Skip to main content

Cancer: Medical Treatments

Volume 479: debated on Monday 1 September 2008

To ask the Secretary of State for Health how many cancer treatments (a) have and (b) have not been considered by the National Institute for Health and Clinical Excellence through the single technology appraisal process since 3 December 2007; and if he will make a statement. (220956)

Since 3 December 2007, the National Institute for Health and Clinical Excellence (NICE) has published guidance on the cancer treatments shown in the table. Information on cancer treatments not considered by NICE is not available.

Treatment

Condition

Process

Publication date

Alimta (pemetrexed disodium)

Mesothelioma

Single technology appraisal

January 2008

Mabthera (rituximab)

Relapsed or refractory Lymphoma (follicular non-Hodgkin’s)

Single technology appraisal

February 2008

Erythropoetin (alpha and beta) and darbepoetin

Cancer-treatment induced anaemia

Multiple technology appraisal

May 2008

Erbitux (cetuximab)

Head and neck cancer

Single technology appraisal

June 2008

To ask the Secretary of State for Health how many (a) new cancer treatments and (b) significant new licensed indications for existing cancer treatments have been referred to the National Institute for Health and Clinical Excellence (NICE) since 3 December 2007; and whether NICE (i) has and (ii) has not initiated a technology appraisal for each. (220957)

The 15th National Institute for Health and Clinical Excellence (NICE) work programme was referred to NICE on 14 December 2007 and included the following six cancer technology appraisals:

lenalidomide in combination with dexamethasone for the treatment of multiple myeloma in people who have received at least one prior therapy;

lapatinib in combination with letrozole for the first-line treatment of metastatic hormone-sensitive breast cancer;

capecitabine for the treatment of advanced pancreatic cancer;

cetuximab for the first-line treatment of metastatic colorectal cancer;

cetuximab for the treatment of advanced non small cell lung cancer; and

ixabepilone for the treatment of metastatic or locally advanced breast cancer.

The 16th work programme was referred to NICE on 20 March 2008 and included the following five cancer technology appraisals:

cetuximab in combination with irinotecan-containing regimens for the treatment of metastatic colorectal cancer following failure of oxaliplatin-containing chemotherapy;

cetuximab in combination with platinum-based chemotherapy for metastatic and/or recurrent squamous cell carcinoma of the head and neck;

intensity modulated radiotherapy for the treatment of head and neck cancer;

intensity modulated radiotherapy for the treatment of breast cancer; and

intensity modulated radiotherapy for the treatment of prostate cancer.

The 17th work programme was referred to NICE on 11 June 2008 and included the following eight cancer technology appraisals:

sorafenib, within its licensed indication for the first line systemic treatment of advanced hepatocellular carcinoma;

eltrombopag within its licensed indication for the treatment of refractory chronic idiopathic (immune) thrombocytopenic purpura;

romiplostim within its licensed indication for the treatment of refractory chronic idiopathic (immune) thrombocytopenic purpura;

mifamurtide within its licensed indications as an adjunct to multi-agent chemotherapy for the treatment of osteosarcoma;

temozolomide within its licensed indication for advanced and metastatic melanoma;

dasatinib within its licensed indication for acute lymphoblastic leukaemia;

topotecan within its licensed indication for the second-line treatment of small cell lung cancer; and

dasatinib and nilotinib within their licensed indications for imatinib-resistant chronic myeloid leukaemia.

We are minded to refer the following nine cancer technology appraisals to NICE as part of the 18th work programme. NICE were asked on 20 March 2008 to consult stakeholders on the remits and scopes for these topics, and the results of that consultation are currently being considered.

bortezomib within its licensed indication for the first line treatment of multiple myeloma;

sunitinib within its licensed indication for the treatment of unresectable and/or metastatic malignant gastrointestinal stromal tumours refractory to imatinib;

topotecan within its licensed indication for the treatment of recurrent and carcinoma of the cervix;

trabectedin within its licensed indication for the treatment of advanced metastatic soft tissue sarcoma;

pemetrexed within its licensed indication for the first line treatment of locally advanced or metastatic non small cell lung cancer;

rituximab within its licensed indication for the first line treatment of chronic lymphocytic leukaemia;

rituximab within its licensed indication for the relapsed treatment of chronic lymphocytic leukaemia;

azacitidine within its licensed indication for the treatment of high risk patients with myelodysplastic syndrome and acute myeloid leukaemia; and

capecitabine within its licensed indication for advanced gastric cancer.

