FROM LONDON DAILY TELEGRAPH...Kidney patients denied 'too expensive'life-extending drugs

Kidney patients denied 'too expensive' life-extending drugs
Cancer patients are to be denied drugs which could keep them alive
after the NHS rationing watchdog ruled that they are too expensive.


By Kate Devlin. Medical Correspondent
Last Updated: 10:50AM BST 07 Aug 2008

Comments 26 | Comment on this article
James Whale, the broadcaster who was diagnosed with kidney cancer in
2000
James Whale, the broadcaster who was diagnosed with kidney cancer in
2000, has urged Nice to think again Photo: ROGER TAYLOR

Patient groups said the decision, announced today by the National
Institute for Health and Clinical Excellence (Nice), would condemn
many sufferers of kidney cancer to an "early death".

The four prohibited medicines include Sutent, which can prolong life
in kidney cancer patients by up to two years. The draft guidance also
rejects Avastin, Nexavar and Torisel.

Nice said the drugs were too expensive, at about £24,000 a year per
patient, for the benefits they offered and would mean the health
service was less able to afford more cost-effective drugs for other
illnesses. However, the decision reignites the debate around how the
NHS prioritises which drugs are approved for use.

It comes just a week after Andrew Dillon, the chief executive of Nice,
said smokers and the obese should not be denied NHS medication because
of their lifestyle.

Following Nice's latest decision, one surgeon said there would be no
point in accepting kidney cancer patients if he was not able to
prescribe Sutent because so few respond to other treatments.

Prof John Wagstaff, from the South West Wales Cancer Institute, in
Swansea, said: "The possibility that we clinicians may be prevented
from offering Sutent to our patients is an outrage.

"This decision will mean that the UK will have the poorest survival
figures [for the cancer] in Europe."

Prof Peter Littlejohns, Nice's clinical and public health director,
said: "Although these treatments are clinically effective, regrettably
the cost to the NHS is such that they are not a cost-effective use of
NHS resources." He added that the organisation had to make some of the
"hardest" decisions in public life.

Around 7,000 patients are diagnosed with kidney cancer in Britain
every year. The disease progresses to the advanced stage in around
1,700 cases annually.

Approximately 3,600 patients in Britain would be eligible for Sutent,
which acts against the growth of advanced kidney cancer and is
available more widely in France and Germany.

Campaigners said patients would be left with just one other option,
Interferon, but many sufferers do not respond to the drug. Otherwise
they would have to pay for the drugs privately.

Nice previously faced controversy over its advice that Herceptin, the
breast cancer drug, could only be used for advanced cases. Following a
sustained campaign and legal battles the drug was allowed for early
stages of the disease.

In May, the Court of Appeal ruled that Nice had been procedurally
unfair in refusing to give anti-dementia medicines such as Aricept,
costing about £2.50 a day, to thousands of Alzheimer's patients. They
have so far been denied the medicines, and are awaiting Nice's
economic reasoning.

James Whale, the broadcaster who was diagnosed with kidney cancer in
2000, said Sutent had given many families "hope for the future" and
urged Nice to think again.

He said: "If final guidance remains as it currently stands it will
certainly mean an early death sentence for many."

Some local health care trusts have been offering the drug to small
numbers of patients.

William James Lloyd, 62, was given Sutent after being diagnosed with
cancer three years ago, and says it allowed him to see the birth of
his two youngest grandchildren.

The retired headmaster from Llanddewi Brefi in Ceredigion, west Wales,
said: "This drug has let me live to see things I could not have seen
otherwise."

Nice does not intend to offer a final decision until January. Patients
already on the medication should continue to receive the drugs until
they and their doctor think it is appropriate to stop treatment,
according to the guidance.

Pat Hanlon, from Kidney Cancer UK, said that the decision would have a
"devastating impact on patients"

"sheder1" <turtletrot1@bellsouth.net> wrote in message
news:beb31471-53f6-45c3-8773-fec3eae57d11@59g2000hsb.googlegroups.com...

Kidney patients denied 'too expensive' life-extending drugs
Cancer patients are to be denied drugs which could keep them alive
after the NHS rationing watchdog ruled that they are too expensive.


