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ANALYSIS:
James Raftery
NICE and the challenge of cancer drugs
BMJ 2009; 338: b67 [Full text]
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[Read Rapid Response] Cancer drugs too challenging?
Terry J Hamblin   (31 January 2009)

Cancer drugs too challenging? 31 January 2009
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Terry J Hamblin,
Visiting Professor of Immunohaematology
SO16 6YD

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Re: Cancer drugs too challenging?

One could take Professor Raftery's views on cancer drugs more seriously if he got the names of the diseases right. His table refers to Lenalidomide being used for a condition called 'multiple myeloid leukaemia'. No such condition exists. Presumably he was trying to think of multiple myeloma for which the pharmaceutical company and NICE have subsequently come to a compromise agreement on.

He also misrepresents NICE's position on the use of fludarabine for what he calls 'lymphocytic leukaemia' - presumably 'chronic lymphocytic leukaemia'. Nobody disputed the fact fludarabine as a single agent offered no advantage over chlorambucil (a meta-analysis by the Cochrane Collaboration told us so [1]); the point was that the combination of fludarabine and cyclophosphamide offered a very considerable advantage over chlorambucil [2], but NICE refused or was unable to consider the advantage of the combination because the drug company did not hold a license for fludarabine to be used in combination. In any event NICE's views did not matter since PCTs sensibly accepted the views of their haematologists that the combination of fludarabine and cyclophosphamide was at that time the treatment of choice for chronic lymphocytic leukaemia.

References:

1. Steurer M, Pall G, Richards S, Schwarzer G, Bohlius J, Greil R; Cochrane Haematologic Malignancies Group. Single-agent purine analogues for the treatment of chronic lymphocytic leukaemia: a systematic review and meta-analysis. Cancer Treat Rev. 2006 ;32:377-89.

2. Catovsky D, Richards S, Matutes E et al. Assessment of fludarabine plus cyclophosphamide for patients with chronic lymphocytic leukaemia (the LRF CLL4 Trial): a randomised controlled trial. Lancet. 2007; 370:230-9.

Competing interests: None declared