Antibiotics in mouthThe Scottish Medicines Consortium (SMC) has accepted 5 new medicines for routine use in NHS Scotland. Two of these medicines, used to treat different types of lung cancer, were accepted through the Patient and Clinician Engagement (PACE) process, for medicines that treat end of life and very rare conditions.

Crizotinib (Xalkori) can be used to treat a very rare form of advanced, incurable lung cancer where the cancer cells contain certain defects affecting the gene responsible for a key protein called anaplastic lymphoma kinase. Crizotinib targets this specific kind of cancer cell and is thought to be a therapeutic advancement. 

In the PACE meeting, patient groups and clinicians highlighted that this form of lung cancer generally affects a younger age group, who may have significant work and family commitments. Average survival for those with this type of cancer is less than a year. Crizotinib can delay progression of the disease for an average of four months, giving patients valuable extra time with a better quality of life in the context of the limited overall survival time. As the medicine is taken orally it also reduces the number of hospital visits required compared to the current treatment option, which is chemotherapy. Crizotinib may also have fewer side effects compared to chemotherapy.

Nivolumab (Opdivo) was accepted for the treatment of a different form of lung cancer known as squamous non-small cell lung cancer (NSCLC). PACE participants highlighted that squamous NSCLC is a particularly aggressive sub-type of lung cancer with few treatment options, and patients tend to be diagnosed with late stage disease and often have a poor prognosis. Nivolumab is the first immunotherapy to be licensed for lung cancer, and it works by increasing the ability of the immune system to kill cancer cells. It can offer patients an extra three to four months’ survival time and improved quality of life, which is extremely valuable in the context of a limited overall survival time of about six months.

The other drugs accepted for use were:

  • Vortioxetine (Brintellix) is a new type of antidepressant. Major depression has a range of symptoms that can affect the patient and also their family and carers. Vortioxetine offers a further treatment option for those who don’t respond to other antidepressants and it may also be associated with fewer side effects in some patients
  • Secukinumab (Cosentyx) is a medicine used to treat ankylosing spondylitis, a progressive, irreversible arthritic disease causing inflammation and pain in the joints of the spine. Most patients tend to be diagnosed before the age of 45 and therefore tend to have work and family commitments that can be affected by their condition. Secukinumab offers a further treatment option for this patient group
  • Brivaracetam (Briviact) for a difficult to control specific type of epilepsy (partial-onset seizures). Epilepsy varies widely in its severity and impact and is a profoundly disabling condition for those who are unable to control their seizures. Brivaracetam offers an additional treatment option, particularly for those patients who have had side effects with currently available treatments.

Professor Jonathan Fox, SMC chairman, said: “We are pleased to be able to accept these five medicines for routine use in NHS Scotland. From what patient groups and clinicians told us during the PACE meetings, we know that crizotinib and nivolumab for two different types of lung cancer will be welcomed. The patient group and clinician contributions played an important part in helping the Committee reach its decisions on these medicines.

“Additional treatments for depression and severe epilepsy are always welcome, while secukinumab may help those with ankylosing spondylitis who have responded inadequately to conventional therapy have a better quality of life.”

Further details of all medicines can be found at: