A gamechanging immunotherapy drug that can extend the life of patients with advanced head and neck cancer has been turned down for use in the NHS because of its high cost.
Nivolumab is one of a new class of drug that stimulates the patient’s own immune system to fight the cancer. Immunotherapy drugs have had some spectacular successes in some patients with some cancers. But although nivolumab can give people with advanced head and neck cancers an extra three months of life – when survival expectancy at present is around six months – the National Institute for Health and Care Excellence (Nice) has rejected it.
“The committee heard that treatment options for patients in this area are limited, and it’s important to patients that treatment extends their life and improves the quality of life. But the additional costs of nivolumab were considered to be very high in relation to its benefit to be recommended for routine NHS use at present,” said Prof Carole Longson, director of the health technology evaluation centre at Nice.
Nice will not approve drugs that cost more than its threshold of £20,000 to £30,000 per year of quality life, except for an end-of-life treatment – as this drug is – in which case the threshold rises to £50,000. But Nice believes nivolumab would cost between £66,000 to £75,000 per year of quality life.
The Institute of Cancer Research (ICR), which led the UK arm of the final phase of trials before licensing, regretted the decision. “It is disappointing and frustrating that today’s decision means doctors will not be able to offer this gamechanging immunotherapy to patients with advanced head and neck cancer,” said Prof Kevin Harrington, consultant clinical oncologist at the Royal Marsden. “Once it has relapsed or spread, the disease is extremely difficult to treat and options, including surgery and radiotherapy, are very limited.
“Nivolumab is an expensive drug but it is also the only treatment shown in a phase-III trial to improve survival for this group of patients – and it did so without worsening patients’ quality of life, and with fewer side-effects than other options. It’s crucial that talks on the drug’s availability continue and ultimately that this decision is reversed, otherwise patients face missing out on a genuinely effective treatment simply because of cost.”
The ICR’s chief executive, Prof Paul Workman, said the price of cancer drugs was too high. “This decision denies patients a genuine breakthrough treatment that makes a real difference for people with relapsed or metastatic head and neck cancer. It is another example, and a particularly stark one, of an innovative cancer therapy not being made available on the NHS because of cost. I’d urge Nice and the manufacturer to work together to reach an agreement on price so that this decision can be overturned as soon as possible.
“We need pharmaceutical companies to bring down the cost of drug development through smaller, more targeted trials, and to do much more to pass on the savings to patients. Nice for its part must take much greater account of innovation in its appraisal processes to give exciting treatments like nivolumab a better chance of reaching patients.”