By Kate Devlin. Medical Correspondent
Last Updated: 10:50AM BST 07 Aug 2008


Patient groups said the decision, announced today by the National
Institute for Health and Clinical Excellence (Nice), would condemn
many sufferers of kidney cancer to an "early death".

The four prohibited medicines include Sutent, which can prolong life
in kidney cancer patients by up to two years. The draft guidance also
rejects Avastin, Nexavar and Torisel.

Nice said the drugs were too expensive, at about £24,000 a year per
patient, for the benefits they offered and would mean the health
service was less able to afford more cost-effective drugs for other
illnesses. However, the decision reignites the debate around how the
NHS prioritises which drugs are approved for use.

Following Nice's latest decision, one surgeon said there would be no
point in accepting kidney cancer patients if he was not able to
prescribe Sutent because so few respond to other treatments.

Prof John Wagstaff, from the South West Wales Cancer Institute, in
Swansea, said: "The possibility that we clinicians may be prevented
from offering Sutent to our patients is an outrage.

"This decision will mean that the UK will have the poorest survival
figures [for the cancer] in Europe."

Prof Peter Littlejohns, Nice's clinical and public health director,
said: "Although these treatments are clinically effective, regrettably
the cost to the NHS is such that they are not a cost-effective use of
NHS resources." He added that the organisation had to make some of the
"hardest" decisions in public life.

Around 7,000 patients are diagnosed with kidney cancer in Britain
every year. The disease progresses to the advanced stage in around
1,700 cases annually.

Approximately 3,600 patients in Britain would be eligible for Sutent,
which acts against the growth of advanced kidney cancer and is
available more widely in France and Germany.

Campaigners said patients would be left with just one other option,
Interferon, but many sufferers do not respond to the drug. Otherwise
they would have to pay for the drugs privately.

Nice previously faced controversy over its advice that Herceptin, the
breast cancer drug, could only be used for advanced cases. Following a
sustained campaign and legal battles the drug was allowed for early
stages of the disease.




Pat Hanlon, from Kidney Cancer UK, said that the decision would have a
"devastating impact on patients"




According to the Western Mail,Cardiff, it is Prof.John Wagstaff
who says "there would be no point in accepting kidney cancer
patients if he was not able to prescribe Sutent because
so few respond to other treatments" not "one surgeon" as stated
in the Telegraph.
this is what the Western Mail says:

'Prof John Wagstaff from the South Wales Cancer Institute
said there was "no Point" in him (sic) now acccepting
referrals for people with advanced kidney cancer as about
75% of them "Do not gain any real benefit" from interferon.'.

He also says:

'The possibility that we clinicians may be prevented from
offering
Sutent to our patients is an outrage ... ...'.

Prof Wagstaff is talking about turning patients away when 25% of them
will benefit from the current treatment which he has to offer.
Thus he condemns one third of them to premature death.

So where does the 'outrage' lie?

Old Bill

"Old Bill" <matbeta@yahoo.com> wrote in message
news:g7fgit$gnl$1@news.datemas.de...
|
| "sheder1" <turtletrot1@bellsouth.net> wrote in message
| news:beb31471-53f6-45c3-8773-fec3eae57d11@59g2000hsb.googlegroups.com...
|
| Thus he condemns one third of them to premature death.
|
| So where does the 'outrage' lie?
|
| Old Bill
|
| Sorry,should have been one quarter not one third.
Old Bill

Old Bill wrote:

> "sheder1" <turtletrot1@bellsouth.net> wrote in message
> news:beb31471-53f6-45c3-8773-fec3eae57d11@59g2000hsb.googlegroups.com...
>
> Kidney patients denied 'too expensive' life-extending drugs
> Cancer patients are to be denied drugs which could keep them alive
> after the NHS rationing watchdog ruled that they are too expensive.
>
> By Kate Devlin. Medical Correspondent
> Last Updated: 10:50AM BST 07 Aug 2008
>
> Patient groups said the decision, announced today by the National
> Institute for Health and Clinical Excellence (Nice), would condemn
> many sufferers of kidney cancer to an "early death".
>
> The four prohibited medicines include Sutent, which can prolong life
> in kidney cancer patients by up to two years. The draft guidance also
> rejects Avastin, Nexavar and Torisel.

