The Scottish Medicines Consortium has accepted four new medicines for routine use by NHS Scotland, offering patients new options for kidney cancer, liver disease and the prevention of nausea and vomiting.

Bristol-Myers Squibb's immunotherapy Opdivo (nivolumab) was backed to treat advanced renal cancer, a terminal condition with poor prognosis.

The drug was considered through the SMC’s Patient and Clinician Engagement (PACE) process, during which it was highlighted that there are limited treatment options and that patients often have to stop work at a relatively early stage due to both the condition and treatment side effects.

According to the cost watchdog, Opdivo offers “the opportunity of increased overall survival and improved quality of life”, and is also better tolerated than other current treatments.

Ipsen’s Cabometyx (cabozantinib) was also accepted for patients with kidney cancer following a PACE process, at which patient groups and clinicians spoke of how the drug can boost the time to disease progression and extend overall survival.

As an oral treatment, it also reduces the number of hospital visits patients have to make to receive treatment, the SMC noted.

Elsewhere, Intercept’s Ocaliva (obeticholic acid) was recommended to treat a liver disease known as primary biliary cholangitis in patients who fail to respond adequately to existing treatments.

PACE participants noted that this group of patients face a decline in liver function and decreasing quality of life, and that the drug may delay progression of the disease.

Finally, MSD’s Emend (aprepitant) was backed for use in combination with other medicines to prevent nausea and vomiting caused by moderately emetogenic chemotherapy in children aged six months to 17 years.

On the downside, the Committee was unable to accept Roche’s Perjeta (pertuzumab) for the treatment of HER2-positive metastatic breast cancer.

The drug was rejected despite consideration through the PACE process because, in spite of the benefits it offered, the costs were simply too high.

“While there was strong support for the medicine from patients and clinicians and we applied as much flexibility as we could through the PACE process, having considered all the evidence the Committee did not consider that the addition of pertuzumab would be a good use of limited NHS resources for treating HER2-positive metastatic breast cancer compared with the use of trastuzumab and docetaxel alone. Pertuzumab is a very expensive medicine,” said Dr Alan MacDonald, chairman of the SMC, explaining the decision.

“We know this decision will be disappointing to patients and their families as we understand how devastating breast cancer can be. However, when we make our decisions we have to take account of the needs of all patients who require treatment by NHS Scotland, not just those who would benefit from the medicine under consideration.”