A terminally-ill cancer patient has gone to the UK High Court to challenge the decision by his Primary Care Trust (PCT) not to fund treatment for him with Celgene’s Revlimid (lenalidomide). If he lived a mile and a half in either direction from where he does, the PCTs covering these areas would have supplied the drug, the court heard.
Doctors at the Royal Marsden Hospital in London treating 55-year-old Colin Ross, who was diagnosed with multiple myeloma in May 2004, had requested “exceptional need” funding for him for up to four courses of Revlimid, totalling £20,000, from West Sussex PCT after he had to stop taking thalidomide and Johnson & Johnson’s Velcade (bortozemib) because he could no longer tolerate their side effects. The PCT refused the request, saying the drug was too expensive and that his case was not sufficiently exceptional.
In court, Richard Clayton QC, representing Mr Ross, described the PTC’s decision as “irrational.” He challenged its interpretation of “exceptional need,” and claimed that it had made mistakes in its cost estimates for the drug, Moreover, with no apparent specialist expertise in treating myeloma on its adjudicating panel, it had misunderstood the medical data, he added.
This is the “end of the road” for Mr Ross unless he gets the drug, Mr Clayton told the court; he is no longer on any life-extending treatment, but treatment with Revlimid, if successful, could extend his life by three years. Without it, he will die within the next three months.
The case also raises the “disquieting” issue of the post-code lottery, as if Mr Ross lived a mile and a half in either direction from where he does, he would have received the drug, said Mr Clayton. 60% of the applications for exceptional funding for Revlimid which have been made to PCTs in England and Scotland have been granted, he added.
Mr Ross’s case is backed by leading cancer specialist Professor Karol Sikora of Imperial College London, who says he is “eminently suitable” for treatment with Revlimid, the court heard.
The case continues on Monday, and the Judge, Simon Grenfell, said he expects to come to a decision by mid-week.
Appraisal of Revlimid is currently underway at the National Institute for Health and Clinical Excellence , although a decision is not expected until next spring. In May, the Scottish Medicines Consortium (SMC) decided in May not to recommend the drug.
