NICE rejects kidney cancer drug

19 April 2011 Last updated at 01:44 GMT Everolimus can help increase survival rates in some cases of kidney cancer A drug to treat an advanced form of kidney cancer will not be made available on the NHS in England and Wales.

The National Institute for Health and Clinical Excellence (NICE) ruled that everolimus, which can prolong life in some cases, was too expensive.

The charity Kidney Cancer UK, which appealed against earlier draft guidelines, said it was disappointed.

Each year, 4,000 patients are diagnosed with advanced renal cell carcinoma.

Two drugs, sunitinib and pazopanib, have been approved for use by the NHS.

Everolimus, also known as Afinitor, has been shown to increase overall survival in cases where the other two have failed.

Too costly

It costs more than £200,000 per patient for a full course of treatment.

Sir Andrew Dillon, NICE chief executive, said: "We regret not to be able to recommend this drug, but we have to ensure that the money available to the NHS, for treating cancer and other conditions is used to best effect, particularly when the NHS, like the rest of the public sector, is under considerable financial pressure."

Dr Pat Hanlon, from Kidney Cancer UK, said his reaction was: "one of deep disappointment".

He added: "We know the NHS cannot afford all drugs, but they are effectively robbing people of a few months of life."

He recommended that doctors and patients apply for help from the government's cancer drug fund, which can be used for medication not approved by NICE.

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Bowel cancer op survival rates 'vary'

12 April 2011 Last updated at 00:37 GMT By James Gallagher Health reporter, BBC News Laparoscopic surgery is used to remove some bowel cancers The survival rate for bowel cancer surgery varies widely between hospitals, a study suggests.

It is the first time the number of people dying within 30 days of an operation has been reported across England for any cancer.

Some 6.7% of the 160,920 who had surgery from 1998 to 2006 died but some hospitals had much higher mortality rates, the report in Gut journal says.

Cancer Research UK said the situation was "worrying".

Bowel cancer is the third most common cancer in the UK.

Significantly higher

The outcomes of all 160,920 people who had surgery to remove a tumour between 1998 and 2006 were analysed.

The overall mortality rate in that period dropped from 6.8% to 5.8%.

Looking at data for the last three years of the study, five hospital trusts had significantly higher death rates and three had significantly lower ones.

The proportion of patients dying within a month of surgery ranged from 15.6% at Burton Hospitals NHS Foundation Trust to 1.7% at Central Manchester University Hospitals NHS Foundation Trust.

Continue reading the main story Burton Hospitals - 15.6%The Whittington Hospital - 13.1%The Rotherham - 11.2%Northampton General Hospital - 10.5%Colchester Hospital University - 10.4%Preliminary data suggests the five hospitals which appeared to perform poorly had all improved by 2008, by when they all had achieved mortality rates close to the average.

Consultant surgeon at Burton Hospitals Trust, James Eccersley, said: "The Trust is aware that constant vigilance and improvement has reduced our mortality rate after surgery. We always strive to take on board new innovations to make surgery even safer."

Variation

The explanation for the variation remains unclear.

Professor Paul Finan, from Leeds General Infirmary, said possible reasons included: "the degree of surgical specialisation, how guidelines were followed, the quality of high-dependency units (after-care surgery), anaesthetic services and whether the surgery was laparoscopic, which is less invasive."

In heart surgery, outcomes improved significantly after death rates were published. By finding out what more successful hospitals do differently, it is hoped bowel cancer care can be improved across the country.

Professor Philip Quirke, consultant pathologist at the University of Leeds, said: "In the past there's not been enough emphasis on routine clinical practice. We can learn a lot, especially from the best. Why are they so good?"

The government's national cancer director, Sir Mike Richards, wants statistics to become available for other cancers.

He said: "It's taken time to get this far, but we've demonstrated this as a proof of principle and are working out how to do the same with other cancers."

It is difficult to make international comparisons as other countries do not have data on a full national scale.

Studies in Scandinavia, Canada and the US have shown mortality rates between 2.7% and 5.7%. However, researchers cautioned against making direct comparisons.

Mark Flannagan, chief executive of Beating Bowel Cancer, said: "This study shows worrying variations in bowel cancer survival that need to be addressed.

"Bowel cancer is the UK's second-biggest cancer killer, yet there are still significant inequalities in survival which need to be better understood before they can be tackled."

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Breast cancer drug 'not approved'

24 February 2011 Last updated at 10:21 GMT The drugs watchdog said Avastin had 'no demonstrable benefit' The drug Avastin should not be used to treat secondary breast cancers, the NHS drugs advisory body NICE says.

The National Institute for Health and Clinical Excellence, which issues guidance for NHS in England and Wales, said there was insufficient evidence that the drug prolonged life.

Cancer charities say the decision is disappointing.

Avastin, also known as bevacizumab, works by starving cancer cells of a blood supply.

It is designed to be used in conjunction with another chemotherapy drug, paclitaxel. Clinical trials in breast cancer patients suggested that it might slow the growth and spread of tumours by five months more than using paclitaxel alone.

The National Institute for Health and Clinical Excellence said there were uncertainties in the evidence and that it was unable to confirm whether the drug could extend a patient's life or improve quality of life.

Sir Andrew Dillon, chief executive of NICE, said: "The evidence for the effectiveness of bevacizumab in prolonging survival was not robust and overall did not show enough of a demonstrable benefit for it to be considered a cost-effective use of NHS resources.

"NICE is committed to ensuring the most effective and efficient treatments. We already recommend a range of treatment options for patients with metastatic breast cancer in our clinical guideline for advanced breast cancer."

Dr Emma Pennery, clinical director at Breast Cancer Care said: "This recommendation will be disappointing for people with secondary breast cancer.

