Patients with pancreatic cancer in England have been left reeling by news that cost regulators are barring use of Celgene’s Abraxane by the National Health Service, just weeks after the drug was dropped from the Cancer Drugs Fund.

The National Institute for Health and Care Excellence has published a final appraisal determination which does not recommend Abraxane (nab-paclitaxel) in combination with gemcitabine for adults with previously untreated metastatic pancreatic cancer, on grounds that the cost does not justify its “limited benefit”.

It says that information provided by Celgene showed that although nab-paclitaxel with gemcitabine was more effective than the latter alone, it resulted in more serious side effects, and also caused more side effects than a gemcitabine/capecitabine regimen despite having similar effectiveness.

“When considering the impact of side effects on a patient’s quality of life and the fact that it is also more expensive, nab-paclitaxel cannot be considered an effective use of NHS resources,” explained NICE chief executive Sir Andrew Dillon. The the most plausible cost per QALY (Quality Adjusted Life Year) for nab-paclitaxel plus gemcitabine compared with gemcitabine alone would lie somewhere between £72,500 and the £78,500, the Institute said.

But the news will be particularly galling because patients in both Wales and Scotland are currently getting routine NHS access to the drug, while those in England won’t even be able to apply for access through the CDF. Although access to Abraxane could now also be removed in Wales on the back of NICE’s position.

Unfair decision

Ali Stunt, Founder and chief executive of Pancreatic Cancer Action, has slammed the decision. “Abraxane, in combination with gemcitabine, is becoming standard of care for metastatic pancreatic cancer across the Western world and we are very saddened that English patients will not have any access to it via the NHS”.

“Pancreatic cancer is a disease with a vast unmet need and, due to its poor prognosis, needs to be assessed differently to other cancers by review bodies, such as NICE. We feel this decision by NICE is unfair to metastatic pancreatic cancer patients in this country who already face one of the worst survival rates of common cancers in England and Wales.”

“As oncologists, we struggle to see the rationale for this in an area of high unmet need,” said Harpreet Wasan, Clinical Medical Oncologist, London. “In removing all potential means of access to Abraxane in combination with gemcitabine via the NHS in England, particularly when patients across the border can readily access the treatment, will mean that some patients will miss out on an effective treatment option”.