We have recently agreed revisions to the topic selection process to implement the Cancer Reform Strategy (CRS) commitments and NICE’s 19 work programme will be the first to be referred to NICE under the revised arrangements. NICE is currently consulting on the remit and scope for the following 13 cancer treatments as part of the 19th work programme, following which Ministers will be asked to make a final decision on referral of these topics to NICE.

vorinostat for cutanieous T-cell lymphoma;

bevacizumab in combination with fluouropyrimidine for metastatic carcinoma of the colon and rectum;

sunitinib for metastatic breast cancer;

aflibercept for advanced chemo-refractory epithelial ovarian cancer;

arsenic trioxide for promyelocytic leukaemia;

temsirolimus for mantle cell lymphoma relapsed and/or refractory;

bevacizumab for breast cancer;

erlotinib in combination with bevacizumab for advanced or metastatic non-small cell lung cancer;

rituximab for follicular non-Hodgkin’s lymphoma;

vandetanib for thyroid cancer;

vandetanib for non small cell lung cancer;

trastuzumab for gastric cancer; and

trabectedin for relapsed ovarian cancer.

NICE commences work on technology appraisals once a final referral has been made by the Department.

To ask the Secretary of State for Health (1) when chemotherapy providers will begin returning an agreed dataset on all patients receiving chemotherapy, as referred to in paragraph 4.52 of his Department’s Cancer Reform Strategy; what information is captured by the dataset; and if he will make a statement; (220959)

(2) when he expects the National Chemotherapy Advisory Group to have defined the information on chemotherapy to be submitted by NHS trusts to cancer registries.

A small working group is currently scoping the requirements for chemotherapy data alongside a comparison of data items for chemotherapy that are already included within the National Cancer Dataset. Any dataset agreed will also include the requirements of the cancer registration dataset.

It is anticipated, subject to testing and approval by the NHS Information Standards Board, that implementation could begin by the end of 2009.

To ask the Secretary of State for Health what assessment he has made of the robustness of chemotherapy cost data submitted as part of the 2007-08 NHS reference cost collection. (220960)

To ask the Secretary of State for Health how many patients in each (a) cancer network and (b) strategic health authority area received (i) chemotherapy for small cell lung cancer and (ii) chemotherapy for non-small cell lung cancer in each year since 1997-98. (220989)

I have been asked to reply.

The information requested falls within the responsibility of the UK Statistics Authority. I have asked the Authority to reply.

Letter from Karen Dunnell, dated 1 September 2008:

As National Statistician, I have been asked to reply to your recent parliamentary question asking how many patients in each (a) cancer network and (b) strategic health authority area received (i) chemotherapy for small cell lung cancer and (ii) chemotherapy for non-small cell lung cancer in each year since 1997-98. [220989]

The latest year for which data are available on the national cancer registry database, which ONS operates on behalf of the Department of Health, is 2005. Tables 1 and 2 show the number of cases of small and non-small cell lung cancer, newly diagnosed in each of the years 1997-2005 in the specified geographical areas, initially receiving chemotherapy. In 55 per cent. of lung cancer cases in the database, either no treatment information was recorded or patients were recorded as having had no treatment. 10 per cent. of cases was recorded as receiving more than one treatment.

Table: 1 Registrations of newly diagnosed cases of small cell lung cancer1 receiving chemotherapy treatment2, by strategic health authority and Cancer Network3, England, 1997-2005

