The Pharmaceutical Journal Vol 264 No 7096 p716
May 13, 2000 Clinical

Paclitaxel should be standard therapy for ovarian cancer, says NICE

Paclitaxel (Taxol) should be part of the standard treatment for women with ovarian cancer, according to the National Institute for Clinical Excellence. In guidance announced on May 5, the NICE said that paclitaxel in combination with a platinum therapy (cisplatin or carboplatin) should be the standard initial therapy for women with ovarian cancer following surgery. The paclitaxel/platinum combination is also recommended in the treatment of recurrent (or resistant) ovarian cancer if the patient has not previously received this combination. If the patient has already received both drugs, the combination is not recommended outside clinical trials. Although paclitaxel is already being prescribed for many women with ovarian cancer, some health authorities have been refusing to fund treatment. It is estimated that the NICE guidance will cost an additional £7m a year in England and Wales. The ovarian cancer recommendations form the first part of the NICE's guidance on use of taxanes. Of the two taxanes marketed in the UK, paclitaxel and docetaxel, only the former is licensed for use in ovarian cancer. Both drugs are licensed for use in breast cancer. An appeal against the NICE's proposed guidance on breast cancer has been upheld and revised guidance will now not be available before the end of June. The NICE says that the estimated gain in median survival due to the addition of paclitaxel to standard platinum-based therapy in ovarian cancer is around 10 to 11.5 months. The combination is generally well tolerated by patients and quality of life appears to be comparable to that associated with the use of platinum-containing drugs alone, it says.

An extra £7m a year needed to comply with guidance

The estimated annual cost to the NHS in England and Wales of adding paclitaxel to standard platinum therapy for ovarian cancer is around £28m. This is calculated on the basis of there being 4,000 patients suitable for treatment each year, with an average cost per patient of around £7,000 (for 4.5 cycles of treatment, at £1,500 per cycle).
The NICE says that around 3,000 patients each year already receive paclitaxel/platinum therapy for ovarian cancer, funded either through the NHS, privately or through clinical trials. The estimated additional cost to the NHS, based on these estimates, is therefore £7m a year. "This guidance means that no matter where they live in England or Wales, both patients and health professionals have access to information on what the NHS considers to be best practice in the use of taxanes for ovarian cancer," the NICE says.
This is the first full pharmaceutical appraisal carried out by the NICE; the zanamivir guidance, announced last year, followed a "fast track" procedure.
Mr John Denham (Health Minister) said on May 5 that the NHS was expected to follow NICE guidance. "NHS bodies should follow up to ensure that any treatment decision not in line with the guidance can be justified in the particular clinical circumstances of each case." He added: "It is unacceptable for patients not to have access to drugs just because they happen to live in a certain area. We are determined to tackle ‘postcode prescribing'."
Mr Denham said that health authorities would be able to use the additional funds that had been made available this year.
Acccording to Professor Hilary Thomas (professor of oncology, Royal Surrey County hospital), around 30 per cent of health authorities have not been funding paclitaxel for all women who could benefit from the drug.
Dr Max Summerhayes (principal oncology pharmacist, Guy's and St Thomas's hospitals NHS trust) said that his trust was already using paclitaxel as standard treatment and so the new guidance would have little effect. However, he thought that it could create financial difficulties for health authorities that were not currently using the drug. At Guy's and St Thomas's, use of paclitaxel for ovarian cancer cost around £0.5m a year, which was 20 per cent of the money spent on oncology drugs.
The Association of the British Pharmaceutical Industry, while welcoming the NICE guidance, expressed concern that women had been deprived of treatment. "Some health authorities, despite the authoritative advice of leading cancer specialists, have held off from making full use of this licensed medicine . . . . It is regrettable that lives will have been lost while a medicine, which had already proven its clinical value, has had to pass through what is effectively a further approval system before being widely prescribed in the UK," said Dr Trevor Jones (director-general, ABPI).
The NICE says that it will review the evidence on use of taxanes in ovarian cancer in March, 2001 and, if necessary, update its guidance.