pancreasThe National Institute for Health and Care Excellence (NICE) has published draft guidance that recommends nab-paclitaxel given with gemcitabine should not be funded by the NHS for previously untreated metastatic pancreatic cancer.

Nab-paclitaxel, which is given in combination with gemcitabine, is also known as Abraxane and is marketed by Celgene. It is a novel formulation of paclitaxel, a chemotherapy, which works by blocking cell division and promoting cell death. In this formulation, paclitaxel is attached to albumin, which helps it move through the walls of blood vessels. NICE is currently looking at how well nab-paclitaxel, given with gemcitabine, works for people whose pancreatic cancer has spread and who have not received any other treatments.

People with newly diagnosed pancreatic cancer are usually offered a combination treatment called folfirininox, but it can be associated with serious side effects and therefore can’t be given to everyone. When this is the case, other options include gemcitabine alone or with capecitabine.

Information provided by Celgene showed that folfirininox is likely to be more effective than nab-paclitaxel with gemcitabine. Although nab-paclitaxel with gemcitabine was more effective than gemcitabine alone, it resulted in more serious side effects. It also resulted in more side effects than gemcitabine with capecitabine, but was shown to have similar effectiveness.

Sir Andrew Dillon, NICE chief executive, said: “In the early stages, pancreatic cancer doesn't usually cause any symptoms, which can make it difficult to recognise and means that many people are not diagnosed until the cancer is very advanced. Without treatment, survival may be only 2 to 6 months. Unfortunately the development of new treatments for pancreatic cancer has been very limited in recent years.”

“Although nab-paclitaxel is more effective than one of the treatment options currently available, is associated with more side effects and is also more expensive.”

Until final guidance is issued, NHS bodies should make decisions locally on the funding of specific treatments. Once NICE issues its final guidance on a technology, it replaces local recommendations across the country. This draft guidance does not mean that people currently taking nab-paclitaxel with gemcitabine will stop receiving it. They have the option to continue treatment until they and their clinicians consider it appropriate to stop.