The National Institute for Health and Clinical Excellence has overturned its previous decision to reject the use of Eli Lilly’s Alimta on the National Health Service for patients with mesothelioma, a cancer associated with asbestos exposure and mostly affecting the lungs.

The Institute’s draft guidance now recommends Alimta (pemetrexed) as a treatment option for malignant pleural mesothelioma in people who have a World Health Organisation performance status of 0 or 1, who are considered to have advanced disease, and for whom surgical intervention is considered inappropriate.

NICE’s review of the available evidence last year failed to demonstrate that the drug was better than other, cheaper therapies on the market. But explaining the u-turn, Dr Gillian Leng, Implementation Director and Executive Lead for this guidance, said that during the subsequent consultation a number of significant factors came to light, “which, taken together, have enabled the independent appraisal committee to recommend pemetrexed disodium as a treatment option for the majority of people with MPM.”

According to NICE, four “key” pieces of information changed its position on the matter: that the number of treatment cycles used in routine practice is lower than that used in its original economic modelling; that the availability of a smaller 100mg vial will further cut treatment costs; that the quality of life benefits in mesothelioma are likely to be greater than had first been assumed initially; and the identification of a subgroup of patients in whom the drug has greater effectiveness (which includes most UK patients), that can be specified in routine clinical practice.

Aggressive cancer

Mesothelioma is an aggressive tumour that is often not diagnosed until the advanced stages, at which point patients have an average life expectancy of five months. An estimated 1,700 people in the UK are diagnosed with the illness every year, a figure that is likely to peak at more than 2,000 cases by 2015.

According to Lilly, NICE’s turnaround means that “hundreds of patients with MPM will have access to Alimta, which could potentially give them an extra year of life and a better quality of life.” But Andrew Hotchkiss, General Manager of Lilly UK, added: “The challenge now is to remove the current postcode lottery of care in England and Wales and make Alimta available to all patients who clinicians believe can benefit from it as soon as possible.”

And Dr Gary Middleton, a Consultant Medical Oncologist at Royal Surrey County Hospital said: “I have a hope, borne out of the success of this appeal, that this moment will come to be seen as the point at which NICE transformed itself from the force that legitimised arbitrary budgetary restriction at the expense of individual suffering into the agency that facilitates excellence in patient care.”

Subject to an appeal being received, NICE’s final guidance is expected in September.

New research lab

Meanwhile, the Right Honourable Stephen Timms MP, Minister of State, Department for Business, Enterprise and Regulatory Reform, formally opened Eli Lilly’s new research laboratory at its Erl Wood Manor Research Centre in Windlesham, Surrey, this morning.

This is a special year for the Research Centre, as the site also celebrates its 40th anniversary, the group said.