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Access to new treatment – immunotherapy availability in the UK
If people know you have been affected by lung cancer, they might tell you about what they
hear in the news about developments in cancer treatment and new drugs. Media coverage
does not always include the details of what treatments are available in the UK and what
particular groups of people may benefit from them.
One of the big topics in the news in the last year has been immunotherapy and how this can
help people with lung cancer. People often ask us about this on our helpline and online
forum.
Research into the benefits of these new drugs is happening now to find out who responds
best to treatment, and at what point in their treatment cycle it works most effectively.
Once you know about these new treatments, you may wonder why you are not getting
them, and feel let down or even angry that what you see as the best possible treatment is
not being made available to you or someone you care for.
At Roy Castle Lung Cancer Foundation we are campaigning for patients across the UK to
get the best possible treatment at a price that is affordable to the NHS.
We are currently monitoring the progress of nivolumab (brand name Opdivo®), the first
available immunotherapy drug.
The process of making a new drug available to patients is complicated, and nivolumab is
currently being considered for treating patients with two different types of lung cancer.
These are:


non-small cell squamous lung cancer, and
non-small cell non-squamous lung cancer
Separate treatment approval is needed for each type of cancer, and the approval processes
are currently at different stages.
Current availability
The Scottish Medicines Consortium (SMC) has completed its evaluation of nivolumab for
those who have stage 4, or advanced, squamous non-small cell lung cancer. It is
recommended that this drug be made available for people treated in Scotland.
The Scottish Medicines Consortium (SMC) is also looking at whether nivolumab can be
made available treat people with stage 4, or advanced, non-small cell, non-squamous lung
cancer who have had chemotherapy. A decision will be made within a few months.
The National Institute for Clinical and Health Care Excellence (NICE) is currently1 looking
at the use of nivolumab to treat people with stage 4, or advanced, non-small cell squamous
lung cancer who have had chemotherapy. It is also looking at the use of nivolumab to treat
people with stage 4, or advanced, non-small cell non squamous cancer. It is also considering
the drug’s clinical and cost effectiveness.
A decision to approve the drug would make it available to people with that type of lung
cancer having treatment in NHS England. A provisional decision was made, which was
negative on cost effectiveness and affordability for the NHS. Comments have been sought
and we are waiting to hear more in the next few weeks.
NICE is also looking at another immunotherapy agent, pembrolizumab ( brand name
Keytruda ® ,which is being considered to treat people with stage 4, or advanced, non-small
cell which is PDL1 receptor positive. If approved pembrolizumab will be available to people
with non-small cell lung cancer who were treated with combination chemotherapy and
where their cancer is now spreading/ growing. Access to pembrolizumab will require a test
for a biologicial marker, PDL-1. We are waiting for NICE’s provisional decision on this.
The health departments in Wales and Northern Ireland assess availability of medicines,
taking into account NICE decisions.
How might you be treated with nivolumab if you live in Scotland and have stage
4 squamous non small cell lung cancer?
Your clinical team will assess whether this treatment may be of benefit to you. Treatment
with nivolumab would mean that you attend hospital for an infusion, which takes about an
hour, once a fortnight.
Your medical team will monitor you and carry out scans to see if the treatment is working
on your cancer. They will also monitor any side effects that the treatment may cause.
Research suggests that approximately 2 people out of every 10 with this kind of lung cancer
may benefit from taking nivolumab after chemotherapy. For those who respond to the
treatment the research suggests a median increase in survival of three months.
About immunotherapy
Immunotherapy drugs are designed to stimulate the body’s own immune system to:



1
kill cancer cells
stop cancer cells spreading
shrink the tumour
As at July 2016
Drugs have been licensed for those with melanoma and are being looked at for a number of
other cancers; including lung cancer. A number of drug companies are currently researching
and developing immunotherapy drugs that may be used with people affected by lung cancer.
Immunotherapy is unlikely to be appropriate for everyone with lung cancer. Like many
treatments it has side effects. The benefits of treatment have to be assessed for each
possible patient.
What to do if you wish to access immunotherapy treatment
In the first instance your doctor or consultant oncologist should be able to advise you on
whether immunotherapy might be a treatment that is suitable for you.
Treatment using an immunotherapy drug may currently be available through the EAMS
(Early Medicines Access Scheme) for pembrozilumab.
Clinical trials involving a range of immunotherapy agents, including nivolumab and
pembrozilumab are currently underway. Trials information is made available on a number of
sites listed below.
Further information
http://www.cancerresearchuk.org/about-cancer/type/lung-cancer/treatment/lung-cancerresearch/whats-new-in-lung-cancer-research#nivolumab
https://www.nice.org.uk/guidance/GID-TAG506/documents/appraisal-consultation-document
https://www.nice.org.uk/guidance/indevelopment/gid-ta10010/documents
https://www.ukctg.nihr.ac.uk/
http://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial