Scottish prostate cancer patients will now be able to get treatment with Janssen’s Zytiga much earlier in the treatment pathway, after the Scottish Medicines Consortium had a change of heart and endorsed the drug’s use before chemotherapy.

Zytiga (abiraterone) is already available in Scotland to treat patients post chemotherapy, but earlier this year the cost watchdog rejected its use pre-chemotherapy because it felt there was “insufficient evidence” of its benefit in this setting.

However, following an Independent Review Panel convened by the SMC, Zytiga has now been accepted for use in pre-chemo patients, in a decision that has been welcomed by The Institute of Cancer Research, at which the drug was discovered.

“This is a drug that is proven to extend life and improve quality of life, so it is great that Scottish men will now be getting the drug earlier, and that some who had been denied it altogether will now be able to receive it,” said Paul Workman, chief executive of the Institute, but also lamented the postcode lottery of care for UK patients.  “What’s excellent news for Scotland will only reinforce the frustration for patients in England and Wales, who continue to be denied abiraterone until they have first gone through chemotherapy”.

The SMC also approved funding for Bayer’s Xofigo (radium 223), which is used to treat men with prostate cancer that has spread to the bones. 

Xofigo is a radio-pharmaceutical agent designed to directly deliver alpha radiation to bone metastases without affecting normal bone marrow.

The National Institute for Health and Care Excellence is also looking favourably on the therapy, having endorsed its use but only in men who have already been treated with docetaxel in draft guidelines early this year.

Elsewhere, the cost regulator also issued a green light for: Roche’s Herceptin (trastuzumab) in combination with capecitabine or fluorouracil and cisplatin for HER2 positive metastatic adenocarcinoma of the stomach or gastro-oesophageal junction in treatment naive patients; Boehringer Ingelheim’s Ofev (nintedanib) for the lung-scarring disease idiopathic pulmonary fibrosis; Santen’s Ikervis (ciclosporin) eye drops for severe keratitis, an inflammation of the cornea caused by dry eye disease; and Novo Nordisk’s Xultophy (degludec/liraglutide) for type II diabetes.

On the downside, it did not recommend Novartis’ Afinitor (everolimus) for use in advanced breast cancer within NHS Scotland, because of “uncertainties surrounding the overall clinical benefit the medicine would provide for patients at the end of their lives”. 

According to Novartis, Afinitor is the first new-targeted therapy licensed in 15 years in this particular patient group, and clinical evidence shows it delays starting chemotherapy on average by six months, a particularly meaningful outcome for those with advanced stage disease.

The Swiss pharma giant said it “disappointed and surprised by the decision”, but is still hoping for a turnaround following “resubmission and continued constructive communication” that would allow Scottish patients access to its drug.

Afinitor was also rejected for advanced breast cancer by NICE.