NHS Scotland's November 2019 Funding Decisions

Nicky Broyd

November 12, 2019

New breast cancer and kidney cancer drugs are among five new medications approved by the Scottish Medicines Consortium (SMC) this month.

Breast Cancer

The SMC accepted Ribociclib (Kisqali, Novartis), used in combination with fulvestrant (Faslodex, AstraZeneca) for post-menopausal women living with advanced breast cancer.

The decision followed a referral through the Patient and Clinician Engagement (PACE) process for rare and end of life conditions. Ribociclib can slow disease progression.

SMC Chairman Dr Alan MacDonald said in a statement: "From the testimonies given by patient groups and clinicians through our PACE process, we know that those with advanced breast cancer value the opportunity to have additional time with family and friends. We hope that our decision on ribociclib will be welcomed by them."

Advanced Renal Cell Carcinoma

PACE was also used for the decision on lenvatinib (Kisplyx Eisai), which was accepted for advanced renal cell carcinoma (RCC) in those previously treated with a vascular endothelial growth factor (VEGF) inhibitor.

Lenvatinib is given together with everolimus (Afinitor, Novartis). Lenvatinib may delay the return of cancer or extend overall survival time.

Dr MacDonald said: "Patients with advanced renal cell carcinoma have to cope with a significant symptom burden as well as coming to terms with their condition. Lenvatinib may provide them with valuable extra time before the disease relapses and for some patients may extend their overall survival time."

Bladder Pain Syndrome

PACE was also used in the approval of pentosan polysulfate sodium (Elmiron, Consilient Health) to treat bladder pain syndrome.

This oral treatment may help avoid the need for medication given via bladder instillation, reduce the need for painkillers, and reduce urinary frequency.

Dr MacDonald said: "For those with bladder pain syndrome, our decision on pentosan polysulfate sodium provides an opportunity to manage their condition and improve their quality of life without recourse to a potentially painful procedure."

Chronic Sialorrhoea

Patients with excessive drooling due to neurological conditions have a new treatment option - clostridium botulinum neurotoxin type A injections (Xeomin, Merz Pharma UK).

Dr MacDonald said: "Our decision to accept clostridium botulinum neurotoxin (Xeomin) means those with sialorrhoea as a result of a neurological disorder may be able to better manage what can be an embarrassing and difficult complication of their condition."

Actinic Keratosis

Imiquimod (Zyclara, Meda Pharmaceuticals) was approved as another option to treat actinic keratosis when other skin treatments are not appropriate.

Non-small Cell Lung Cancer

Despite the PACE process, atezolizumab (Tecentriq, Roche) was rejected for patients with non-small cell lung cancer (NSCLC) that has spread but who have not yet had chemotherapy.

Atezolizumab is given in combination with bevacizumab (Avastin, Roche) paclitaxel (various brands), and carboplatin (various brands).

Dr MacDonald said: "Although the PACE process gives our committee members additional flexibility in their decision making, they were unable to accept atezolizumab for the treatment of NSCLC as the company’s evidence around its benefits when compared to existing treatment options was not strong enough."


The Scottish Health Technologies Group (SHTG) said autologous haematopoietic stem cell transplantation (AHSCT) should be considered as a treatment option for people with highly active relapsing remitting MS (RRMS) who do not respond to disease-modifying therapies.   

There are currently no centres in Scotland offering stem cell treatments for MS but NHS Scotland is required to consider SHTG advice.


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