Credit: Steven Harbour
The National Health Service (NHS) has increased the budget for England’s Cancer Drugs Fund (CDF) and added a new drug to treat 2 hematologic malignancies, but 5 other blood cancer drugs will be removed from the fund in March.
The budget for the CDF will grow from £200 million in 2013/14 to £280 million in 2014/15.
However, 16 drugs (for 25 different indications) will no longer be offered through the fund as of March 12, 2015.
Still, the NHS said it has taken steps to ensure patients can receive appropriate treatment.
Review leads to cuts
A national panel of oncologists, pharmacists, and patient representatives independently reviewed the drug indications currently available through the CDF, plus new applications.
They evaluated the clinical benefit, survival, quality of life, toxicity, and safety associated with each treatment, as well as the level of unmet need and the median cost per patient. In cases where the high cost of a drug would lead to its exclusion from CDF, manufacturers were given an opportunity to reduce prices.
The result of the review is that 59 of the 84 most effective currently approved indications of drugs will rollover into the CDF next year, creating room for new drug indications that will be funded for the first time.
These are panitumumab for bowel cancer, ibrutinib for mantle cell lymphoma, and ibrutinib for chronic lymphocytic leukemia.
However, 16 drugs, including 5 blood cancer drugs—bendamustine, bortezomib, bosutinib, dasatinib, and ofatumumab—will no longer be offered through the CDF.
Following these changes, the NHS will put 4 measures in place to ensure patients can receive appropriate treatment. First, any patient currently receiving a drug through the CDF will continue to receive it, regardless of whether it remains in the CDF.
Second, drugs that are the only therapy for the cancer in question will remain available through the CDF. Third, if the CDF panel removes a drug for a particular indication, some patients may instead be able to receive it in another line of therapy or receive an alternative CDF-approved drug.
And finally, clinicians can apply for their patient to receive a drug not available through the CDF on an exceptional basis.
Cuts to blood cancer drugs
The full list of cuts to the CDF is available on the NHS website, but the following list includes all drugs for hematologic malignancies that will no longer be available. These drugs will still be available for other indications, however.
- Bendamustine for the treatment of low-grade lymphoma that is refractory to rituximab alone or in combination.
- Bortezomib for the treatment of:
- relapsed/refractory mantle cell lymphoma after 1 or more prior chemotherapies or stem cell transplant
- relapsed multiple myeloma patients with a previous partial response or complete response of 6 months or more with bortezomib
- relapsed Waldenstrom’s macroglobulinemia patients who received previous treatment with alkylating agents and purine analogues.
- Bosutinib for the treatment of:
- blast crisis chronic myeloid leukemia (CML) that is refractory to nilotinib or dasatinib if dasatinib was accessed via a clinical trial or via its current approved CDF indication
- blast crisis CML where there is treatment intolerance, specifically, significant intolerance to dasatinib (grade 3 or 4 adverse events) if dasatinib was accessed via its current approved CDF indication.
- Dasatinib for the treatment of lymphoid, blast crisis CML that is refractory to, significantly intolerant of, or resistant to prior therapy including imatinib (grade 3 or 4 adverse events); also when used as the 2nd- or 3rd-line treatment.
- Ofatumumab for the treatment of CML as the 2nd- or 3rd-line indication and if the patient is refractory to treatment with fludarabine in combination and/or alemtuzumab or if treatment with fludarabine in combination and/or alemtuzumab is contraindicated.
More about the CDF and the NHS
The CDF—set up in 2010 and currently due to run until March 2016—is money the government has set aside to pay for cancer drugs that haven’t been approved by the National Institute for Health and Care Excellence (NICE) and aren’t available within the NHS in England. Most cancer drugs are routinely funded outside of the CDF.
NHS England said it is working with cancer charities, the pharmaceutical industry, and NICE to create a sustainable model for the commissioning of chemotherapy. The agency has also updated its procedures for evaluating drugs in the CDF, in an effort to ensure sustainability.
In addition, NHS England has set up an appeals process by which pharmaceutical companies can challenge the decision-making process.
And a newly assembled national taskforce, headed by Harpal Kumar, chief executive of Cancer Research UK, is set to produce a refreshed, 5-year cancer plan for the NHS.
