The Fund's appeal against NICE Appraisal Consultation Document
5 May 2009
The James Whale Fund for Kidney Cancer is appealing against the recently issued NICE Appraisal Consultation Document (ACD) which does not support the use of bevacizumab, temsirolimus, sunitinib (second-line) and sorafenib for the treatment of renal cell carcinoma. This appeal is on the basis that NICE have failed to act fairly and have reached illogical and perverse conclusions, as summarised below. The fund does this on behalf of patients and families who are, or will be affected by kidney cancer.
In this Appraisal Consultation Document the NICE Committee have not enabled the clinician to choose the appropriate therapy for their patient with advanced and/or metastatic renal cell carcinoma under the NHS. The guidance only allows for sunitinib to be prescribed as first-line treatment for patients with advanced and/or metastatic renal cell carcinoma.
Patients for whom sunitinib is not a therapeutic option because of intolerance or co-morbidities (e.g. congestive heart failure, poor nutritional state, impaired mobility, hypertension) and patients who are unsuitable for immunotherapy (due to e.g. organ impairment, presence of hepatic metastases, and contraindications such as liver dysfunction or brain
metastases) are discriminated against and will not have any therapeutic option under the NHS. The equalities statement in the Appraisal Consultation Document is, therefore, untrue since not all patients are affected by the guidance in the same way.
The NICE Committee has not taken into consideration the probability that the drugs under consideration could one day (in the near future) be used in combination with each other to further extend the life expectancy of advanced renal cell carcinoma patients.
The NICE Committee has not considered second-line treatments when first-line treatments fail or the patient is found to be intolerant. The guidance does not allow for second-line treatments to be reimbursed under the NHS.
The NICE Committee was made aware that a large proportion of renal cell carcinoma patients will not benefit from sunitinib as a first-line treatment option and, therefore, have failed to consider the implications of their earlier guidance when considering the remaining drugs evaluated within this Appraisal Consultation Document.