"In the mean time, doctors who believe their patients could benefit from bevacizumab can apply for funding through the Cancer Drugs Fund and we encourage people to discuss this option."

Meg McArthur, senior policy officer at Breakthrough Breast Cancer, said: "We are disappointed with NICE's final decision not to approve Avastin with a taxane. However, as a treatment for metastatic breast cancer, it would not be appropriate for everyone and so we encourage continued investment into effective treatment options.

"We follow with interest new initiatives, including the Cancer Drugs Fund, which could improve access to drugs for cancer patients."

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Blocking enzyme cut cancer spread

22 February 2011 Last updated at 05:47 GMT Blocking an enzyme can prevent can cells spreading Scientists at the UK's Institute of Cancer Research have prevented breast cancer spreading to other organs in mice by blocking a chemical.

In their experiments, they showed that blocking the enzyme LOXL2 prevented metastasis.

They said their findings, published in Cancer Research, provided a "fantastic drug target" and were "highly likely" to be used in a clinical setting.

Cancer charities say the research shows great promise.

The authors of the report say 90% of cancer deaths are due to tumours migrating around the body.

When they looked at patients with breast cancer, they showed that high levels of the enzyme LOXL2 were linked with cancer spread and poor survival rates.

They also showed that LOXL2 was important in the early stages of cancer spread. It helps cancerous cells escape from the breast tissue and get into the bloodstream.

Continue reading the main story

This laboratory research shows great promise and we look forward to seeing how it translates into patients”

End Quote Arlene Wilkie Breast Cancer Campaign In their studies on mice, they used chemicals and antibodies to block the activity of LOXL2. This stopped breast cancer spreading to other tissues.

Lab to Medicine

Dr Janine Erler, team leader at the Institute of Cancer Research, said: "LOXL2 is a fantastic drug target, it's highly likely to be used in a clinical setting."

She said the findings were not just important for drug development, but also for developing a test which can predict the likelihood of cancer spreading and as a result, patient outcomes.

Arlene Wilkie, Director of Research and Policy at Breast Cancer Campaign, which funded the study with the ICR and Cancer Research UK, said: "Dr Erler's results are very exciting, as although currently we can treat breast cancer that has spread, we cannot cure it.

"By using LOX2 to predict whose cancer will spread and drugs to block the enzyme to stop this from happening, many more lives could be saved. This laboratory research shows great promise and we look forward to seeing how it translates into patients."

Dr Julie Sharp, senior science information manager at Cancer Research UK, said: "Cancer spread is an important problem in breast and other cancers, and scientists are searching to find new ways to stop cancer spread and save many more lives.

"The team have shown that targeting the molecule LOXL2, which plays a key role in spread, could offer new approaches to tackle this problem."

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Cancer deaths in Europe 'to fall'

9 February 2011 Last updated at 03:28 GMT By Michelle Roberts Health reporter, BBC News Lung cancer death rates among European women have been steadily increasing in recent years Experts are predicting a fall in overall cancer death rates for men and women across Europe in 2011.

Using data from the World Health Organization, they say cancer deaths should fall by 7% in men and 6% in women compared with rates in 2007.

Overall, almost 1.3 million people will die from cancer in 2011, they estimate.

Recent declines in stomach, colon, breast, womb, prostate and male lung cancers should continue, the researchers say in Annals of Oncology.

But they say female lung cancer is rising in all major EU countries except the UK.

According to the researchers, the UK has had the highest rates of female lung cancer deaths for a decade and, although they are not going down, they do appear to be levelling off.

Continue reading the main story

Lung, colorectal and breast cancers are the top causes of cancer deaths, and these are showing major changes”

End Quote The study authors Professor Carlo La Vecchia of the University of Milan in Italy and Professor Fabio Levi from the University of Lausanne in Switzerland reached their calculations by looking at overall cancer rates in the EU as well as individual cancer rates in six major EU countries: France, Germany, Italy, Poland, Spain and the UK.

Based on cancer trends between 1970 and 2007, they predict there will be 1,281,436 cancer deaths in the EU in 2011 (721,252 men and 560,184 women), compared with 1,256,001 (703,872 men and 552,129 women) in 2007.

More survivors

When these figures are converted into world standardised rates per 100,000 of the population, this means there will be a fall from 153.8 per 100,000 to 142.8 per 100,000 in men, and from 90.7 to 85.3 in women - a drop of 7% in men and 6% in women - since 2007.

The overall downward trend in cancer death rates is driven mainly by falls in breast cancer mortality in women, and lung and colorectal cancer in men.

"Lung, colorectal and breast cancers are the top causes of cancer deaths, and these are showing major changes," say the researchers.

But in the EU as a whole, world standardised death rates from lung cancer in women have gone up from 12.55 per 100,000 of the female population in 2007 to 13.12 in 2011.

However, a worrying increase in deaths from pancreatic cancer in women, which had been observed in 2004, appears to have levelled off.

Professor Stephen Spiro, of the British Lung Foundation, said lung cancer remained the most common killing cancer in men and women and was related to smoking in 80% of cases.

"Over the last 30 years, lung cancer rates have dropped in men as they have quit smoking in large numbers. However, this trend is not seen in women as nearly a quarter continue to smoke.

"The rates of lung cancer in women are not falling in the UK and the disease has overtaken breast cancer as the most common cause of cancer deaths in the UK and in many European countries."

Mike Hobday, head of policy at Macmillan Cancer Support, welcomed the fall in death rates but warned the number of people living with cancer in the UK was increasing by 3% every year.

"We know that there are currently two million people in the UK living with a cancer diagnosis, if the current rate continues, the number will have doubled to four million people by 2030.

"Cancer is changing. For many cancer is now a long-term condition and it is important to realise that it is no longer just about people dying quickly of cancer or being cured."

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