1997

1998

1999

2000

2001

2002

2003

2004

2005

England

1,614

1,785

1,896

2,035

1,836

1,647

1,634

1,750

1,727

Strategic Health Authority

North East

131

248

259

255

201

210

218

223

227

North West

257

219

282

296

248

148

239

264

248

Yorkshire and the Humber

275

304

272

315

273

298

272

271

253

East Midlands

92

99

116

129

101

97

94

91

85

West Midlands

145

162

180

192

180

159

141

167

156

East of England

172

200

188

193

213

170

159

203

173

London

228

235

231

291

250

220

228

200

230

South East Coast

118

142

132

137

123

136

116

130

131

South Central

66

67

77

112

96

75

68

56

77

South West

130

109

159

115

151

134

99

145

147

Cancer network

3 Counties

23

19

17

27

26

24

20

32

26

Anglia

83

94

85

98

103

90

83

110

96

Arden

28

34

38

39

32

24

43

43

25

Avon, Somerset and Wiltshire

38

29

51

29

36

29

24

60

50

Central South Coast

6

12

29

34

34

23

12

22

22

Derby/Burton

13

9

12

12

14

13

13

11

9

Dorset

11

8

12

17

31

23

12

26

27

Essex

49

62

59

56

64

55

47

59

48

Greater Manchester and Cheshire

194

140

140

156

141

67

138

161

141

Greater Midlands

42

56

71

78

71

75

47

59

81

Humber and Yorkshire Coast

59

60

68

63

51

58

64

70

65

Kent and Medway

63

55

65

58

52

57

47

49

62

Lancashire and South Cumbria

48

63

58

67

65

64

81

88

81

Leicestershire Northants and Rutland

37

45

51

39

42

33

29

38

34

Merseyside and Cheshire

3

2

65

53

26

11

5

6

14

Mid Trent

41

39

41

54

33

40

44

37

26

Mount Vernon

33

31

34

31

33

17

21

25

17

North East London

50

58

54

62

52

48

62

45

40

North London

36

59

53

50

46

46

39

37

44

North of England

154

273

286

284

220

227

248

234

247

North Trent

40

40

36

51

41

50

35

34

35

Pan Birmingham

65

59

61

62

62

45

38

40

36

Peninsula

62

58

78

46

62

65

45

35

50

South East London

64

60

52

79

59

50

50

44

74

South West London

51

49

58

72

55

46

47

55

48

Surrey, West Sussex and Hampshire

24

30

32

35

35

29

25

34

30

Sussex

27

47

27

37

31

38

37

34

29

Thames Valley

59

65

57

85

68

57

66

50

62

West London

41

28

30

42

55

48

41

36

44

Yorkshire

170

201

176

219

196

195

171

176

164

1 Lung cancer is coded to C34 in the International Classification of Diseases Tenth Revision (ICD-10)

2 More than one type of treatment was recorded for some cases.

3 Cancer Network boundaries as at January 2008.

Source:

Office for National Statistics

Table 2: Registrations of newly diagnosed cases of non-small cell lung cancer1 receiving chemotherapy treatment2, by strategic health authority and Cancer Network3, England, 1997-2005

1997

1998

1999

2000

2001

2002

2003

2004

2005

England

1,377

1,745

2,124

2,524

2,78

2,841

3,38

4,202

4,632

Strategic Health Authority

North East

59

136

137

196

229

271

304

365

462

North West

141

215

351

354

358

225

409

774

671

Yorkshire and the Humber

112

148

116

183

230

293

395

438

539

East Midlands

61

92

128

172

144

144

159

227

236

West Midlands

194

224

277

262

267

297

309

343

393

East of England

136

168

186

250

311

406

427

437

555

London

348

386

430

493

514

541

661

707

697

South East Coast

158

172

195

263

281

310

309

392

364

South Central

54

81

114

129

136

123

121

161

257

South West

114

123

190

222

312

231

289

358

458

Cancer network

3 Counties

8

12

24

19

41

25

46

68

88

Anglia

59

88

101

152

167

220

242

269

314

Arden

30

44

30

55

48

71

67

91

38

Avon, Somerset and Wiltshire

37

42

58

72

88

65

65

125

161

Central South Coast

14

25

62

54

56

53

25

34

87

Derby/Burton

6

8

8

2

6

16

21

43

36

Dorset

5

7

27

30

48

46

64

72

83

Essex

50

49

52

68

101

124

130

114

151

Greater Manchester and Cheshire

113

173

198

220

255

125

265

576

479

Greater Midlands

34

54

80

80

112

96

128

120

175

Humber and Yorkshire Coast

19

21

35

51

62

68

87

103

116

Kent and Medway

83

93

88

136

119

152

130

177

155

Lancashire and South Cumbria

29

34

62

46

57

58

104

153

147

Leicestershire Northants and Rutland

37

52

69

112

85

79

67

88

102

Merseyside and Cheshire

0

7

87

83

37

21

13

17

21

Mid Trent

15

26

37

44

38

39

62

85

68

Mount Vernon

13

17

24

21

28

33

39

34

65

North East London

65

59

88

118

126

130

161

161

145

North London

70

79

95

71

89

119

120

123

129

North of England

61

139

143

209

244

294

335

409

503

North Trent

9

17

22

31

38

49

70

74

78

Pan Birmingham

123

117

152

118

93

108

88

76

127

Peninsula

68

70

79

102

133

97

115

109

144

South East London

83

106

85

100

133

140

145

167

185

South West London

113

112

119

157

125

122

144

146

144

Surrey, West Sussex and Hampshire

38

43

60

64

77

81

91

98

90

Sussex

25

18

34

41

62

55

71

92

91

Thames Valley

42

57

68

84

88

81

108

146

193

West London

41

61

64

76

83

82

128

152

148

Yorkshire

87

115

73

108

143

192

252

280

369

1 Lung cancer is coded to C34 in the International Classification of Diseases Tenth Revision (ICD-10)

2 More than one type of treatment was recorded for some cases.

3 Cancer Network boundaries as at January 2008.

Source:

Office for National Statistics