It is looking likely that patients in England will loose NHS access to Ipsen’s Cometriq and Sanofi Genzyme’s Caprelsa via the Cancer Drugs Fund, after cost-regulators turned down funding for their use.

The National Institute for Health and Care Excellence has published draft guidelines rejecting their routine commissioning on the NHS in England and Wales to treat unresectable, locally advanced or metastatic disease, on finding that while clinical trial evidence indicates they are effective in delaying disease progression they may not actually prolong survival.

Both Cometriq (cabozantinib) and Caprelsa (vandetanib) are linked with substantial side effects, so are only used when the disease has become symptomatic and the benefits of treatment outweigh the burden of side effects. However, they are the only systemic treatments available, and the only other option for patients at this stage of disease is best supportive care.

According to NICE, cost-effectiveness estimates for both drugs are “much higher” than what would normally be considered an acceptable use of NHS resources, while neither treatment meets its end-of-life criteria or is suitable for use in the Cancer Drugs Fund.

Ipsen picked up certain rights to Cometriq - outside the US, Canada and Japan - from Elixis last year in a deal worth $855 million. Earlier this year, the French drugmaker was forced to cut the price of the drug to secure NICE approval for its routine commissioning for some patients with kidney cancer.

Genzyme bought rights to Caprelsa in 2015 from AstraZeneca, in a deal valued at $300 million.