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The Pharmaceutical Journal
Vol 269 No 7208 p127
27 July 2002

NICE decision on colorectal cancer drugs merits review, says DTB

Recommendations made by the National Institute for Clinical Excellence on the use of irinotecan (Campto), oxaliplatin (Eloxatin) and raltitrexed (Tomudex) in patients with advanced colorectal cancer should be reviewed before the planned date of 2005, according to the July issue of Drug and Therapeutics Bulletin. The recommendations have raised much controversy among cancer specialists (PJ, 15 June, p827).

The bulletin says that NICE recommendations against first-line use of irinotecan or oxaliplatin appear to rest heavily on analyses of cost-effectiveness data and that cancer specialists in the United Kingdom have contested both the interpretation of trial data and the validity of cost analyses.

It concludes that in patients without metastatic colorectal cancer, survival without disease progression and overall survival may be extended by a median of two to three months if irinotecan is added to first-line treatment.

Addition of oxaliplatin to fluorouracil plus folinic acid also prolongs progression-free survival. Although one-year survival rates of around 70 per cent have been reported with this combination when used as first-line treatment, survival benefit over using fluorouracil and folinic acid alone has not been conclusively demonstrated (2002;40:49).

Topical terbinafine The July issue of Drug and Therapeutics Bulletin also discusses the use of antifungals for athlete's foot. It concludes that first-line treatment of uncomplicated athlete's foot should be a topical antifungal and that terbinafine 1 per cent cream is the most effective topical antifungal available.

The bulletin recommends that oral antifungals, which it says are more expensive than topical antifungals and have potentially serious adverse effects, should only be used when topical treatments have failed or when the fungal infection is widespread. However, more data are needed before any firm recommendations can be made as to whether one oral antifungal is more effective than another, it says (ibid, p53).