Twenty-three cancer therapies have been dropped from England’s Cancer Drugs Fund in a second round of de-listing that has angered industry, patients groups, charities and doctors.

Sixteen different medicines - used as twenty-three different cancer therapies - will no longer be offered to new patients by the scheme, triggering renewed calls for a different commissioning system that is fair and fit for purpose.

Medicines now dropped from the Fund include: Roche’s Avastin (bevacizumab) for recurrent or metastatic cervical cancer, advanced breast cancer, and advanced colorectal cancer and Celgene’s Revlimid (lenalidomide) for second-line treatment of multiple myeloma.

The CDF was set up to provide patients with access to cancer medicines not routinely available on the National Health Service, because they have not been through an appraisal or have not been deemed ‘cost-effective’ by the National Institute for Health and Care Excellence.

For the financial year 2015/16, the CDF cash pot has been set at £340 million. But, according to NHS England, current projections forecast a spend of £410 million this year, surpassing the budget by £70 million and triggering the need for further prioritisation.

“It is our duty to ensure we get maximum value from every penny available on behalf of patients,” said CDF chair Peter Clark. “We must ensure we invest in those treatments that offer the most benefit, based on rigorous evidence-based clinical analysis and an assessment of the cost of those treatments.”

But Paul Workman, chief executive at The Institute of Cancer Research, London, said the decision is “an example of the confusion at the heart of our drug assessment system - with some treatments first being refused by NICE, then accepted onto the Cancer Drugs Fund and now to be removed from the list and denied to new patients”. 

“What we urgently need is a new unified system for evaluating treatments that can attract widespread support and ensure that the most innovative and effective cancer drugs reach the patients who need them as fast as possible,” he stressed.

A new system

Indeed, NHS England and NICE are shortly to consult on a proposed new system for commissioning cancer drugs, which health chiefs say will be designed to provide the health service with “a more systematic approach to getting the best price for cancer drugs, meaning more treatments can be made available, and give a greater focus on evaluation, leading to the best drugs progressing swiftly to routine commissioning”.

But the distressing de-listing process could have been avoided “if NICE and NHS England had transitioned earlier to a more appropriate, sustainable solution for evaluating and approving cancer medicines for routine use,” argues Alison Clough, the Association of the British Pharmaceutical Industry’s acting chief executive.

“We are pleased that treatments for existing patients will be protected, but remain of the view that this re-evaluation process was fundamentally flawed”.

Deborah Lancaster, Director, Roche Products Limited, called for “a pragmatic, flexible and sustainable system - one that puts patients first and one that works for clinicians, government, NHS, patient groups and companies”. 

“We have always known the CDF was never meant to be a long-term approach to funding cancer medicines. Although we understand its financial pressures, patients should not be denied access to innovative and clinically effective medicines,” she stressed.