Details of the eagerly-awaited NHS Cancer Drugs Fund review has been released, which shows that its budget will grow but 16 drugs (covering 25 indications) out of 84 drugs will be chopped.

The CDF notes that the budget will rise from £200 million in 2013/14 to £280 million in 2014/15, and an estimated £340 million from April 2015. It argues that this represents an increase of 70% since August 2014 and will create projected savings of £80 million “through a combination of negotiated price reductions and improved clinical effectiveness”.

It argues that if action had not been taken, the fund is projected to have grown to around £420 million next year, “necessitating offsetting cuts in other aspects of cancer treatment such as radiotherapy, cancer diagnoses, cancer surgery, and other important NHS services for other patient groups”.

UPDATE 1: The panel claims to have carried out “a detailed assessment of the evidence, looking at clinical benefit, survival and quality of life, the toxicity and safety of the treatment, the level of unmet need and the median cost per patient”. This has resulted in 59 of the 84 most effective currently approved indications of drugs can “rollover into the CDF next year, creating headroom for new drug indications that will be funded for the first time”.

These are Amgen’s Vectibix (panitumumab) for bowel cancer, Pharmacyclics and Johnson & Johnson’s Imbruvica (ibrutinib) for mantle cell lymphoma ands chronic lymphocytic leukaemia.

Peter Clark, chair of the CDF said: “We have been through a robust, evidence-based process to ensure the drugs available offer the best clinical benefit, getting the most for patients from every pound”. He added that “there were drugs that did not offer sufficient clinical benefit so we simply cannot go on funding those”.

Prof Clark went on to say “there were others that offered some benefit but were costly and I am pleased that a number of pharmaceutical firms worked with us to make prices more affordable, saving millions of pounds that can now be reinvested in other treatments”. He concluded by saying “these are difficult decisions, but if we don’t prioritise the drugs that offer the best value, many people could miss out on promising, more effective treatments that are in the pipeline”.

UPDATE 2: Drugmakers affected by the de-listing (see link below for full list) have been reacted to the move.

Bayer’s Stivarga (regorafenib) will be removed for gastrointestinal stromal tumours but the company notes that further data on overall survival are being presented later this month and it is confident that “once published in a peer-reviewed journal, Stivarga will once again be on the CDF”.

Eli Lilly says it is “extremely disappointed” in the CDF’s decision to stop funding Alimta (pemetrexed) based on what it believes is a flawed assessment of this treatment option for patients with non-squamous non-small lung cancer. It is recognised “as a standard of care by the NHS England’s own treatment algorithm, is reimbursed by the SMC in all indications and by NICE in two lung cancer indications”, the firm notes, adding that its price “has not been increased in the ten years since launch”.
The delisting of pemetrexed for continuation maintenance “is based on, what Lilly believes is the incorrect application of an overly simplistic scoring tool and a flawed process”, the firm says.

Eisai stated that it was “aghast” at “the arbitrary process that has led to one of the lowest priced cancer treatments on the CDF being removed”, namely its breast cancer treatment Halaven (eribulin). Tarja Stenvall, general manager of Sanofi in the UK, said “we are hugely shocked and disappointed” at the decision against its prostate cancer drug Jevtana (cabazitaxel), adding that “we will do everything in our power to appeal this decision and are willing to hold open discussions to find a way forward”.

UPDATE 3: Jayson Dallas, general manager at Roche Products, said the firm is happy about maintaining access via the CDF to the breast cancer drugs Perjeta (pertuzumab) and Kadcyla (trastuzumab emtansine) “at prices that reflect their clinical benefit”. He added that “the review demonstrates that industry and NHS England can work together to make sure the very latest medicines are available to patients”.

However, Dr Dallas expressed his disappointment that Avastin (bevacizumab) has been delisted for advanced bowel and second-line platinum-sensitive advanced ovarian cancer. He said “we are now seeing the first casualties of a failure to reform the wider system of access for established cancer medicines, such as Avastin, “the most clinically requested cancer medicine through the CDF and the standard of care for advanced bowel and ovarian cancer in England and Europe”.

NHS England announced that Celgene’s myeloma drugs Imnovid (pomalidomide) and Revlimid (lenalidomide), plus one indication of Janssen’s Velcade (bortezomib) are set to remain on the list. However Myeloma UK noted that in two months time patients who have multiply relapsed myeloma and need retreatment with Velcade might not be able to access it.

Eric Low, chief executive of the charity, said recent events “have reaffirmed what Myeloma UK has always argued - that quick-fix measures such as the CDF are not effective long-term solutions to securing cancer patients access to medicines”. He added that “throwing money at fixing a complex issue does not solve the underlying reasons why these drugs are not available on the NHS in the first place”.

UPDATE 4: At the ABPI, chief executive Stephen Whitehead said the decision to delist 16 cancer medicines with 25 separate clinical uses is "extremely disappointing and a significant blow to the health and wellbeing of future NHS patients". While the association is pleased that treatment for existing patients will be protected and that some new meds will be included, "it does not detract from our longstanding belief that the CDF and this re-evaluation process was fundamentally flawed," he added.

Mr Whitehead concluded by saying that "the CDF remains a sticking plaster. The solution to this issue remains the urgent reform of NICE which will ensure that the right patients get the right medicines at the right time whatever their condition.”