Cabozantinib has been declined for a second time by the Scottish Medicines Consortium (SMC) for use within NHS Scotland for people with untreated, intermediate-risk or poor-risk advanced renal cell carcinoma (RCC). KCSN are extremely disappointed with this decision, which was made despite new anecdotal evidence as to the effectiveness of the drug against advanced RCC submitted in response to this appeal.
This decision was made despite cabozantinib’s proven effectiveness at significantly extending progression-free survival in untreated patients compared to first-line sunitinib (8.6 months with cabozantinib versus 5.3 months for sunitinib). In addition, anecdotal evidence suggests that cabozantinib is particularly effective against bone metastases, an area of unmet need in the treatment of advanced RCC.
The SMC declined this submission as a result of weak evidence submitted by the pharmaceutical company that did not prove cabozantinib offers value for money to NHS Scotland. This was despite the fact that cabozantinib is a medicine for the treatment of an end-of-life condition, and the special dispensations applied to the assessment because of this.
It is well known that a clinical response to cancer drugs is individual, and some patients respond better than others; we believe that clinicians need to have a choice of drugs to be able to effectively treat kidney cancer patients. The SMC’s decision leaves clinicians in Scotland with a limited choice of drugs with which to treat advanced kidney cancer in the first-line. This decision also has a profound effect on the way Scotland treats cancer patients, leaving people with kidney cancer at a significant disadvantage and more likely to die prematurely compared to England, Wales, the rest of Europe and America.
“This refusal to fund cabozantinib for kidney cancer patients in Scotland demonstrates yet again the current frustrating and fragmented approach to reviewing cancer medicines in the UK” said Rose Woodward from the KCSN. “In England, NICE has accepted the evidence and approved the drug in the first-line setting, recognising the benefits for kidney cancer patients, and yet the SMC choose to block the drug. Once again cancer patients are “piggy in the middle”; trapped between the pharmaceutical manufacturers on one side and regulatory bodies like the SMC on the other. Receiving a cancer diagnosis is devastating; being told you cannot have a life extending drug that is routinely available across the border is another cruel blow. What are patients to make of this?”