NHS under pressure to provide new breast cancer drugs

The National Health Service in the UK is being put under considerable pressure by Cancer charities to widen access to a promising new class of breast cancer drug as new evidence suggests the latest treatment is far superior to Tamoxifen, the long established premier drug for women with the early stage of the disease.

The combined results from three European trials of anastrozole, one of the new drugs, suggests that postmenopausal women who switched from Tamoxifen two years into treatment after surgery were more likely to be alive two and a half years later.

Apparently there were 29% fewer deaths among patients who changed, compared with those who remained on Tamoxifen, a drug which has revolutionised breast cancer care and survival prospects over the last two decades.

The trials with anastrozole involved more than 4,000 women in Austria, Germany and Italy, and it was found that of the 2,009 who changed to anastrozole, 66 died, while of those who stayed on Tamoxifen, 90 died.

The health secretary, Patricia Hewitt, will be pressurised by these results to increase provision of the new generation of cancer drugs through the NHS.

Hewitt has recently bowed to calls to fund Herceptin, the as-yet unlicensed drug for women with a particularly aggressive form of early breast cancer, telling trusts to pay for it at a cost of £21,800 a year.

Cancer Research UK is suggesting the time has come to reappraise the role of Tamoxifen in the hierarchy of cancer care, while experts express concern that the publicity given to the new drugs may make some women on Tamoxifen question whether they are on the right treatment.

But no guidance is expected to be given to the NHS in the UK on the overall effectiveness and value for money of anastrozole, marketed by AstraZeneca as Arimidex, or similar treatments, until November 2006, which has raised fears that some NHS trusts will not fund a switch from Tamoxifen.

Arimidex has already been backed by the NHS in Scotland.

Studies show that Tamoxifen given over five years after initial surgery has reduced the risk of breast cancer recurrence by about half and last year it was revealed that anastrozole given instead of Tamoxifen for that period improved that by 26%.

Therefore for every four women on Tamoxifen whose cancer returned, only three women on anastrozole experienced a recurrence.

The new results are from trials where about half the patients were switched to anastrozole after two years, and showed they were less likely to die and less likely to see their breast cancer return.

It is estimated that as many as 32,000 postmenopausal women in Britain are newly diagnosed with breast cancer each year and about three-quarters of these might be suitable for treatment with the new class of drug as they have tumours fuelled by the sex hormone oestrogen.

AstraZeneca says about a third of newly-diagnosed women in this group are now being prescribed Arimidex, which is up from a fifth in August.

The medication was only licensed for such patients in the summer but had been used off-licence before that, including by women unable to use Tamoxifen because of side effects.

Arimidex is amogst a class of drugs called aromotase inhibitors which prevent the body developing extra supplies of oestrogen, the hormone which encourages cells, including cancer cells, to multiply.

It is more expensive than Tamoxifen, but enthusiasts say it will not only save more lives but also mean fewer instances of doctors having to treat women for the return of their breast cancer or its spread to other parts of the body.

Breast cancer experts say it is clear that at whatever point you use it, anastrozole is a more effective alternative to Tamoxifen.