There was good news for lung cancer patients in the UK this week after the National Institute for Health and Clinical Excellence waved through GlaxoSmithKline’s Hycamtin onto the National Health Service.
Specifically, the cost regulator has published final guidance recommending the use of oral Hycamtin (topotecan) in patients with small cell lung cancer, under the provisos that re-treatment with the first-line therapy is not appropriate or that the combination of cyclophosphamide, doxorubicin and vincristine (CAV) is contraindicated.
The Institute stopped short of endorsing the drug in patients with relapsed small cell lung cancer, but stressed that any patients currently receiving oral Hycamtin who do not meet the treatment conditions, including those on intravenous dosing of the drug, should be allowed to continue therapy until their clinicians consider it appropriate to stop.
Every year there are around 38,000 new cases of small cell lung cancer, a particularly aggressive form of the disease that, without treatment, can leave patients with a life expectancy of just 3.5 months for limited-stage and six weeks for extensive-stage disease. In clinical trials, oral Hycamtin clearly showed its ability to increase overall survival, with the median overall survival for patients taking the pill 25.9 weeks compared to just 13.9 weeks for those receiving best supportive care alone.
A course of treatment (four cycles) with oral Hycamtin costs an average £2,552 and, under new guidelines for the appraisal of life-extending, end-of-life treatments, the independent appraisal committee concluded that this offers the NHS value for money given its survival benefits. Intravenous Hycamtin, which has not been recommended by the NICE, costs more than double the pill version at £5,980 per patient per course.
