The Cancer Drugs Fund (CDF) is changing in 2016. Our Policy Team summarise the key changes to the CDF and outline what these changes might mean for patients.

Thursday 28 July 2016      Policy and campaigns blog
The new Cancer Drugs Fund

You may have seen the news that the Cancer Drugs Fund (CDF) is changing in 2016. In a previous blog, we explained the key points raised in our CDF consultation. Now that the final details have been published on how the new CDF will work, we have summarised what the key changes are and what these are likely to mean for patients.

The CDF began in 2011 and during this time it has benefitted over 95,000 patients across England. There are four breast cancer drugs currently on the Cancer Drugs Fund:

  • Kadcyla (trastuzumab emtansine)
  • Perjeta (pertuzumab)
  • Afinitor (everolimus)
  • Halaven (eribulin)

If you are currently taking any of these drugs, please see the questions and answers below on how the changes might affect you.

The new CDF is being launched on 29 July 2016 and it will have a new purpose:

  • To allow some new drugs to be available to patients as soon as they are licensed in the UK and
  • To collect additional data on the effectiveness of promising drugs while they are on the new CDF.

Since 2010, cancer drugs have been assessed by both the National Institute of Health and Care Excellence (NICE) and by the Cancer Drugs Fund panel. These processes were slightly different, which meant that some cancer medicines rejected or not appraised by NICE, were made available through the CDF. The start of the new CDF will mean that all new cancer drugs will now be assessed by NICE and there will be three possible decisions that the body will be able to make:

  • Yes – NICE recommends a drug for use on the NHS going forward and it becomes available to all patients in England
  • No – NICE does not recommend a drug and it will not be available to patients
  • Maybe – This is the new option. If NICE thinks that the drug shows promising results, but the evidence is not robust enough to allow a final decision to be made, the drug could be recommended for the CDF. If the pharmaceutical company agrees with the terms and conditions of the new CDF, the drug will become available to all patients in England, where their clinician thinks the treatment is appropriate.

New drugs recommended for the new CDF

Unlike the old CDF, new drugs recommended on the new CDF will only be allowed to stay on the Fund for a maximum of two years (with some exceptions for some drugs for very rare types of cancer). The length of time will depend on how long it will take to collect the additional data needed to allow NICE to make a final decision on a cancer drug as to whether it should be made available on the NHS going forward.

All new drugs will also be assessed much earlier. This should allow drugs to become available to patients as soon as they are licensed for use in the UK, however this is subject to the pharmaceutical company providing all the necessary evidence to NICE on time and on both NICE and the pharmaceutical company being able to agree a suitable price for the drug.

A drug will only be recommended onto the CDF if it has the potential to meet NICE’s cost-effectiveness criteria and the pharmaceutical company agrees to the terms of the new CDF. Furthermore, a drug will only be allowed on to the CDF if there is some way to collect accurate real world data about how well it works or to fill in a gap in the evidence that is preventing NICE from making a final decision.

All drugs on the new CDF will be available to all patients who could benefit from the treatment in England.

What happens if I am receiving one of the four drugs from the old CDF?

You will continue to have access to the drugs as long as your doctor thinks the drug is still effective to manage your cancer.

What happens if one of the four drugs listed above are my next drug?

All drugs on the old CDF will continue to be available to new patients until the drug is reappraised by NICE. Over the next 12 months, NICE will be re-appraising all the drugs currently on the CDF. There will be a Committee meeting, where the drug will be discussed. About a month after this meeting, NICE will publish a draft decision on the drug. If this decision is a ‘yes’ or a ‘maybe’, the drug should continue to be made available to new patients. If the draft decision is a ‘no’, there will be approximately a six month period before the drug is no longer available to any new patients, who are not already taking this drug.

Which breast cancer drugs will be reappraised first?

The first drug to be reappraised is Afinitor, with a draft decision due at the end of August 2016, followed by Kadcyla, for which a draft decision is due around the end of October. Exact timings are not yet known for the other two drugs.

We are also expecting a couple of new drugs to be appraised over the next 12 months: palbociclib (for metastatic hormone positive breast cancer) and etirinotecan pegol (for metastatic breast cancer that has spread to the brain).

What if I live outside of England?

Drugs on the Cancer Drugs Fund have always been available only to patients based in England, however some of the drugs that used to be on the CDF are now available on the NHS in some of the devolved nations.

You can find more information on which of the four drugs are available where you live, in the table below*:

Drug

Scotland

Wales

Northern Ireland

Kadcyla (trastuzumab emtansine)

Not available

Not available

Not available

Perjeta (pertuzumab)

Not available

Not available

Not available, to the best of our knowledge

Afinitor (everolimus)

Available

Available

Not available

Halaven (eribulin)

Available

Available

Not available

*Information correct July 2016

What does Breast Cancer Now think about these changes?

While some of these changes could be positive for some drugs and therefore for some cancer patients, we are not certain whether the new system will work well for breast cancer patients. The last eight breast cancer drugs have been rejected by the standard NICE process, which will now be used to assess all new and old cancer drugs. We also know that this process has not changed significantly since 1999, so it is not clear whether different decisions on these drugs are likely. Furthermore, we will need to wait and see how well the new system works – for example how many new drugs will be made available on the CDF? Will it be possible to collect extra data through the new CDF and will this lead to a positive decision from NICE? Will it work for all cancer patients equally well or benefit some diseases more than others?

We will be keeping a close eye on how breast cancer drugs fare over the next 12 months and we'll be taking action if the best drugs are under threat of being removed from the NHS.

More information

To stay up-to-date on our work on this issue, please sign up to receive our campaign emails or visit our Cancer Drugs Fund page. If you would like to share your story with us to help us campaign to make breast cancer drugs available, please get in touch with us at campaigns@breastcancernow.org.