NICE Says No To Life Saving Treatment For Childhood Bone Cancer

Main Category: Bones / Orthopedics
Also Included In: Cancer / Oncology;  Pharma Industry / Biotech Industry
Article Date: 10 Jul 2010 - 1:00 PDT

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Takeda UK announces that in its draft appraisal the National Institute for Health and Clinical Excellence (NICE) does not recommend the use of Mepact(R) for the treatment of bone cancer (osteosarcoma) in children, adolescents and young adults.(1) This comes following NICE's inability to recommend Mepact(R) due to its strict criteria for cost-effectiveness which does not currently accommodate the assessment of rare, ultra orphan diseases - and despite the fact that Mepact(R) meets many of the criteria for 'Deviating from the Threshold' by the NICE Citizen's Council reviewed by the NICE Board on 20 May 2009.(11) This stated that if the treatment in question is life saving, the patients are children, the intervention will have a major impact on patient's family and the illness is extremely severe and/or rare, then the medicine is of additional value to society and shouldn't have to meet NICE's current cost-effectiveness criteria.(11) In these conditions, Mepact(R) meets all of these criteria.

Chairman of the Bone Cancer Research Trust, Michael Francis, said: "The Trust is astonished by the decision taken by NICE. We really thought that NICE would recognise that Mepact(R) offers the first real opportunity to help these young people. Money seems to be available for treatments that will extend the life of a patient with another type of cancer for a matter of a few months but not when a young life could be extended into a working life, paying taxes, raising a family and contributing to society. Of course we do not begrudge funding for treatment for other cancers, but it seems perverse that we are prepared to let those young people die for the sake of GBP2.5 million - a sum which would dramatically allow more young people to survive. We hope that some means can now be found within the NHS to review how Mepact(R) can help at least some of those with osteosarcoma."

Sarcoma UK is also disappointed by the recommendation from NICE that Mepact(R) should not be funded for the treatment of osteosarcoma in the NHS. Sarcoma UK's director, Roger Wilson, has been an open critic of NICE and its approach to assessing new drugs for rare cancers. He comments: "If we take the decision down to its essentials, this means that NICE is prepared to sacrifice children on its self-justified altar of cost-effectiveness," he said. "I believe that our society has higher moral principles and will not allow an academic process, which has already been shown to be flawed, to take this unprincipled route."

Osteosarcoma is a rare and often fatal form of bone cancer, with approximately 100-150 new patients diagnosed in the UK each year.(4) It is a cancer that is mainly found in children, adolescents and young adults with the average age of patients being 15 years, although children as young as two years have been diagnosed with it.(12) It is usually a highly aggressive disease that can spread to other parts of the body, usually the lungs in about one-fifth of patients.(13) For up to one-third of newly diagnosed patients the cancer will return.(14)

Although Takeda are disheartened with NICE's decision, they want to ensure that the suitable young patients that are diagnosed with osteosarcoma each year are provided with a fighting chance, and will therefore work with NICE through to the end of its appraisal.

There have not been any advances in the treatment of osteosarcoma for more than 20 years,(1) with patients currently being treated with chemotherapy given before and after the tumour has been surgically removed from the bone (resection).(15) Between half and one-third of patients receiving this treatment will not survive beyond five years.(5)

The new bone cancer drug, Mepact(R) can reduce the risk of death by almost one-third(3), which means that it has the potential to save an additional eight lives each year.(3-5)

Leading osteosarcoma expert Professor Ian Lewis, Professor of Cancer Studies at St James University Hospital, Leeds, said of the announcement, "It's a great disappointment and cause for much frustration that we now have another hurdle to get over and I would urge those involved to make Mepact(R) a priority so that we can start saving more young lives. We hope that another avenue be sought to ensure that Mepact(R) can be made available to patients as soon as possible."

References

1. National Institute for Health and Clinical Excellence. Appraisal consultation document - Mifamurtide for the treatment of osteosarcoma. July 2010

2. IDM Pharma's Mepact (Mifamurtide, L-MTP-PE) Receives Approval in Europe for Treatment of Patients with Non-metastatic, Resectable Osteosarcoma.

3. Meyers PA, et al. Osteosarcoma: The Addition of Muramyl Tripeptide to Chemotherapy Improves Overall Survival - A Report From The Chrildren's Oncology Group. J Clin Oncol 2008;26:633-638

4. MattsonJack Epi Data Feb 2009 (Based in the assumption that 56% of sarcoma is osteosarcoma (NCI))

5. Lewis I, et al. Improvement in Histologic Response But Not Survival in Osteosarcoma Patients Treated With Intensified Chemotherapy: A Randomized Phase III Trial of the European Osteosarcoma Intergroup. J Natl Cancer Inst 2007;99:112-28

6. Takeda UK new submission of evidence to NICE: Mifamurtide for the treatment of Osteosarcoma: 10th December 2009

7. The Health and Social Care Information Centre. Statistics on alcohol: England, 2009

. 8. The Health and Social Care Information Centre. Statistics on obesity, physical activity and diet: England, February 2010.

9. The Health and Social Care Information Centre. Prescribing for diabetes in England: Supplement - January 2002 to March 2009.

10. The Health and Social Care Information Centre. Statistics on smoking: England, 2009.

11. NICE Citizen's Council Report on Departing from the Cost Effectiveness Threshold document; Nov 27-29, 2008.

12. Mascarenhas L, Siegel S, Spector L, et al. Malignant Bone Tumours. SEER AYA Monograph, 2002;8:97-109

13. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am 1997;4:973-989

14. Grimer RJ. Surgical options for children with osteosarcoma. Lancet Oncol 2005;6:85-92

15. Bielack S, Carrle D, Casali PG, et al. Osteosarcoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Annals of Oncology, 2009;20(supplement 4);iv 137-iv 139, 2009

Source: Takeda UK LTD

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