Bevacizumab (first-line), sorafenib (first-and-second-line), sunitinib (second-line) and temsirolimus (first-line) for the treatment of advanced and/or metastatic renal cell carcinoma

On 28 April 2009, the National Institute for Health and Clinical Excellence (NICE) issued final guidance in which it did not recommend the above drugs for people with advanced and/or metastatic renal cell carcinoma.  The decision was challenged in a number of appeals which were heard on 13 July 2009.  Rarer Cancers Forum appealed jointly with Macmillan Cancer Support.

Today NICE has issued the result of the appeals.  It has dismissed them all.  Rarer Cancers Forum is bitterly disappointed that NICE has now issued its final guidance in which it states that:

• Bevacizumab, sorafenib and temsirolimus are not recommended as first-line treatment options for people with advanced and/or metastatic renal cell carcinoma.
• Sorafenib and sunitinib are not recommended as second-line treatment options for people with advanced and/or metastatic renal cell carcinoma.

This decision will not affect patients already receiving these treatments.  NICE states that people who are currently being treated with bevacizumab (first-line), sorafenib (first- and second-line), sunitinib (second-line) and temsirolimus (first-line) for advanced and/or metastatic renal cell carcinoma should have the option to continue their therapy until they and their clinicians consider it appropriate to stop.

Commenting on the announcement of NICE’s decision, Stella Pendleton, Executive Director of the Rarer Cancers Forum, said:

“This a deeply disappointing decision and a bitter blow for patients and their families.  It’s harrowing for them to know that effective treatments are available but they can’t get them on the NHS.

“NICE recommends further research and highlights a number of kidney cancer drug trials which are currently actively recruiting patients.  This is a way in which patients may be able to gain access to new treatments. 

“This guidance will be considered for review by June 2011.  Rarer Cancers Forum strongly believes that review of the guidance and reversal of this decision cannot come fast enough for the many kidney cancer patients in desperate need of a wider range of treatment options”. 

NOTE
NICE makes a number of recommendations for further research in this area and draws attention to a number of ongoing trials which are actively recruiting participants and which are relevant to this appraisal.  Some of these trials are investigating the optimum sequences of treatment. Full details of ongoing research can be found at NIHR Clinical Research Network Coordinating Centre, ClinicalTrials.gov and Current Controlled Trials.