New breast and lung cancer treatments approved in Scotland

A breast cancer cell

3 new cancer treatments have now been approved by the Scottish Medicines Consortium (SMC) for use on the NHS in Scotland, but a fourth has been rejected.

The approved treatments are:

  • Osimertinib (Tagrisso) to treat adults with advanced non small cell lung cancer (NSCLC) that tests positive for a faulty version of a molecule called EGFR;
  • Tucatinib (Tukysa) in combination with the cancer drugs trastuzumab and capecitabine to treat adults with advanced HER2-positive breast cancer who have already received at least 2 anti-HER2-based treatments;
  • Trastuzumab deruxtecan (Enhertu) has also been provisionally approved to treat adults with advanced HER2-positive breast cancer who have already received at least 2 anti-HER2-based treatments and who couldn’t receive surgery. The drug is now available to these patients but is subject to ongoing evaluation and will be reassessed when more information is available.

The immunotherapy drug nivolumab (Opdivo) in combination with ipilimumab (Yervoy) and platinum-based chemotherapy was rejected as a treatment option for non small cell lung cancer that’s spread to another part of the body.

“We were unable to accept nivolumab as the evidence provided by the company was not strong enough to satisfy the committee of its cost effectiveness,” said Mark MacGregor, chairman of the SMC.

New options for an aggressive breast cancer

Around 2 in 10 breast cancers test positive for a protein called HER2, which encourages cancer growth and makes the disease more aggressive. New treatments are needed for people who don’t respond to what’s currently available.

Tucatinib specifically targets HER2, helping slow or stop cancer cells from growing. A trial showed that those who received the drug in combination with the cancer drugs trastuzumab and capecitabine lived for longer without their disease progressing compared to a placebo.

Whilst now approved for use on the NHS in Scotland, this combination is not yet cleared for use in NHS England.

The second treatment to be approved, trastuzumab deruxtecan, works differently to tucatinib. It combines 2 drugs, using trastuzumab to attach to HER2 proteins on cancer cells and then delivering the antibody drug deruxtecan directly into the breast cancer cells to kill them.

“This medicine is a breakthrough treatment for people with HER2 positive breast cancer that can’t be removed by surgery, or whose cancer has spread,” said David Ferguson, public affairs manager for Cancer Research UK in Scotland.

“Recent and ongoing studies suggest that the drug could give patients with HER2 positive breast cancer more time before their disease progresses. Today’s decision means people will have early access to this promising new medicine while the Scottish Medicines Consortium gathers further evidence in advance of its final decision.”

Whilst current evidence is promising, it comes from a trial that did not compare the treatment to either a placebo or another treatment, meaning it’s not clear whether it’s better than existing treatments.

The drug will be subject to ongoing evaluation and the SMC will consider further evidence on its effectiveness when it’s available.

A new option for Scotland’s most common cancer

The targeted drug osimertinib was the third cancer treatment approved in the latest batch of SMC decisions.

“Scotland is the only part of the UK where lung cancer is the most common cancer. It’s great news that a better treatment option is being made available for people with advanced forms of the disease,” said Ferguson.

Around 10% of non small cell lung cancers, the most common type of lung cancer, have a genetic error that means they produce a faulty version of a molecule called EGFR, which drives the growth of the cancer cells. Osimertinib works by blocking this faulty EGFR molecule, helping to stop the cancer from growing and spreading.

A trial showed that the drug improved the amount of time that adults with EGFR-positive advanced non small cell lung cancer lived for without their cancer growing significantly compared to 2 other drugs that target EGFR.

In making their decision, the SMC also considered that osimertinib may have fewer side effects than existing drugs.

The decision to approve osimertinib will be “welcome news for patients and their families in Scotland,” said Ferguson.

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