http://www.bccancer.bc.ca/HPI/Cancer...nt/default.htm

# Chemotherapy, such as vinblastine or other chemotherapy agents, is not
recommended.
# Interferon-alpha has proven superiority over medroxyprogesterone acetate
within a randomized trial in patients with metastatic RCC. Interferon-alpha
provides response rates of 6-15% resulting in a modest survival benefit of 3-4
months. Single patients with long term survival have been reported. Only good
prognosis patients appear to benefit, so generally, only highly selected RCC
patients with good prognosis features should be considered for interferon. This
includes patients with clear cell histology, good performance status, a
progression-free interval following initial diagnosis of more than 1 year and
preferably lung metastases as the sole metastatic site.
# Other cytokines such as interleukin or cytokine combinations such as
interferon plus interleukin have not shown significant benefit in randomized
trials or have not been validated compared to best supportive care in
randomized trials.
# Patients that have had nephrectomy with a good disease-free interval and are
found to have asymptomatic recurrence.(e.g. small lung metastases) may also be
observed without treatment. Such a period of observation can be very prolonged
in selected patients. This allows a better knowledge of the tempo of the
disease and is associated with a better quality-of-life than any of the
systemic treatments. This appears to be a safe alternative to immediately
starting treatment as long as patients remain under close observation.
Treatment should be initiated upon progression.

http://www.manchestereveningnews.co...._sutent_battle
Last summer broadcaster Tony Wilson, who later died of a heart attack, had to
rely on showbiz friends to pay for the drug because health bosses wouldn't
approve the treatment.

Salford Primary Care Trust said that a small number of studies on the
effectiveness of Sutent, indicate that for the majority of patients - around 60
per cent - the drug had no effect in delaying the progression of cancer.

In 40 per cent of sample studies, there was an indication that the progression
of the disease was delayed typically, for eight months.

The Trust says that while Sutent is an advance in the treatment of Mrs Murphy's
type of cancer, it does not provide a cure to what is inevitably, a terminal
condition.

It says the Trust is investing new money into cancer services for Salford
people, including £1.5 million for services at Christie, £700,000 at local
hospitals and £430,000 on breast cancer screening.

By funding Sutent treatment, it says the Trust would have make choices about
which other services not to fund.

<http://uk.reuters.com/article/health...26236020080213. >
Pfizer's Sutent causes heart failure in some: study
Wed Feb 13, 2008 2:00

WASHINGTON (Reuters) - Fifteen percent of patients who took Sutent, a pill used
to treat kidney and stomach cancers, developed heart failure, U.S. researchers
reported on Wednesday.

The study, presented at a meeting of cancer specialists, confirmed other
studies that suggest the drug causes the risky but reversible side-effect.

"Cardiac adverse effects need to be carefully examined in future trials of
sunitinib to determine the factors that place patients at risk for this
complication. That information will allow us to administer this medication more
safely to patients for whom the benefits of treatment clearly outweigh the
risks."

While heart failure is serious, it can be treated with a variety of drugs. When
caused by drugs, stopping the medication usually clears up the problem.

Her team studied 48 patients with kidney cancer or gastrointestinal stromal
tumor (GIST) who got Sutent. Seven of them, or 15 percent, experienced heart
failure, a chronic condition in which the heart loses its ability to pump blood
properly, she told the American Society of Clinical Oncology meeting.

Sutent works by starving tumors -- it stops them from growing blood vessels to
feed themselves. It is being widely tested for the treatment of several other
cancers.

In December, researchers reported in the medical journal Lancet that half of 75
patients with GIST who took the drug in a clinical trial developed high blood
pressure, 8 percent developed heart failure, and two had heart attacks.

J, no> wrote:

> Old Bill wrote:
>

Apology to Bill. I (apparently)picked the wrong post to reply to (and snipped the rest) .
J