In the latest Scottish Medicines Consortium (SMC) meeting, the committee has recommended four new medicines and rejected two.

Among the positive opinions are Kite pharma’s Yescarta (axicabtagene ciloleucel), MSD’s cancer blockbuster Keytruda (pembrolizumab), Ipsen's Decapeptyl SR (triptorelin acetate) and AbbVie’s Skyrizi (risankizumab).

Yescarta, initially rejected by the organisation in February this year, was accepted following consideration through SMC’s Patient and Clinician Engagement (PACE) process, which is used for medicines to treat end of life and very rare conditions.

The initial rejection meant that patients with aggressive forms of non-Hodgkin lymphoma (NHL), including relapsed or refractory diffuse large B-Cell lymphoma and primary mediastinal large B-cell lymphoma, who have potentially exhausted all treatment options, were not be able to access the technology.

The CAR-T cell therapy works by using the patient’s own immune cells (T-cells) to destroy the cancer cells, and was approved after PACE participants spoke of how there are limited treatment options for this condition.

The committee says that the treatment could potentially offer long-term disease control and may be life extending for some patients.

Secondly, Keytruda was approved for metastatic non-squamous non-small cell lung cancer (NSCLC), also through the PACE process. When added to chemotherapy, the drug can control symptoms, meaning patients are likely to remain well and live longer.

The committee also accepted Decapeptyl for the treatment of early stage breast cancer, as it offers another treatment option for those at high risk of recurrence.

Finally, the group gave a positive opinion to Skyrizi for the treatment of moderate to severe plaque psoriasis in adults, as currently available treatments can cause unwanted side effects in some patients and even where a medicine initially controls the condition, in time it may stop working so well.

On top of the four acceptances, the committee rejected Perjeta (pertuzumab) and Xtandi (enzalutamide) for the treatment of early stage breast cancer and prostate cancer, respectively.

Perjeta was rejected due to the company’s evidence about the clinical and economic benefits of the medicine being “not strong enough’” and Xtandi was not accepted due to “uncertainty in the company’s evidence around the benefits of using it at this stage in the treatment pathway.”

Richard Erwin, general manager, Roche Products, commented on the rejection, saying that the company is “frustrated and disappointed that the SMC has declined to make Perjeta available in this adjuvant indication.”

He continued to say: “We have worked closely with all stakeholders in Scotland to find a route to make Perjeta available. Roche is committed to finding a solution to ensure that access is granted as soon as possible. We will meet the SMC this week to discuss the reasons why the medicine was declined and make a decision on our next steps from there.”

SMC, chairman Dr Alan MacDonald, rounded up the decisions by saying he is “pleased our committee members were able to accept these four new medicines for use by NHSScotland”, before going on to comment:

“We know there are currently limited treatment options for those with this stage of lymphoma. Axicabtagene ciloleucel offers an innovative and potentially life extending treatment for those with this condition, and we hope our decision will benefit them, their families and carers.

“For those with metastatic non-squamous non-small cell lung cancer (NSCLC), pembrolizumab can extend life expectancy giving patients the chance of some valuable extra time with their families in the context of this incurable illness.”

He also said “We know from patient groups and clinicians that triptorelin acetate will be a welcome additional treatment option for those with early stage breast cancer at high risk of recurrence.”