Time To Stop Hiding Behind The Skirts of NICE—The UK Renal Cell Carcinoma Expert

Sunitinib and sorafenib uptake

Lapatinib (Tyverb, GlaxoSmithKline), an oral tyrosine kinase inhibitor for the treatment of breast cancer, was placed on the NICE assessment list before a licence was granted. Originally due to be reviewed in October 2007, the NICE assessment process then had to be postponed because the UK licence has taken longer to be granted than expected (UK approval now granted in June 2008). Contrast this scenario with that of the oral targeted agents sorafenib (Nexavar, Bayer) and sunitinib (Sutent, Pfizer). These oral drugs were licensed over the summer of 2006 by the European Medicines Evaluation Agency for use throughout the EU for the treatment of advanced or metastatic renal cell carcinoma. Their licensing represents excellent news, since their clinical effectiveness far outweighs that of alternative treatments (namely interferon alpha and interleukin 2),^3-9 which are more difficult to administer and make only a small impression on the course of the disease.¹⁰ Both have been adopted as standards of care in many countries worldwide. However, without NICE endorsement (not expected until 2009—after the review of lapatinib will have taken place), uptake in the UK of these two novel drugs has been poor for the reasons stated above. The pressure on clinicians to prescribe sorafenib and sunitinib will continue to grow, and, with no effective alternative treatment options available, arguments against their use will be increasingly difficult to muster or, indeed, defend. As such, those treating renal cell cancer are compelled to fight for access to sorafenib and sunitinib for their patients. With approximately 6,600 patients a year developing kidney cancer in the UK, and half of those either presenting with or going on to develop metastatic disease, this is quite an undertaking.¹¹

 

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