults. Currently available treatments can cause unwanted side effects in some patients and even where a medicine initially controls the condition, in time it may stop working so well. Risankizumab offers another treatment option for patients who have failed to respond to standard therapies.

The committee was unable to accept pertuzumab (Perjeta) for the adjuvant treatment of early stage breast cancer following consideration through PACE. In the PACE meeting, participants emphasised the impact that fear of recurrence can have on patients and their families. Despite the additional flexibility in decision making, pertuzumab was not recommended as the company’s evidence about the clinical and economic benefits of the medicine was not strong enough.

The committee was also unable to accept enzalutamide (Xtandi) for the treatment of early stage prostate cancer. Despite consideration through PACE, the committee was unable to accept the medicine because of uncertainty in the company’s evidence around the benefits of using it at this stage in the treatment pathway.

SMC Chairman Dr Alan MacDonald said:

“I am pleased our committee members were able to accept these four new medicines for use by NHSScotland.”

“We know there are currently limited treatment options for those with this stage of lymphoma. Axicabtagene ciloleucel offers an innovative and potentially life extending treatment for those with this condition, and we hope our decision will benefit them, their families and carers.”

“For those with metastatic non-squamous non-small cell lung cancer (NSCLC), pembrolizumab can extend life expectancy giving patients the chance of some valuable extra time with their families in the context of this incurable illness.”

“We know from patient groups and clinicians that triptorelin acetate will be a welcome additional treatment option for those with early stage breast cancer at high risk of recurrence.”

“Plaque psoriasis is a condition for which additional treatment options are required, so our decision on risankizumab will be helpful to those for whom previous treatments have been unsuccessful.”

“While the PACE process gives committee members additional flexibility in their decision making, we were unable to accept pertuzumab (Perjeta) for the treatment of early stage breast cancer as the company’s evidence around its clinical and economic benefits was not sufficient. “

“We were also unable to accept enzalutamide (Xtandi) for early stage prostate cancer following consideration through PACE. This was because of uncertainties in the company’s evidence about the benefits of using enzalutamide at this point in treatment.”

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