The National Institute for Health and Care Excellence has published new recommendations rejecting the use of Celgene’s Abraxane (nab-paclitaxel) on the National Health Service to treat patients with advanced pancreatic cancer.

According to the cost regulator, the drug, a novel formulation of the chemotherapy paclitaxel, is not as effective as standard therapy and is more expensive, and thereby fails to hit value-for-money criteria.

NICE says that data provided by Celgene show that the chemo regimen FOLFIRINOX, a first-line option for patients with the disease, was actually more clinically effective than the Abraxane/gemcitabine combination. And while Abraxane/gemcitabine was more effective than gemcitabine alone, it resulted in more serious side effects.

Ultimately, the most plausible cost per QALY (Quality Adjusted Life Year) gained for Abraxane/gemcitabine compared with gemcitabine alone was calculated at £78,500 per QALY gained, and thus far above the normal bounds of what is considered a cost-effective use of NHS resources (up to £50,000 in certain life-extending circumstances). 

Noting the limited progress in the development of new pancreatic cancer treatments, NICE chief executive Sir Andrew Dillon said while a number of newer treatments including Abraxane have been introduced, it is disappointing that “when considering the impact of side effects as well as how effective the treatment is the evidence fails to show that it works any better for patients than other treatments already provided by the NHS”.

Equal access

Patients with pancreatic cancer in England could still get access to the drug via the Cancer Drug’s Fund, after Abraxane was added to its list of approved treatments earlier this year.

Celgene, however, is still urging NICE to re-consider its preliminary recommendation so that metastatic pancreatic cancer patients in England will have the same unrestricted access to Abraxane as patients in Wales, where the treatment is currently recommended for use.

“This is very disappointing news for both clinicians and patients, particularly considering the poor survival rates and the limited number of treatments that are currently being developed in pancreatic cancer,” said Professor David Cunningham, Consultant Medical Oncologist, commenting on the draft guidelines. “If this negative preliminary recommendation is upheld…it will mean that NICE has not recommended any new treatments for pancreatic cancer in well over a decade,” he added