Published: 21/03/2002, Volume II2, No. 5797 Page 8 9

Leading cancer specialists have written to health secretary Alan Milburn this week, urging him to undertake an urgent review of the decision by the National Institute for Clinical Excellence to restrict severely the use of a cancer drug.

Twenty-seven experts have signed a letter which asks Mr Milburn to review immediately the decision on the use of the drug Irinotecan to treat colorectal cancer.

The drug is now standard treatment across the continent and the US. But NICE has recommended that Irinotecan should be used only as a second-line treatment for patients where treatment with an older drug for bowel cancer has failed. Irinotecan in combination with the older drug, 5FU, was not recommended as routine treatment 'on the basis of insufficiently robust evidence of their clinical and cost-effectiveness'.

Cancer specialists have questioned the wisdom of this decision and are outraged that NICE has dismissed the evidence supporting the use of Irinotecan as part of routine treatment.

Dr David Cunningham of the Royal Marsden trust in London said: 'The evidence supporting the use of this drug as part of first-line treatment is very strong.'

Colorectal cancer is the second biggest cause of cancer-related deaths in the UK. Survival figures for colorectal cancer in the UK are already lagging behind the rest of Europe and the US. In the UK, around 38 per cent of people with the illness are still alive after five years. But in the rest of Europe, the five-year survival rate is 45 per cent and in the US it is 65 per cent.

Dr Mark Saunders, consultant clinical oncologist at Christie Hospital trust in Manchester, believes NICE's decision was influenced largely by economic rather than clinical arguments.

'This decision is a case of cost considerations prevailing over clinical judgement and patient care.'

He said NICE's recommendations would mean worse care for a third of patients who do not respond to the older drug and will not be fit enough to receive Irinotecan. 'This means we are being asked to leave offering the best treatment until it is too late for a substantial proportion of our patients, ' said Dr Saunders.

Cancer specialists argue that Irinotecan in combination with 5FU should be available as a firstline treatment because it lengthens survival rates. Studies have shown that combination treatment leads to an average survival of 15-17 months, compared with 10-12 months for 5FU treatment alone.

Dr Saunders added: 'This may not seem like much of an increased benefit, but I want to be able to offer the best to my patients, and if you had colorectal cancer which drugs would you want?'

Dr Saunders claims that adhering to the NICE guidance will lead to increased use of resources.

'Giving patients a combination of the best treatment available uses up less resources then giving patients second-class treatment, then offering them the best when that has failed.'

NICE this week approved the use of Trastuzumab (Herceptin) for specific types of advanced breast cancer.

Cancer patients in Scotland are facing 'unacceptably long' delays for radiotherapy, according to reports this week from an official standards watchdog.

Not a single hospital meets the government standard of providing radiotherapy treatment within four weeks for 70 per cent of patients, warned the Clinical Standards Board for Scotland.

The findings on breast and ovarian cancer are the first detailed review of cancer services, and are based on standards published in January 2001.Review teams assessing hospitals against the standards were encouraged by some moves, such as one-stop breast clinics.

However the CSBS points out that the outlook for ovarian cancer, which presents at a late stage in 60 per cent of cases, is less 'favourable', and expresses concern about delays diagnosing the cancer. The reports also show that chemotherapy services are 'stretched' due to the volume of patients and shortage of oncologists.