The Pharmaceutical Journal
Vol 270 No 7251 p741
31 May 2003

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National Institute for Clinical Excellence (www.nice.org.uk)

NICE issues guidance for breast and colon cancer

The National Institute for Clinical Excellence has issued further guidance on the use of drug treatments in breast and colorectal cancer.

NICE's latest recommendations, published earlier this week, mean that patients with locally advanced or metastatic breast cancer should be offered capecitabine (Xeloda) in combination with docetaxel (Taxotere) rather than docetaxel on its own when anthracycline-containing treatment has failed or is unsuitable. Capecitabine is also recommended as monotherapy when anthracycline and taxane-containing treatment have failed. For patients with metastatic bowel cancer, NICE recommends that capecitabine or tegafur with uracil (Uftoral) should be options for first-line treatment.

Both sets of guidance stress the importance of patient involvement in decisions about treatments. "The patient should be informed about the options and the differences between the medicines so that he or she can be fully involved," NICE says.

In the guidance on use of capecitabine in breast cancer, NICE says evidence suggests that capecitabine combination therapy is likely to be more effective than docetaxel monotherapy for several outcomes. "However, the side effects of combination therapy may be less acceptable, and the final choice of therapy may be influenced by factors such as contraindications and the health and preference of individuals," NICE says.

The guidance for colorectal cancer states that both capecitabine and tegafur with uracil are likely to have clinical effectiveness similar to that of standard chemotherapy (intravenous fluorouracil/folinic acid). It adds that because intravenous regimens may be preferable under certain circumstances, capecitabine and tegafur with uracil should be available as options for treatment rather than as the preferred choices.

The full guidance is available online at www.nice.org.uk.