The National Institute for Health and Clinical Excellence has once again knocked back Erbitux, this time for head and neck cancer, and has defended its record on appraising oncology drugs.

NICE, which rules on the drugs that can be prescribed on the NHS in England and Wales, has issued its final draft guidance on Erbitux (cetuximab), developed by ImClone and marketed by Bristol-Myers Squibb and Merck KGaA, and says it does not recommend the treatment in combination with radiotherapy for patients with locally advanced squamous cell cancer of the head and neck.

Explaining the rationale behind the decision, Andrew Dillon, NICE’s chief executive, said that the evidence presented to the independent advisory committee did not persuade them that cetuximab “works any better or offers better therapeutic value than existing treatments for head and neck cancer.” He added that NICE did consider whether there are any subgroups of patients for whom cetuximab could be clinically and cost effective “but they were not presented with any robust evidence to demonstrate this.”

Appeals against the decision are expected before NICE issues its final guidance next month but the prospects for Erbitux do not look too good. In January, the committee rejected an appeal from charities over its decision to reject Erbitux for bowel cancer patients.

NICE is bracing itself for more criticisms about the way it does its appraisals but Mr Dillon has hit back at critics of the system. He said that “contrary to reports, NICE has reviewed 39 cancer drugs for a variety of indications since its inception. Of these we have recommended 35 for routine or selective use; only 4 treatments are not recommended for use in the NHS.”

He added that the NHS “has finite resources and it is our job to ensure that these are spent on treatments that confer enough of a benefit to patients in relation to the amount of money they cost.” His comments come days after a report from Sweden’s Karolinska Institute and the Stockholm School of Economics which claimed that patient access to innovative cancer drugs in the UK pales in comparison with the majority of other European and the USA.