Cancer Drugs

Nicholas Dakin Excerpts

Tuesday 19th January 2016 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

As ever, Mr Streeter, it is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on securing a debate on this important subject; she has tirelessly raised the issue of access to cancer treatments since she entered the House. She was right to describe the Cancer Drugs Fund as having moved from being a temporary measure to being a mainstay, and therein lies much of the challenge we face today. In that respect, the hon. Member for Solihull (Julian Knight) was right to remind us of the many good things the fund has done, and the hon. Member for Strangford (Jim Shannon) was right to emphasise the increased number of people with cancer and the need for cancer treatment.

Let us be clear: last year’s delisting of drugs from the Cancer Drugs Fund was a retrograde step for many cancer patients across the country. The decision affected many thousands of patients, and I am sorry to report, as the chair of the all-party group on pancreatic cancer, that that included hundreds of pancreatic cancer patients, because the pancreatic cancer drug Abraxane was removed from the CDF on 4 November.

Pancreatic cancer has the worst survival rate of any of the 21 most common cancers, with less than 5% of patients surviving five years or longer. That survival rate has barely changed over the last 40 years. Sadly, as my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) emphasised, pancreatic cancer is often diagnosed late, with about 80% of diagnoses taking place when the disease has spread to another part of the body. Patients diagnosed when the disease is metastatic live, on average, for just two to six more months.

Trials have shown that Abraxane, when used in combination with the standard chemotherapy drug gemcitabine, can extend eligible patients’ lives by an average of about two months more than gemcitabine alone. However, it is important to note that some patients live for significantly longer than two months, with some on the trials living for more than two years, and with a significant increase in the number surviving for more than one year. Clearly, when the average survival rate is between two and six months, even an extra two months’ survival gain represents a relatively large amount of time for patients to spend with their loved ones, and the value of that was indicated earlier.

That survival gain is why Abraxane is now in use around the world. From Germany to the USA, and from Austria to Australia, it is making a small but tangible difference to patients. It is worth noting that Scotland and Wales have also approved Abraxane for use on the NHS. Yet, in England, as of 4 November, it is no longer available to new patients, creating a devastating postcode lottery, as the hon. Member for Strangford said.

There has been a significant outcry from members of the public—people such as my constituent Maggie Watts who lost her husband, Kevin, to pancreatic cancer in 2009, and the 102,000 people who signed her petition on Change.org calling for Abraxane to be put back on the CDF list.

Why was Abraxane removed? Unlike some other drugs, it was not removed because of cost. Instead, it was decreed that it did not meet the minimum clinical effectiveness threshold when that was raised in 2015. In short, it was removed because the CDF scoring system did not take account of relative survival gain. The scorecard CDF panel members must complete requires them to give a score of zero to a drug that gives an average of less than three months’ life extension. Despite there being few treatments for pancreatic cancer, the system also did not recognise that this cancer has an unmet need in terms of treatment options. Abraxane is the first significant new treatment for nearly two decades, but the scoring system was inflexible, so the drug scored low.

That is the issue: we cannot just compare a new treatment for, say, breast cancer, where the average five-year survival rate is more than 80%, and where there are many effective treatments, with a new drug for a cancer such as pancreatic cancer, which has the lowest survival rate and few treatment options. Put simply, where a cost-benefit analysis takes place in a system with a finite budget, and where drugs for cancers with relatively high survival rates are scored on the same basis as drugs with the lowest survival rates, that system will always work against new drugs for cancers such as pancreatic cancer.

That brings us to the NICE consultation on how the CDF will be used in the future, which the all-party group will be submitting its views on. If a NICE committee defines a drug as an end-of-life drug, it can approve it at a higher cost threshold than other drugs. That is extremely important for cancer drugs and especially for pancreatic cancer drugs. However, the consultation document suggests only minor changes to the end-of-life three-month threshold, which, as hon. Members will gather from my earlier comments, is vital for cancers such as pancreatic cancer. This is where the issue of relative survival gain needs to be properly addressed.

Another way to have addressed issues affecting cancers with the worst survival rates would have been to introduce a system of patient and clinician engagement for pre-defined end-of-life drugs. That system is being used successfully in Scotland. Introducing it here would mean that NICE had to engage more with clinicians and patients to establish what extra benefits certain drugs might bring. NICE committees would then have to give due weight to that PACE evidence, in addition to the clinical and cost-effectiveness data they usually review. Without PACE, Abraxane would not be available in Scotland. The system could make a big difference to patients in England if it were introduced for certain pre-defined cancer types, such as rare cancers—the hon. Member for Mid Derbyshire mentioned the failure we have seen in that respect—and cancers of unmet need with the lowest survival rates.