Cancer patients on chemotherapy, who are anaemic, are set to see six newly recommended treatments available through the NHS.

The National Institute for Health and Care Excellence has drawn up draft guidance to recommend six treatments (known as erythropoiesis-stimulating agents or ESAs) which boost levels of red blood cells. NICE is now starting a consultation on the guidance.

Chemotherapy can temporarily stop the production of red blood cells (erythropoiesis) - causing anaemia.

People with anaemia have fewer red blood cells or low levels of the chemical haemoglobin which carries oxygen around the body. This can cause headaches, palpitations and severe fatigue. Anaemia can also reduce the effectiveness of cancer treatment and maybe lower chances of survival.

Almost two-thirds of people (60%) with solid tumours on chemotherapy will become anaemic. For blood cancers it is even more common. In multiple myeloma, a cancer that affects white blood cells in the bone marrow, three quarters of people are anaemic at diagnosis.

Using a new cost effectiveness analysis, the committee recommended six treatments, in line with their marketing authorisations, which are clinically effective and value for money. The independent appraisal committee looked at results from several clinical trials and reviewed the existing guidance. They concluded that ESAs were effective in increasing haemoglobin levels and managing anaemia when compared to current standards of care.

ESAs work by mimicking a hormone naturally produced in the kidneys which is responsible for stimulating red blood cell production in the bone marrow. The draft guidance recommends five epoetins (alfa, beta, theta and zeta) and one darbepoetin that are given by injection under the skin.¹

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: “Most people with cancer undergoing chemotherapy will become anaemic. This could affect their quality of life. This updated draft guidance recommends six treatments as options to tackle anaemia in people who are receiving cancer treatments.

“Not only can these treatments (epoetin and darbepoetin) improve anaemia but they can also reduce the need for regular blood transfusions and significantly improve quality of life.”

In severe cases, anaemia in those having cancer treatment will need to be managed with blood transfusions. However, limited supplies of blood can make it hard to get transfusions, and they can also cause problems such as viral and bacterial infections.

The committee concluded that ESAs reduced the need for blood transfusions in people receiving cancer treatment. The draft guidance also recommends that healthcare professionals should offer patients the appropriate ESA with the lowest cost.

Consultees - including the manufacturer, healthcare professionals and members of the public - can now comment on the recommendations until Friday 9 May 2014.

Comments will be fully considered by the committee before final draft guidance is issued.

Until then, 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.

Ends

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Notes to Editors

About the guidance

1. The draft guidance is available here. 

2. The preliminary guidance recommends the following erythropoiesis-stimulating agents (epoetin and darbepoetin), within their marketing authorisations, as an option for treating cancer treatment associated anaemia:

a.Epoetin alfa (Eprex, Janssen-Cilag) and (Binocrit, Sandoz), and epoetin zeta (Retacrit, Hospira UK) have UK marketing authorisations to treat anaemia and to reduce transfusion requirements in adult patients receiving chemotherapy for solid tumours, malignant lymphoma or multiple myeloma, who are at risk of transfusion as assessed by the patient's general status (e.g. cardiovascular status, pre-existing anaemia at the start of chemotherapy). Binocrit and Retacrit are both a biosimilar medicine referenced to Eprex. Eprex, Binocrit and Retacrit are available in pre-filled syringes at net prices of £5.53, £5.09 and £5.66 per 1000 units respectively.

b.Epoetin beta (NeoRecormon, Roche Products) has a UK marketing authorisation to treat symptomatic anaemia in adult patients with non-myeloid malignancies who are receiving chemotherapy. NeoRecormo is available in a pre-filled syringe at a net price of £3.51 per 500 units.

c.Epoetin theta (Eporatio, Teva UK) has a UK marketing authorisation to treat symptomatic anaemia in adult patients with non-myeloid malignancies who are receiving chemotherapy. Eporatio is available in a pre-filled syringe at a net price of £5.99 per 1000 units.

d.Darbepoetin alfa (Aranesp, Amgen) has a UK marketing authorisation to treat symptomatic anaemia in adult cancer patients with non-myeloid malignancies who are receiving chemotherapy. It is recommended for use at haemoglobin concentrations of 100 g/l or lower, with target values up to 120 g/l. Aranesp is available in a pre-filled syringe at a net price of £14.68 per 10 micrograms

Costs (excluding VAT; ‘British national formulary' [BNF] edition 66) may vary in different settings because of negotiated procurement discounts

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