David Simpson – 2015 Parliamentary Question to the Department of Health

The below Parliamentary question was asked by David Simpson on 2015-02-11.

To ask the Secretary of State for Health, what change there has been in access to colon cancer treatments since 2012.

George Freeman

Since April 2013, NHS England has been the responsible commissioner for chemotherapy and radiotherapy services, together with a number of specialist surgical services, which include some complex urology and colorectal cancer surgeries. Clinical commissioning groups are responsible for the diagnostic pathway and some surgeries for both colorectal and urological cancers.

NHS England routinely commissions a range of anti-cancer drug treatments for both colorectal and prostate cancer. These are drug indications that have either been recommended in National Institute for Health and Care Excellence (NICE) technology appraisal guidance, or have been considered as routine practice in the treatment of these cancers for many years.

NICE is the independent body that assesses the clinical and cost-effectiveness of treatments for routine use in the National Health Service. NICE has recommended the following treatments for prostate cancer through its technology appraisal process since 1 January 2012:

– abiraterone (Zytiga) for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen; and

– enzalutamide (Xtandi) for metastatic hormone‑relapsed prostate cancer previously treated with a docetaxel‑containing regimen.

NICE is in the process of appraising the following treatments:

– sipuleucel-T (Provenge) for the first line treatment of metastatic hormone relapsed prostate cancer;

– degarelix depot (Firmagon) for treating advanced hormone dependent prostate cancer;

– enzalutamide for treating metastatic hormone-relapsed prostate cancer not previously treated with chemotherapy; and

– radium-223 dichloride (Xofigo) for hormone relapsed prostate cancer with bone metastases.

NICE is currently reviewing technology appraisal guidance on cetuximab (Erbitux) and panitumumab (Vectibix) for the first-line treatment of metastatic colorectal cancer and expects to publish updated final guidance on these treatments in April 2016.

In addition to routinely commissioned treatments, the Cancer Drugs Fund (CDF) provides access to other treatments that would not normally be available.

From April 2013, NHS England assumed operational responsibility for the CDF. As of 19 January 2015, the following drugs are available through the national CDF list for the treatment of prostate cancer:

– abiraterone;

– cabazitaxel (Jevtana);

– enzalutamide; and

– radium-223 dichloride.

Cabizitaxel is due to be removed from the national CDF list on 12 March 2015.

The following drugs are also available through the national CDF list for the treatment of colorectal cancer:

– aflibercept (Zaltrap);

– bevacizumab (Avastin);

– cetuximab; and

– panitumumab.

Aflibercept, bevacizumab as a first-line treatment and cetuximab as a second- or third-line treatment with combination chemotherapy are due to be removed from the national CDF list on 12 March 2015.

Since April 2013, there has been progress in meeting the Government’s commitment to increase patient access to inverse planned Intensity Modulated Radiotherapy (IMRT). The success of this planned expansion of access is demonstrated in the increased number of IMRT episodes (patients), which has risen from just over 8,500 per year in 2012-13 to a projected figure of over 25,000 in 2014-15 of which around 40% of these patients are treated with IMRT for prostate cancer.

NHS England has not altered the service specification or published any commissioning policies which have altered those colorectal cancer surgical services that fall within the remit of specialised commissioning.