The Scottish Medicines Consortium has recommended the use of Anglo-Swedish drugmaker AstraZeneca’s Arimidex (anastrazole) on the Scottish National Health Service as adjuvant treatment for postmenopausal women with hormone receptor-positive early invasive breast cancer. According to AstraZeneca, the drug is the first and only therapy to show improved efficacy and tolerability over the 30-year gold standard treatment tamoxifen, which is also marketed by the group as Nolvadex.

The SMC’s recommendation for Arimidex is based on results of the landmark ATAC trial, the largest and longest independent evaluation of its kind, which revealed that Arimidex cut the risk of breast cancer returning by an additional 26% over and above the 50% reduction in risk already offered by tamoxifen. In addition, spread of the disease was reduced 14%, the risk of cancer occurring in the other breast fell more than 40% and women taking Arimidex had fewer life-threatening side effects than those seen with tamoxifen, such as blood clots, strokes and cancer of the womb lining.

Chris Wilson, consultant surgeon at the Western Infirmary in Glasgow, Scotland, stated that “the SMC’s announcement is a defining moment in the treatment of breast cancer and it’s exciting that Scotland has taken the lead. 3,500 Scottish women are diagnosed with breast cancer each year but now women with this particular type of breast cancer will be among the first in the UK to benefit from access to this more effective drug immediately after their surgery. This is important because it is well accepted that there is an increased risk of the cancer returning in the first few years following a pateint’s operation.”

The SMC’s recommendation closely follows the UK Medicines and Healthcare products Regulatory Agency’s approval of the drug for use in oestrogen receptor-positive early-stage breast cancer. However, according to a survey conducted by The Times, breast cancer patients in England are missing out on treatment with Arimidex and other new therapies as a result of funding chaos.

The Times’ investigation of care practices in 34 cancer centers in England has revealed significant divisions in care and management of the condition. In some centers, patients are unable to benefit from treatment with the latest drugs such as Arimidex as the National Institute for Health and Clinical Excellence has not, as yet, recommended their use, while in other areas doctors and health trusts are ignoring the advice of the NICE by prescribing these agents, reflecting the current “postcode lottery” for best treatment.

The NICE effectively determines NHS funding for drug treatments but the organization is not likely to make a decision on the use of Arimidex for another 15 months after being forced to drop an appraisal committees on governement cut-backs, The Times notes.

Joanne Rule, chief executive of CancerBACUP, said that patients frequently ask how they can gain access to proven treatments that might help them to fight their condition. “Sadly we have to tell them it could take years before they are widely available on the NHS. For many that could be too late. That’s why a fast-track system is urgently needed for those cancer drugs which are recognised as potentially increasing survival rates and why the process needs to be generally speeded up for others,” she told the newspaper.

Pfizer's’ Aromasin (exemestane), an aromatase inhibitor similar to Arimidex, is also currently awaiting a recommendation by the NICE. The drug has just been granted a licence extension in the UK, allowing it to be prescribed to postmenopausal women with early breast cancer following surgery and two to three years of tamoxifen therapy.

Clinical trials of the agent have shown that it can cut the risk of disease relapse by almost a third, and that switching to Aromasin from tamoxifen therapy for five years reduces the risk of cancer recurrence by an extra 30%, thereby representing yet another highly-effective treatment which is ready for use but on the shelf until the NICE reaches a decision.