Intended for healthcare professionals


NICE and the challenge of cancer drugs

BMJ 2009; 338 doi: (Published 13 January 2009) Cite this as: BMJ 2009;338:b67

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


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

Competing interests: No competing interests

31 January 2009
Terry J Hamblin
Visiting Professor of Immunohaematology
SO16 6YD