The National Institute for Health and Care Excellence has now published final guidelines backing routine NHS use of Novartis' Afinitor in certain patients with advanced kidney cancer.

The drug can now routinely be considered, as per its UK license, as an option to treat advanced renal cell carcinoma that has progressed during or after treatment with vascular endothelial growth factor targeted therapy, but only if the company provides it with the discount agreed in the patient access scheme.

Afinitor (everolimus) is an active inhibitor of the mammalian target of rapamycin (mTOR) protein, a central regulator of tumour cell division and blood vessel growth in cancer cells. The Institute originally published guidance rejecting the drug in this setting back in April 2011, but it was subsequently made available in the CDF.

During a reappraisal of Afinitor - part of a wider programme NICE is undertaking to assess the cost-effectiveness of medicines currently available through the CDF - Novartis offered a further discount on the drug's cost of £32,076 per patient, which helped secure its routine use.

The price for a pack of 10‑mg tablets (30 tablets per pack) is £2,673 (excluding VAT; British national formulary), but taking the PAS discount into account, the committee concluded that the most plausible ICER for Afinitor compared with best supportive care would be less than £30,000 per QALY gained.